You know the feeling, butterflies in your stomach, racing heartbeat, sleep problems, no appetite… the list goes on.  You wonder is this normal stress everyone feels or is it something more.  Your friend Alex has this, but he sees a therapist and says he has Anxiety. But what’s the difference, could you have an Anxiety Disorder too?  The confusion alone is enough to make you anxious.

In the decades I’ve been treating young adults, this is a common question. And think about it, you are in a time of your life where you are expected to make most of your own decisions.  In high school, you had counselors and teachers to talk to. In college you have counselors, but maybe you aren’t sure you want to go to college.  Maybe that’s one of the things that is making you anxious!




In my 2 decades plus of counseling young emerging adults, I’ve answered many questions related to how to tell if a client has Anxiety or Stress.  I’ll try to answer some here…

“Are Anxiety and Stress the same thing?”

No, they are not.  Stress is a reaction when our stressors (the things that cause us daily stress) are greater than our coping strategies to handle them.  This can lead to the “Stress Response” which is the physiological response in our body including, fast heartbeat, sweating, headaches, heartburn, rapid breathing, etc.  These reactions usually resolve when the stressor is removed, and we go on with our day.

Anxiety, on the other hand, is a feeling we have when the stressors are happening.  It is also a mental disorder with physical symptoms—just like arthritis, diabetes or other medical conditions.  With anxiety, if it goes away and doesn’t affect your life daily, it’s more of a feeling.  An Anxiety Disorder, on the other hand, occurs when the stress response or anxiety doesn’t really go away.  It’s sort of an experience that you have most days and begin to be anxious about having anxiety.

The stress response is inborn in us from the days of the caveman and I imagine cavewoman…  When the cave people were in survival mode they knew they had to eat or be eaten.  They learned to deal with that stress by running (which we call the flight response) or getting a weapon and defending oneself by fighting back. (the fight response).  We also have another internal response which is to Freeze.  This is when we are faced with something that is out of our range of dealing with or so out of our experience, or the no-win situation-where there is no good response, so we Freeze.  This is also where we might mentally take flight and “check out”. You may have seen this if you’ve ever been in a situation where your life or the life of someone you are with is in jeopardy.  This is when the experience can be called a Trauma. Traumas often have a long-lasting effect on the person.  We’ll explore Trauma in more detail in future blog entries.

“How do I know if it’s Stress or an Anxiety Disorder”?

When you have lots of stress that you are having to deal with daily, even if it doesn’t rise to the level of an Anxiety Disorder, it is still important to have ways to deal with the stress.  It’s true what they say that if you bottle up your stress it gets worse.  In many cases, you don’t need to see a therapist right way.  If this is a temporary stressor that home self-care can reduce and manage, that is usually a good start.  The following are some questions that you can ask yourself to determine if home “self-care” will reduce your stress.

  • Do you have a Friend or Family member that you are comfortable sharing your stressful situation with?
  • Do you have a Pastor or another person who you can get support from?
  • Are your physical resources strong enough to help you stay healthy when dealing with this stress?
  • Do you exercise, eat healthily and get at least 8 hours of sleep most nights?

If you answered YES to most of the above questions and your stress isn’t to the point where it is greatly interfering with your ability to do your job, even if your job is as a student, then self-care may reduce your stress to a manageable level.

If you answered NO to most of the above questions or your stress is to a point where you are missing school or work, not sleeping well, not eating well, and don’t get much physical activity, OR you are not meeting the obligations at home school or work due to distractions from your stressors, then it’s time to consider seeing a therapist.

If you are somewhere in between, there is no reason to avoid seeing a therapist.  They won’t ever tell you that you aren’t bad enough to see me.  (However, your insurance may state that is not significant enough to pay for it if it doesn’t rise to the level of medical necessity.  If this is the case, the therapist will let you know.  Then you have the option of paying yourself or trying self-care if you haven’t already.

“Who will Find Out if I See a Therapist”?

Counseling and Therapy are bound by confidentiality within limits of the law and in some cases the organizational policies.  Licensed therapists are bound by confidentiality by the ethics code and laws that govern their type of license.  In college settings, there are various professionals who have more or less obligation of confidentiality and experience with dealing with the privacy of various types of information.  Generally, Advisors which include Academic Advisors, Student Life Advisors, or other types of staff and Advisors are governed by FERPA which limits access to private student information.  However, if your records are by the court or someone at the school with an educational need to know, that person can access your records.  If you are seeing a Counselor, that is not licensed, potentially those records could be requested by a supervisor, all the way up to a college president.  In my 20+ years of counseling, that never happened but it is always a possibility.  It is always a good idea to ask the counselor or advisor how private your conversation is either at work or college before sharing information you may not want to be public information to make sure you are comfortable with disclosing your private information.

If you are on your parents’ insurance, your parents will receive the bills for your therapy along with your diagnosis.  If you have your own insurance or are paying on your own, bills are sent to you and as long as you get your own mail, no one else will know that you are seeing a therapist unless you choose to tell them.

“What Can I Do If I Don’t Want To See a Counselor at School or if they Don’t Provide What I Need?” 

Some young adults, due to privacy concerns, prefer to not see a therapist at school or through work. This is when an outside therapist may be most helpful. I can consult with anyone at the college if requested and through written permission thereby, keeping your information separate from the school or work.

If you have medical insurance, you should look at the back of your insurance card (or your parents’ card if you are under your parents’ insurance). On the back of the card, you should see a phone number or instructions to access mental health services. (it may be listed under Behavioral Health Services).  Call that number to get referrals to therapists in your area.

Emerging Adult Counseling provides therapy to young emerging adults and others related to issues of Depression, Anxiety, PTSD, Social Anxiety, and other issues.  Sue Smith MA, LMFT specializes in issues related to college adjustment, career adjustment, expanding support systems and making friends, relationships and other issues that are common for emerging adults 18-30.  She also provides support for parents and family members who are supporting the emerging adult with or without the emerging adult present.

Sue Smith is credentialed to see clients under Blue Cross Blue Shield of MN, Preferred One, Medical Assistance, ComPsych EAP, Magellan, Medical Assistance, Optimum, (Medica, United Healthcare), U Care.

Contact Sue at 651-401-3218 or at


Sue Smith

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