Risk Factor and Causes for Anxiety and Anxiety Disorders

There are several Causes and Risk Factors in term of Anxiety and Anxiety Disorders:

• Comorbidities – Comorbidity is more common than not with anxiety disorders, meaning that most individuals who experience significant anxiety experience multiple different types of anxiety. Given this comorbidity, it is not surprising that many risk factors are shared across anxiety disorders, or have the same underlying causes. There is a lot of research identifying risk factors for anxiety disorders, and this research suggests that both nature and nurture are very relevant. It is important to note that no single risk factor is definitive. Many people may have a risk factor for a disorder and not ever develop that disorder. However, it is helpful for research to identify risk factors and for people to be aware of them. Being aware of who might be at risk can potentially help people get support or assistance to prevent the development of a disorder.

• Genetics – Genetic risk factors have been documented for all anxiety disorders. Clinical genetic studies indicate that heritability estimates for anxiety disorders range from 30-67%. Many studies, past and present, have focused on identifying specific genetic factors that increase one’s risk for an anxiety disorder. To date, an array of single nucleotide polymorphisms (SNPs) or small variations in genetic code, that confer heightened risk for anxiety have been discovered. For the most part, the variants that have been associated with risk for anxiety are located within genes that are critical for the expression and regulation of neurotransmitter systems or stress hormones. It is important to note that genetic factors can also bestow resilience to anxiety disorders, and the field continues to pursue large-scale genomics studies to identify novel genetic factors that are associated with anxiety disorders in hopes of better understanding biological pathways that 1) contribute to the development and maintenance of anxiety; 2) may lead to better treatment for these disorders. Most people are not aware of what specific genetic markers they may have that confer risk for anxiety disorders, so a straightforward way to approximate genetic risk is if an individual has a history of anxiety disorders in their family. While both nature and nurture can be at play with family history, if several people have anxiety disorders, genetic vulnerability to anxiety likely exists in that family.

• Environment Factors – Concerning environmental factors within the family, parenting behavior can also impact the risk of anxiety disorders. Parents who demonstrate high levels of control (versus granting child autonomy) while interacting with their children has been associated with the development of anxiety disorders. Parental modeling of anxious behaviors and parental rejection of the child has also been shown to relate to greater risk for anxiety potentially. Experiencing stressful life events or chronic stress is also related to the development of anxiety disorders. Stressful life events in childhood, including experiencing adversity, sexual, physical, or emotional abuse, or parental loss or separation may increase the risk of experiencing an anxiety disorder later in life. Having experienced a traumatic event or very stressful event can be a risk factor for the development of anxiety across different age groups. Consistent with the notion of chronic life stress resulting in increased anxiety risk, having lower access to socioeconomic resources or being a member of a minority group has also been suggested to relate to greater risk.

• Medical Condition – Experiencing a chronic medical condition or severe or frequent illness, can also increase the risk for anxiety disorders, as well as dealing with a significant illness of a family member or loved one. Given that several medical conditions have been linked to significant anxiety, in some cases, a physician may perform medical tests to rule out an underlying medical condition. For instance, thyroid disease is often characterized by experiencing significant symptoms of anxiety. Menopause, heart disease, and diabetes have also been linked to anxiety symptoms. Additionally, drug abuse or withdrawal from many substances is characterized by acute anxiety, and chronic substance abuse can increase the risk of developing an anxiety disorder. Anxiety can also be a side effect of certain medications. Experiencing significant sleep disturbances, such as difficulty falling asleep or staying asleep, may also be a risk factor for developing an anxiety disorder. For some people, anxiety may be linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators of a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order tests to look for signs of a problem. Examples of medical problems that can be linked to anxiety include: Heart disease, Diabetes, Thyroid problems, such as hyperthyroidism, Respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and asthma, Drug misuse or withdrawal, Withdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medications, Chronic pain or irritable bowel syndrome, Rare tumors that produce certain fight-or-flight hormones.

• Behavioral Choices – Behavioral choices can also significantly impact risk, as excessive tobacco or caffeine use can increase anxiety, whereas regular exercise can decrease anxiety. Specific temperament and personality traits also may confer the risk of having an anxiety disorder. With regards to temperament, shyness, and behavioral inhibition in childhood can increase the risk of developing an anxiety disorder later in life. About personality traits, the Five-Factor Model of Personality consists of five broad trait domains, including Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. An individual higher on trait Neuroticism or low on Conscientiousness is at a higher risk for all anxiety disorders, and an individual low on trait Extraversion is at a higher risk of developing social phobia and agoraphobia. Some more narrow personality traits have also been found to relate to risk for anxiety, including anxiety sensitivity, a negative or hostile attributional style, and self-criticism. Personality disorders have also been shown to relate to increased risk for anxiety disorders.

• Demographics – Demographic factors also impact the risk of anxiety disorders. While there is not a strong consensus, research suggests that risk for anxiety disorders decreases over the lifespan with the lower risk being demonstrated later in life. Women are significantly more likely to experience anxiety disorders. Another robust biological and sociodemographic risk factor for anxiety disorders is gender, as women are twice as likely as men to suffer from anxiety. Overall symptom severity has also been shown to be more severe in women compared to men, and women with anxiety disorders typically report a lower quality of life than men. This sex difference in the prevalence and severity of anxiety disorders that put women at a disadvantage over men is not specific to anxiety disorders but is also found in depression and other stress-related adverse health outcomes (i.e., obesity and cardiometabolic disease). Basic science and clinical studies suggest that ovarian hormones, such as estrogen and progesterone, and their fluctuations may play an important role in this sex difference in anxiety disorder prevalence and severity. While changes in estrogen and progesterone, over the month as well as over the lifetime, are linked to change in anxiety symptom severity and have been shown to impact systems implicated in the etiology of anxiety disorders (i.e., the stress axis), it still remains unclear how these hormones and their fluctuations increase women’s vulnerability to anxiety.

• Trauma – Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders. Living through a traumatic event increases the risk of posttraumatic stress disorder (PTSD), which can cause panic attacks. Severe trauma, such as child abuse or military combat, increases your risk of developing anxiety. This can include being the victim of trauma, being close to someone who’s the victim of trauma, or witnessing something traumatic. Difficult experiences in childhood, adolescence, or adulthood are a common trigger for anxiety problems. Going through stress and trauma is likely to have a particularly big impact if it happens when you’re very young. Experiences that can trigger anxiety problems include things like: physical or emotional abuse, neglect, losing a parent, being bullied, or being socially excluded. Having parents who don’t treat you warmly, are overprotective, or are emotionally inconsistent can also be a factor.

• Low self-esteem – Negative perceptions about yourself may lead to social anxiety disorder.

• Sex or gender – Women are twice as likely as men to have a generalized anxiety disorder and other related conditions.