Emotional Disorders in Childhood

"Emotional disorders of childhood" is a collective term from the International Classification of Diseases, ICD-10 (the WHO’s diagnostic code). It is designated by the code F93 and encompasses anxieties and emotional distress that begin in childhood and exceed what is typical for the child’s developmental stage.

F93 encompasses several forms:

• F93.0 Separation anxiety: the fear of being separated from a close attachment figure is central to this condition.
• F93.1 Phobic disorder: an age-appropriate fear, such as of animals or the dark, that remains pronounced.
• F93.2 Social anxiety: marked shyness and fear of strangers.
• F93.3 Sibling rivalry: persistent emotional disturbances following the birth of a younger sibling.

The term therefore does not describe a single disorder, but rather a group of related anxiety conditions that begin in childhood.

Fear is a normal part of development. It changes with age and usually goes away on its own. The Federal Institute for Public Health describes typical phases:

• During the first year of life: stranger anxiety, fear of loud noises, and fear of heights.
• During toddlerhood: fear of animals, the dark, and being alone.
• Ages four to six: imaginary creatures such as monsters and ghosts, as well as natural phenomena like thunderstorms.
• During school age: Worries about school, performance, and illness.

A disorder classified under F93 is only present if the anxiety is significantly more severe than in peers, persists for months, and interferes with the child’s daily life. The diagnostic system lists generalized anxiety disorder and the closely related disorders of social functioning in childhood (F94) separately.

A single moment of fear doesn't mean much. Specialized websites list signs that parents should look for together:

• The child cries frequently, withdraws, or becomes silent.
• They sleep poorly, tremble, or complain of headaches and stomachaches with no physical cause.
• They avoid situations, places, or people, thereby increasingly limiting their own lives.
• The anxiety persists for several months and does not subside.

Avoidance, in particular, is an important sign. A child who, out of fear, no longer goes to school or visits friends loses practice in dealing with the situation, and the anxiety becomes entrenched. If school performance anxiety persists, it’s worth taking a closer look.

Anxiety disorders are among the most common mental health conditions in childhood and adolescence. According to the Robert Koch Institute’s BELLA study, about one-tenth of children and adolescents in Germany are affected by an anxiety disorder at some point in their lives.

There is no single cause. Experts believe it results from a combination of factors: an innate tendency toward an anxious temperament, stressful experiences, and the behavior of those around them. The family’s reaction also plays a role. If a child is allowed to avoid anxiety-provoking situations indefinitely, the anxiety persists. This does not imply that parents are to blame; however, understanding this helps them respond differently in everyday life.

Cognitive behavioral therapy is considered the most effective treatment. It consists of several components:

• Psychoeducation: The child and parents learn how anxiety works.
• Exposure: The child approaches the feared situation in small steps and experiences that the anxiety subsides on its own.
• Parental involvement: Parents learn not to unintentionally reinforce anxious behavior and to gently reduce avoidance.

Medications, usually SSRIs, are only considered if behavioral therapy is insufficient.

Whether an F93 disorder underlies the fears can only be determined by a professional. This classification and any diagnosis should be handled by a child and adolescent psychiatrist (KJP) or a medical or psychotherapeutic specialist. Rückenwind “Eltern” provides coaching to support you through this time and is not a substitute for diagnosis or therapy. Janike is a social worker and parent coach currently training to become a child and adolescent psychotherapist; she does not make diagnoses herself.