What are Anxiety Disorders and what causes it?

Medically reviewed: 18, January 2024

Anxiety disorders: what is it?

Anxiety disorders represent a group of prevalent psychiatric conditions affecting millions worldwide. They manifest themselves as excessive, persistent feelings of fear, worry, and unease that disrupt daily functioning and negatively impact quality of life.

Despite being highly treatable, many individuals go undiagnosed or untreated due to insufficient awareness, societal stigma, and misconceptions surrounding these invisible illnesses.

The American Psychiatric Association defines anxiety disorders as a set of mental health conditions characterized by intense, irrational, and debilitating fears, concerns, or dread.

Various diagnostic categories fall under this umbrella term, each presenting distinct clinical pictures and requiring tailored therapeutic approaches. Distinguishing characteristics typically involve avoidance behaviors, somatic complaints, cognitive distortions, mood fluctuations, sleep disturbances, and difficulties concentrating.

Key takeaways about Anxiety Disorders

• According to global estimates, anxiety disorders affect approximately 264 million people annually, accounting for nearly 4% of the world population. Women tend to experience higher prevalence rates compared to men, although gender disparities depend on cultural contexts, sociodemographic factors, and availability of mental health services. Moreover, comorbidity with other psychiatric or medical conditions often complicates accurate diagnostics and exacerbates functional impairments associated with anxiety disorders.
• While numerous anxiety disorder subtypes exist, several warrant particular attention given their high burden of morbidity and disproportionatly large shares of affected individuals. These salient variants include:

1. generalized anxiety disorder (GAD),
2. panic disorder (PD),
3. phobias,
4. social anxiety disorder (SAD),
5. agoraphobia,
6. separation anxiety disorder (SAD),
7. post-traumatic stress disorder (PTSD),
8. acute stress disorder (ASD),
9. obsessive-compulsive disorder (OCD).

Each condition possesses unique symptomatologies, developmental trajectories, etiologic mechanisms, and recommended interventions.

• Unmanaged or poorly controlled anxiety disorders inflict considerable emotional distress, psychological suffering, occupational disability, reduced productivity, strained relationships, increased healthcare utilization, diminished self-esteem, elevated risk of substance abuse, and premature mortality derived from suicide or organic diseases exacerbated by chronic stress exposure. Furthermore, economic consequences extend beyond direct costs associated with service provision, incorporating indirect expenses linked to absenteeism, presenteeism, lost earnings, and decreased workforce participation rates.

What Causes Anxiety Disorders and Who Gets Them?

Factors which may be associated with the development of anxiety disorders.

A person’s genetics, biochemistry, environment, and psychologic profile all seem to contribute to the development of anxiety disorders. Most people with these disorders seem to have a biological vulnerability to stress — making them more susceptible to environmental stimuli than the normal population.

Anxiety Disorders and Biochemical Factors

Abnormalities in the Brain

Studies suggest that an imbalance of certain substances called neurotransmitters (chemical messengers in the brain) may contribute to anxiety disorders. Advanced imaging techniques have revealed over-activity in the locus ceruleus — the part of the brain important in triggering a response to danger — in people experiencing anxiety, indicating that some people’s brains may be more vulnerable to the disorder.

Scientists are now beginning to identify the different areas of the brain associated with specific anxiety responses. For example, mechanisms causing OCD may be generated in part by the striatum, the portion of the brain involved with motor control.

Generalized anxiety and panic disorder, however, are associated with the amygdala, a part of the brain that regulates fear, memory, and emotion and coordinates them with heart rate, blood pressure, and other physical responses to stressful events.

Chemical Hypersensitivity

Some people have panic attacks after exposure to certain foods or chemicals, such as those contained in perfumes or hair sprays. Some studies have indicated that many children and adults with anxiety disorders may have a hypersensitive response to high levels of carbon dioxide, which can occur in crowded spaces, such as airplanes or elevators.

Injections of lactic acid have also been known to set off panic attacks in people with anxiety, but not in people without it.

Genetic Factors

About 20% to 25% of close relatives of people with panic disorder or obsessive-compulsive disorder experience these disorders. Researchers have identified a gene associated with people who have personality traits that include anxiety, anger, hostility, impulsiveness, pessimism, and depression.

The gene produces reduced amounts of a protein that transports serotonin, an important neurotransmitter for maintaining positive emotions.

This gene, however, would account for only a very small fraction of people with anxiety disorders.

Genetic mutations that affect other neurotransmitters have also been identified that contribute to obsessive-compulsive disorder.

The importance of genetics in GAD is still being investigated. Some experts have identified a genetic defect that affects dopamine, another important neurotransmitter, which appears to cause a syndrome that includes migraine headaches, anxiety, and depression.

