Understanding the Development of Anxiety Disorders

Anxiety is an emotion felt by everybody at some point in their life. Whether you’ve got an exam in the morning or are about to walk into an important job interview, we all know about those butterfly feelings that can take over. But what happens when this sensation occurs constantly, randomly, or when faced with a seemingly innocuous task? Well, that’s when we enter the world of anxiety disorders.

To understand what causes anxiety disorders, we must dissect and explore genetic, environmental, and sociocultural triggers. Understanding how anxiety develops can lead us towards helpful strategies and treatments to control this unwanted sensation.

This information is not intended to replace professional medical advice. If you or a loved one are worried about the impact of an anxiety disorder, seek support from your healthcare provider.

What is an anxiety disorder?

It is normal to feel anxious occasionally. Life is full of stressors that can produce worrying thoughts and feelings. However, anxiety disorders are diagnosed when these feelings go beyond the occasional worry. Anxiety may start to appear seemingly at random, triggered by events not usually associated with fear, or even pretty much constantly.^[1]

There are several distinct anxiety disorders to be aware of. Some common conditions are:^[2]

• Generalized anxiety disorder (GAD) – a persistent and excessive worry that affects daily activities.
• Panic disorder – the presence of recurrent panic attacks.
• Specific phobias – fear triggered by something that is not normally harmful.
• Social anxiety disorder – anxiety brought on by concerns about social functioning.

It is a common misconception that GAD is the most common anxiety disorder. In fact, it is estimated that specific phobias (affecting 8-12% of the U.S. population) are the most widespread anxiety condition. GAD is estimated to affect around 3% of U.S. adults.^[2]

Are Anxiety Disorders Genetic?

Genetics affects many different physical and mental health conditions. Anxiety disorders are no exception. In this section, we’ll discuss the genetic basis of generalized anxiety disorder. Other anxiety disorders have also been found to have similar genetic links.

Children of parents with anxiety are over twice as likely to develop generalized anxiety disorder. Whilst some of this may be due to social and family dynamic factors discussed later in the article, researchers have demonstrated that a significant proportion of this increased risk is due to genetics.^[3]

Twin studies have also identified several overlapping gene patterns between GAD and the neuroticism personality trait. This means that there is a hereditary link to neuroticism in families, and this, in turn, can result in a genetically increased anxiety risk.^[3]

When considering the genetic factors in anxiety disorders, it is worth considering the presence of specific gene variants. Studies continue to identify new single gene variants that are linked to having an increased chance of developing anxiety.^[3]

The wealth of information about the role genetics plays in GAD helps to discredit stereotypical and discriminatory views of mental health that wrongly seek to ‘blame’ an individual for their condition. We know that anxiety disorders are complex and have a range of causes.

Can Environmental Factors Cause Anxiety Disorders?

Understanding the environmental triggers for anxiety is important as it allows us to control and modify these risk factors where possible. There are several key environmental influences to be aware of:^[4]

• Negative life experiences
• Acute and chronic stress
• Childhood trauma
• Physical or mental health problems
• Social isolation
• Female gender

Negative Life Experiences

Exposure to negative life experiences can have a substantial emotional impact. These events can leave us vulnerable and disrupt our feelings of security. Repeated exposure to negative life experiences increases the risk of an anxiety disorder as individuals find themselves constantly consciously or subconsciously looking out for the next threat. Some examples of negative life events include:^[4]

• Financial strain
• Challenges in the work, school, or home environment
• Job insecurity
• An accident or significant injury
• Abuse
• Divorce or a significant break-up
• Relocation

Acute and Chronic Stress

Stress is a natural response triggered by situational challenges. Stress is actually a useful evolutionary tool that alerts us to changes in our environment that could be dangerous. The resultant physical symptoms, such as an increased heart rate and muscle tension, are simply preparations for the body’s fight-or-flight response.^[5]

Acute stress occurs in response to daily but short-lived occurrences (for instance, being late for work). For most people, once the situation passes, so do the feelings of anxiety associated with stress. However, some people may be unable to deescalate these feelings and even develop an anxiety disorder in response to repeated acute stress.^[5]

Chronic stress is caused by a long-term trigger that is unlikely to disappear quickly. Some chronic stressors include unhealthy relationships, location-based dangers, and employment challenges. Unlike in acute stress, feelings of anxiety and the physical symptoms associated with it serve no useful purpose in chronic stress. Individuals with unresolved chronic stress are at significant risk of developing an anxiety disorder.^[5]

Childhood Trauma

Childhood trauma is an extensively studied risk factor for the development of an anxiety disorder. Trauma describes someone’s emotional response to a terrible event that usually results in emotional dysregulation. In children, trauma has been shown to affect brain development, causing changes in brain structure and function, as well as impacting the formation of relationships and normal emotional response systems.^[6]

The wide-ranging effects of childhood trauma all serve to increase the risk of developing an anxiety disorder. Interestingly, an anxiety disorder may not manifest straight away, instead appearing later in life when the traumatic events are in the distant past.^[6]

Neurobiological Causes of Anxiety

In order to fully understand how anxiety disorders develop, we should first try to answer another question, ‘Why does anxiety happen?’ Identifying what happens in the brain to cause feelings of anxiety can give us clues as to the development and maintenance of an anxiety disorder.

