Raina Telgemeier became hero to millions of readers by showing how uncomfortable growing up can be

In the late 1980s, young Raina Telgemeier tried to deliver a report in front of her grade-school class in San Francisco. Before she could finish, she bolted for the restroom, gripped by the symptoms of her intense anxiety.

Over Labor Day weekend, Telgemeier, now a celebrated 42-year-old graphic novelist, strode onto the main stage at the National Book Festival in Washington, D.C., before a thrumming crowd of about 4,000 fans. Radiating confidence, she smiled broadly as she shared her story of nerves and nausea. It is a message of empathy and reassurance that encourages young listeners to talk about what scares them.

“I’m proud to tell you at this moment,” Telgemeier said, “I don’t have a stomach ache.”

There was laughter among her ponytailed legions. Over the past decade, the accidental memoirist has grown into a YA rock star by becoming an open book. Telgemeier’s largely autobiographical stories are so accessible and emotionally resonant that there are 13.5 million copies of them in print, as she’s tapped into a largely overlooked comics-loving female readership.

Now, because her fans kept asking, she is getting more personal than ever. The Eisner Award-winning author who launched her publishing empire with 2010’s “Smile,” about her years-long dental adventures as a kid, is prepared to bare new parts of her interior world with “Guts,” available Tuesday, which centers on how fear affected her body.

“This is the reality of my life,” Telgemeier told her fans. She quickly got to the heart and GI tract of the matter: “I was subject to panic attacks and (was) worrying that something was really wrong with me.”

A young girl in a bright-fuchsia shirt soon asked which of Telgemeier’s books was the author’s favorite – from a shelf that includes not only “Smile” but also such other New York Times bestsellers as “Sisters,” “Drama” and “Ghosts.” The author nodded to a few titles before replying: “I like ‘Guts’ because it’s so personal and because people are really getting to know me, the person, when they read ‘Guts.’ ”

On one level, she said in an interview the previous day, the book is about how her anxiety manifested itself. Beginning in fourth grade, she developed a fear of vomit (termed “emetophobia”) and of how her “guts” acted up, which in turn triggered fear about her food choices.

On another level, the title refers to mustering the courage to receive treatment and share one’s honest vulnerabilities with people who care about you. (Seven percent of Americans age 3 to 17 – more than 4 million young people – have been diagnosed with anxiety, according to the Centers for Disease Control and Prevention.)

“Guts” is dedicated to “anyone who feels afraid.” That signals the approachable tone of the memoir, which tries to help destigmatize mental illness and therapy and provide paths to discussion among young readers.

Telgemeier notes in the “Guts” afterword that she has employed various therapies and meditation apps and has taken anxiety medication, writing: “They’ve all helped, but I’ve realized that my phobias and worries are just part of who I am. I do my best to manage them!”

It is that kind of comforting honesty that especially appeals to millions of students.

“Kids today are reading more comic books and graphic novels than ever, and Raina is a big reason why,” said Gene Luen Yang, the acclaimed graphic novelist (“American Born Chinese”) and past Library of Congress ambassador for Young People’s Literature. “She’s a true comics superstar who essentially created a brand new category of comics in the American market: middle-grade graphic memoir.

“I still remember hearing discussions in the ’90s about whether or not girls would read comics – ridiculous, of course, but Raina’s work has proven just how ridiculous,” continued Yang, a longtime schoolteacher. “Not to say that only girls read Raina’s work.”

It took Telgemeier many years before she was ready to share from her own experience. Between ages 11 and 25, she kept a private diary created in comics format. She was inspired by such strips as “For Better or for Worse” and “Calvin and Hobbes,” as well as the book series “The Baby-Sitters Club.”

In 2002, shortly before graduation from the School of Visual Arts in New York, she created a short comic about the power of reading the Hiroshima graphic novel “Barefoot Gen” – a gift from her father when she was 9. It caught the attention of the publisher Scholastic, which soon hired her to illustrate “The Baby-Sitters Club.” It wasn’t long before Telgemeier pitched her own story to Scholastic editors.

Telgemeier said some people had doubted whether a memoir about her braces could be popular. But her breakthrough “Smile” is not just about her nearly five-year saga of facial reconstruction after accidentally smashing her front teeth in 1989 but also about the fragile nature of friendship and stirring insecurities in middle school. Students read; critics raved.

Even after the success of “Smile,” though, it was a long personal journey to “Guts,” her third memoir. “I don’t think I was ready to come out of the gate and just start writing about poop,” she said with a laugh. Besides, there was some personal work to be done.

Five years ago, she began cognitive behavioral therapy because anxiety “was starting to impede my life,” she said. But, “When I went to tackle the thing in my life, I started to see the story in it and started to tell the story – because when you go into a therapist’s office, they want to know why you’re there and where you are. They want to see how it all connects.”

Telgemeier was already 80 pages into a different story at the time. But then she developed writer’s block. While she was stuck, a friend asked about the author’s passing anecdote about anxiety – that “stomach story.” Telgemeier had never written it down, but the friend’s question immediately sparked inspiration.

“I said: ‘You know what? I’ve got to go!’ ” she recounted. “I just sat down, and 11 hours later I had the first couple of chapters sketched out. So it was all in there.”

The Bay Area-based author set out to write the kind of book about phobias and anxieties that she wishes had been available to her as a kid. “Reading is where you find your common ground with others,” Telgemeier said. As a child, “Sometimes you might not know another kid who’s in therapy or tackling a really heavy thing in their life, but you might read a book about it and find yourself.”

This year, Telgemeier published the creative guide book “Share Your Smile” to prompt her fans to write and draw their own tales. Now, as she goes on tour in support of “Guts” – which has already charted as an Amazon Top 10 bestseller – she continues to encourage her readers to express their feelings: “You can’t connect unless you open up.”

The author believes in addressing many aspects of grade school head on, including LGBT representation. Her book “Drama,” inspired by her high school theater club experience, features a gay character whose sibling is coming to terms with his sexual identity. The graphic novel won a Stonewall Book Award while also being banned multiple times in Texas.

So will Telgemeier end her memoir series as a trilogy? “I feel like three is a really good number,” she said at the festival.

She then noted playfully: “But I have one or two more stories from my childhood that I might want to tell. So maybe I will.”