Family Background in anxiety disorders

Panic Disorder and Family Influence

Psychodynamic theories suggest that panic disorder is caused by the inability to solve the early childhood conflict of dependence vs. independence. (This theory is backed up by one study reporting that young adults who had experienced childhood anxiety were more likely to live with their parents until their early to mid-twenties.)

Many people with panic disorder perceive their parents as being frightening and extremely controlling.

One study reported, however, that the incidence of inconsistent, neglectful, or abusive parenting was higher than average in panic disorder patients only if they also had agoraphobia. In fact, people who have severe agoraphobia with or without panic disorder generally report less parental affection and more strictness, overprotection, and encouragement of dependence than those without these disorders.

Phobias and Family Influence

Multiple research studies have consistently demonstrated a significant and compelling association between the fears experienced by parents and the fears subsequently developed by their children. Although an inherited trait may be present, some researchers believe that many children can even “learn” fears and phobias just by observing a parent or loved one’s phobic or fearful reaction to an event.

Obsessive Compulsive Disorder and Family Influence. One recent study found that parental influence played no part in obsessive-compulsive disorder when the patient was also not suffering from depression.

Patients who had both OCD and depression reported lower levels of parental care and overprotectiveness.

Other Factors that cause anxiety disorders

Specific traumatic events in childhood, including abuse – sexual, physical, or both – can later on cause anxiety and other emotional disorders. Some individuals may even have a biological propensity for specific fears, for instance of spiders or snakes, that can be triggered and perpetuated after a single first exposure.

A number of studies have reported a strong link between childhood rheumatic fever, which is caused by a streptococcal infection, and the development of tic-related disorders, including OCD and Tourette’s syndrome. The effects of alcohol on the developing fetus now appear to increase the risk for mental disorders as well as birth defects.

Who Gets Anxiety Disorders?

Anxiety disorders affect more than 23 million Americans, and as many as 25% of all American adults experience intense anxiety at sometime in their lives. Anxiety disorders run in families and genetic or biological factors play a role in most forms.

Age factor

Worry is very common among children and is often intense, but only about 5% have anxiety that can be classified as a disorder; moreover, depression is a common companion in such children. Studies have suggested that extremely shy children and those likely to be the target of bullies are at higher risk for developing anxiety disorders later in life.

One study suggests that such children could be identified as early as two years of age and possibly treated to avoid later anxiety disorders. Prolonged television viewing also puts children at risk for anxiety, depression, and behavioral problems.

The onset of panic disorders typically occurs during the later stages of adolescence, typically starting in late teenage years, and reaches its highest prevalence around the age of 25. Signs of obsessive-compulsive disorder (OCD) can occur in childhood but usually develops fully in adulthood.

The risk for generalized anxiety disorder spans a lifetime although it appears to be the most common form of anxiety at older ages. One study reported that depression in adolescence was a strong predictor of generalized anxiety disorder (GAD) in adulthood.

Gender

Women have twice the risk for most anxiety disorders that men do, although obsessive-compulsive disorder occurs equally in both genders. A number of factors may increase the risk in women, including hormonal factors, cultural pressures to meet everyone else’s needs except their own, and less self-restrictions on reporting anxiety to physicians.

Socioeconomic Factors

A study of Mexican adults living in California reported that native-born Mexican-Americans were three times more likely to have anxiety disorders (and even more likely to be depressed) as those who had recently immigrated to America. And the longer the immigrants lived in the U.S. the greater was their risk for psychiatric problems.

Traditional Mexican cultural effects and social ties, then, appear to protect newly arrived immigrants from mental illness, even when they are poor.

Eventually, however, the consequences of Americanization lead to depression and anxiety — probably resulting from feelings of alienation and inferiority — not only in many Mexican Americans, but in other impoverished minority groups.

Anxiety Disorders Diagnostics

Reliable diagnosis forms the bedrock upon which successful treatment plans rest. Overlooking or misinterpreting signs of anxiety disorders can lead to erroneous conclusions, perpetuating needless distress for affected individuals and families alike. Thus, arming ourselves with current diagnostic tools and techniques proves crucial in distinguishing genuine cases from benign states, enabling timely intervention and improving long-term prospects.

Clinical Interviews and Questionnaires

At the forefront of diagnostic arsenals stand structured interviews and validated questionnaires designed to probe depths of subjective experiences, uncovering clues indicative of impending threats. Among these, gold-standard evaluations include the Structured Clinical Interview for DSM-5 (SCID-5), Mini International Neuropsychiatric Interview (MINI), Composite International Diagnostic Interview (CIDI), and Primary Care Evaluation of Mental Disorders (PRIME-MD).