Brain Structures

The limbic system is responsible for the majority of emotional processing in the brain. It is comprised of 4 key structures that are responsible for our experience of anxiety: ^[7]

• The amygdala is centrally involved in fear processing and response.
• The hippocampus forms memories and creates associations between triggers and responses.
• The hypothalamus is responsible for producing hormonal responses that contribute to the physical symptoms of stress and anxiety.
• The thalamus is also responsible for producing hormonal responses that contribute to the physical symptoms of stress and anxiety.

Anxiety disorders are thought to occur as a result of a disruption in the normal functioning of the limbic system. Research shows that individuals with anxiety may have heightened activity in these brain areas.^[8]

Neurotransmitters

Neurotransmitters are the signaling chemicals of the brain and nervous system. There are several key neurotransmitters involved in the experience of anxiety:

• Serotonin – has a variety of functions but is known to enhance fear and anxiety.^[9]
• Dopamine – central to the brain’s reward pathway, but overstimulation has been linked to anxiety.^[10]
• Norepinephrine – key to the fight-or-flight response.^[11]
• GABA – involved in the inhibition of anxiety and fear responses.^[12]

Disturbances in the balance of these neurotransmitters are one of the central targets for doctors to address when treating anxiety disorders. Medications such as selective serotonin reuptake inhibitors (SSRIs) are designed to modify the brain’s response to these neurotransmitters.

Can Personality Factors Contribute to Anxiety?

Personality traits describe an individual’s consistent internal characteristics, which can be understood from the pattern of behaviors and actions that they display. Researchers have identified two central personality traits associated with individuals with an anxiety disorder: neuroticism and introversion.^[13],^[14]

Neuroticism

Neuroticism is a personality trait associated with several negative experiences and responses. Generally, neuroticism describes feelings of anger, anxiety, emotional instability, low self-esteem, and emotional dysregulation.^[15]

Neuroticism is directly linked to how an individual experiences and processes stress. Research has consistently shown that all anxiety disorders are directly related to higher levels of neuroticism.^[14]

Introversion

Introversion describes a preference for avoiding excess social interactions. Introverts are commonly described as shy, quiet, and reserved. When compared to extroverts, introverts are more likely to be driven by a fear of things going wrong.^[14]

Research has shown that introverts are more likely to develop an anxiety disorder. Social anxiety is the most common form of anxiety for people with high levels of introversion. However, it is important to remember that not all individuals with anxiety are introverted, and many extroverts also suffer from anxiety disorders.^[14]

Sociocultural Causes of Anxiety

A wide range of social and cultural pressures have been implicated in the development of an anxiety disorder. The pressures of modern life have been pointed towards as a major driver of increasing rates of anxiety worldwide. People often feel pressured to meet society’s expectations and norms. The pressure to succeed, have the perfect body, achieve high grades, and excel in the workplace are all stressors directly linked to anxiety.^[4]

Gender expectations can also exert intense pressure on individuals. People who identify as LGBTQ+ are twice as likely to suffer from anxiety when compared to heterosexual peers. People from marginalized groups are more likely to experience discrimination, harassment, hostility, and inequality. These experiences can have detrimental effects on a person’s mental health.^[4]

It is also important to be aware of culture-specific forms of anxiety disorders. ‘Taijin kyofusho’ is a disorder prominent in Japanese and Korean cultures that describes individuals excessively concerned about being observed, leading them to prefer social isolation.^[16]

The Impact of Other Mental Health Conditions on Anxiety Disorders

There is a significant overlap in the occurrence of anxiety disorders and other mental health conditions. Many of the biological, psychological, and sociocultural risk factors for anxiety also increase the risk of developing a related condition. Some common co-occurring mental health conditions include:^[17]

• Eating disorders
• Another anxiety disorder
• Depression
• Substance use disorders
• Hoarding disorder
• Other health conditions with a significant psychiatric component – fibromyalgia, sleep disorders, irritable bowel syndrome, and chronic pain conditions.
• Neurodevelopmental conditions with mental health implications – autism and ADHD.

There are many reasons why co-occurring conditions can impact and worsen the experience of anxiety. For instance, individuals with anxiety may develop a substance use disorder in an attempt to self-medicate negative feelings. However, the vicious cycle of substance use can, in turn, feed and worsen anxiety symptoms in the long term.^[18]

Treatment must focus on addressing both conditions for successful recovery. Co-occurring disorders are associated with more severe symptoms and poorer outcomes without proper intervention.^[19]

Can You Prevent the Development of Anxiety Disorders?

Now that we’ve explored what triggers anxiety, we can consider what can be done to prevent anxiety disorders. It’s important to remember that despite a person’s best efforts, they may still develop an anxiety disorder. As such, blame should never be assigned, and loved ones should always focus on giving their unconditional love and support in the face of mental health challenges.

Early intervention is key to preventing poor outcomes in anxiety disorders. Based on the risk factors identified, there are several steps that you can take to manage feelings of anxiety:^[20],^[21]

• Reach out to support networks and open up about mental health.
• Engage with self-help tools and groups (including accessing psychological therapies such as CBT).
• Identify the need for support early and get professional help.
• Look after your physical and mental health.
• Avoid harmful ‘self-medication’ through substance use.
• Research mindfulness and breathing techniques that work for you.
• Identify any lifestyle factors or stressors that may be contributing to feelings of anxiety and plan for how to manage them successfully.