Alongside formal interview guides, complementary self-report instruments serve to bolster clinician insight, offering alternative perspectives on subtle dimensions masked within conversational settings. Noteworthy inventories encompass:

• the Hospital Anxiety and Depression Scale (HADS),
• Generalized Anxiety Disorder Assessment (GAD-7),
• Beck Anxiety Inventory (BAI),
• State Trait Anxiety Inventory (STAI),
• Panic Disorder Severity Scale (PDSS),
• Social Phobia Inventory (SPIN),
• Agoraphobia Cognitions Questionnaire (ACQ),
• Posttraumatic Stress Disorder Checklist (PCL-5).

Physiological Measures

Beyond behavioral indices gleaned from verbal narratives, bodily signals furnish auxiliary data points reflecting autonomic nervous system activation associated with surges of trepidation. Standard modalities measuring sympathetic hyperactivity incorporate:

• electrocardiogram (ECG),
• galvanic skin response (GSR),
• heart rate variability (HRV),
• respiratory sinus arrhythmia (RSA),
• blood pressure monitoring,
• pupillometry, thermal imagery,
• neuroimaging technologies such as functional Magnetic Resance Imaging (fMRI),
• Positron Emission Tomography (PET),
• Electroencephalography (EEG).

Neuropsychological Testing

Subtle variations characterizing cognition, memory, learning, perception, language, executive function, processing speed, visuospatial skills, and reaction times differentiate anxious populations from normative controls, elucidating latent correlates suggestive of neuropathological substrates underpinning psychiatric syndromes.

Insightful batteries comprising:

• Wechsler Adult Intelligence Scales (WAIS),
• Wisconsin Card Sorting Task (WCST),
• Stroop Color Word Test, Trail Making Test,
• California Verbal Learning Test (CVLT),
• Hopkins Verbal Learning Test Revised (HLVT-R),
• Boston Naming Test,
• Finger Tapping Test.

These diagnostic methods hold promise as adjunctive markers illuminating discrete facets underscoring complex anxiety constructs.

Multivariate Analytic Methods

Contemporary advances in computational analytics facilitate identification of multi-dimensional profiles encapsulating heterogeneous expressions of anxiety disorders via machine learning algorithms, pattern recognition software, network analysis platforms, and predictive modeling architectures.

Utilizing sophisticated mathematical models permits classification accuracy enhancement, dimensionality reduction, outcome prediction, and prospective stratification based on estimated risks.

Examples of informative techniques embraced within this domain span:

• principal component analysis (PCA),
• cluster analysis (CA),
• discriminant function analysis (DFA),
• logistic regression (LR),
• random forests (RF),
• gradient boosting machines (GBMs),
• artificial neural networks (ANNs),
• support vector machines (SVMs).

Full Recovery From Anxiety Disorders Is Within Reach

Anxiety disorders pose a significant challenge to those who struggle with them day in and day out. It might seem impossible at times to overcome these overwhelming feelings of fear, worry, and unease.

But it’s essential to realize that reaching a point of lasting wellness and liberation from anxiety disorders isn’t merely wishful thinking; rather, it represents a tangible goal within grasp. Let’s explore how.

First and foremost, the road to recovery begins with accepting the situation, shedding any lingering shame or guilt. Millions of individuals encounter anxiety disorders in their lifetime, thus normalizing this shared human experience helps remove unnecessary barriers to getting help. Once validation settles in, committing to a tailored treatment strategy crafted with the guidance of mental health experts comes to the fore.

Recovery usually doesn’t happen overnight and often includes trial-and-error phases while searching for the ideal mix of interventions.

Psychotherapy, specifically cognitive-behavioural therapy (CBT), demonstrates impressive efficacy for anxiety disorders.

Medications, such as Selective Serotonin Reuptake Inhibitors (SSRIs), likewise play crucial roles in easing symptoms and stabilizing emotional states, especially during initial stages of recovery.

Simultaneously, lifestyle modifications concerning exercise, sleep hygiene, nutrition, and stress management bolster progress made through evidence-based therapies and pharmaceutical means.

It is worth noting that everyone’s pathway towards healing varies considerably. What works brilliantly for one person might prove less helpful for another. Adjustments must be made accordingly, keeping a close eye on individual response patterns. Progress measurement assumes significance too, regularly tracking increments achieved supports ongoing momentum and builds motivation along the way.

Moreover, developing a strong support network ought to be considered an indispensable ingredient throughout this process. Friends, family, peers, and mental health professionals can supply valuable feedback, reinforce coping skills, foster resiliency, and act as cheerleaders celebrating milestones reached. Having trusted allies walking shoulder-to-shoulder amid challenging moments enormously improves chances of maintaining focus, resolve, and optimism.

Perhaps surprisingly, experiencing setbacks constitutes an ordinary aspect of the recovery journey. Slipping back into old habits or encountering temporary increases in symptomatology shouldn’t cause despair or panic. Instead, these instances offer teachable moments, spotlighting areas needing extra attention, fine-tuning employed tactics, or sparking conversations with therapeutic allies.