What Really Causes Anxiety?
Where Does It Come From?
Anxiety is, without doubt, one of the most prevalent problems in the modern world. The number of people who report suffering with some form of serious anxiety on a regular basis is staggering. In the US, it is estimated that about 40 million people are dealing with a diagnosed anxiety disorder in any given year. That’s almost 20% of the population!
The problem is not confined to the US. According to this study, published in 2010, the prevalence of anxiety in the UK in 2003-04 was 7.2%. Other studies have found that the prevalence of Common Mental Disorders in the UK (including anxiety and depression) was about 17%, which matches up well with the US figures. Interestingly, in both of those investigations the researchers found the prevalence to be far higher among women than men.
Statistics aside, we are now just more generally aware of anxiety as a condition than we were in the past. We increasingly hear people talking about their experiences with generalized anxiety on TV, on the radio, and online. We hear the word used as separate from mere stress. Our colleagues may take time off due to anxiety.
Indeed, social anxiety has become something of a meme on popular social media sites such as Reddit. Recognizing your anxiety is now almost a part of internet subculture.
Yet it is still seriously misunderstood.
People often wrongly believe that getting over anxiety is simply a matter of recognizing that you have nothing to worry about after all!
Tell someone you’re suffering with anxiety, and you’ll probably hear the words “just calm down”.
The truth is, we all have a lot to be seriously worried about.
If you’re an entrepreneur, then your business could implode at any given moment, leaving you penniless and destitute.
The world could be engulfed in nuclear war at any moment. Global warming might be unstoppable. We could be sitting right on the brink of total economic and societal collapse.
The question therefore isn’t “what are you so worried about”, but rather, “why do you feel so worried about these things when others do not”?
To answer that question, we need to look at the biological underpinnings of anxiety; what is happening in the brain to bring about those feelings of dread?
We also need to look at the psychological causes of anxiety.
Ultimately, I’m going to try to explain anxiety in a way that is comprehensive and accurate, yet easy to understand. My hope is that by better understanding anxiety you can deal with it a little better going forward.
At the end, I’ll talk about some of the ways that you can naturally counter anxiety yourself.
But before we get into any of that, we first need to properly define anxiety as distinct from feeling momentarily stressed or worried.
What Is Anxiety?
When we say anxiety here, we’re not referring to the feeling of worry you experience right before a job interview.
I’m not talking about the times you feel stressed trying to get all of your work done by 6pm on a Friday night.
Anxiety in this context refers to a group of disorders in which excessive feelings of fear, unease, and worry occur – sometimes without an identifiable cause – and do not go away for prolonged periods of time.
Feeling anxious is normal, but feeling incredibly anxious for several days without a concrete reason – or feeling disproportionately anxious about a small problem – is not. It is this generalized, excessive and lasting feeling of dread that we refer to when we say “anxiety”.
There are several different disorders that fall under the umbrella term ‘anxiety’.
They all have their own specific set of symptoms, causes and diagnostic criteria, but they all share one or more of the same key, central features:
- The feeling of anxiety is severe, causing behavioral or physiological problems
- The anxiety is disproportionate to the cause of concern
- There may be several causes that are difficult to identify
- There may be no identifiable cause of the anxiety
- Feelings of anxiety last for prolonged periods of time, and do not necessarily subside when the problem is fixed or shown to be trivial
- The anxiety causes impairment in important functional areas (work, social life, school, family, etc)
If you are suffering with some form of anxiety then it is highly likely that a few or all of the above features apply to your situation.
You won’t necessarily fall neatly into one of the more specific subsets of anxiety disorder, but it is worth looking at them to see if they apply to your situation more accurately than simply “anxiety”. After all, finding a label for your problem can be a huge help; it gives you something concrete and definable to manage, and it makes your experience much more predictable and therefore normal.
One of the most common forms of anxiety disorder is social anxiety.
Sometimes referred to as social phobia, social anxiety disorder is when you have an excessive fear of being embarrassed or exposed as a fraud in social situations. The most readily identifiable criteria for diagnosing social anxiety disorder is the persistence of avoidance behaviors; basically, the person will avoid parties, dinners, and even school at all costs.
Here are some of the different types of anxiety, along with their symptoms and diagnostic criteria.
This is where people experience severe panic symptoms, usually without warning or any specific triggers. Symptom onset is rapid, and an episode of panic is usually followed by a lingering worry that the panic will happen again soon. This can create a vicious cycle, with people having panic attacks because of their anxiety about having panic attacks.
- Profuse sweating
- Erratic movements
- A generalized feeling of imminent danger
- Elevated heart rate
- Shortness of breath
- Difficulty breathing
- Feeling completely out of control of one’s emotions
- Difficulty thinking about things clearly
Panic attacks rarely last longer than 10-15 minutes. They are often followed by a lingering anxiety about recurrence – people will be generally worried that they’ll have another attack. They might avoid certain situations or behaviors as a result.
If you ever experience anything like this then you should seek proper medical attention right away.
To class as a panic attack, these symptoms cannot be attributable to drugs, medications, or related mental illnesses. If the attacks come on in very specific circumstances (e.g at parties), then you may be better diagnosed as suffering from a different anxiety disorder.
Separation Anxiety Disorder
I think the best definition for this disorder can be found on Anxiety.org: “Excessive anxiety concerning separation from home or major attachment figures that is beyond what would be expected for one’s developmental level.” So the important factor here is that the anxiety is significantly more severe than you would expect for the situation or the age of the sufferer.
It’s normal to get a little anxious when your spouse or your children are going on a long trip. It’s perfectly fine to be worried if they’re going somewhere a little more dangerous than home. Separation anxiety disorder is when the worry is not proportional to the risks.
- Persistent feelings of severe anxiety about the possibility of losing a major attachment figure
- Feelings of serious mental distress when separated from home or major attachment figure
- Excessive, persistent worry that a traumatic event will lead to separation from a major attachment figure
- Reluctance to spend the night away from home (or a major attachment figure)
- Regular nightmares about separation
- Unusually frequent complaints of physical ailments when separated from major attachment figures
Separation anxiety is most common in children, although it can occur at any time of life. It is just that the triggers for developing separation anxiety disorder are much less common in adults. However, when it does occur in adults, it tends to last much longer.
Children will typically experience this for about a month or two. Adults can go through separation anxiety disorder for 6 months in serious cases.
As with all anxiety disorders, the feelings of concern or worry must be disproportionate to the situation, and they must not be brought on by drugs or alcohol.
Co-morbidity is extremely high with anxiety.
This means that, if you experience one type of anxiety, you are significantly more likely to experience another.
In fact, co-morbidity is more likely than not when it comes to anxiety disorders. Most people who suffer from anxiety experience two or three different subsets of anxiety disorder at some point in their life.
That is why it is so important that people receive some sort of help when they first experience anxiety. These disorders are extremely hard to deal with by yourself. Dealing with two or three different forms of anxiety is a big thing to take alone.
Causes & Risk Factors
Now that we’ve established what anxiety is – as well as some of the ways in which it manifests itself – we can start to look at what causes anxiety.
As with all of these questions, there’s a pretty ferocious nature-nurture debate going on. And as with all of these questions, ideological debates get us nowhere.
After looking at the evidence and at what clinical psychologists have to say, it’s clear to me that there are both hereditary/neurobiological and developmental/psychological factors that contribute to the onset of anxiety disorders.
Different types of anxiety obviously have more psychological causes than biological, and vice versa.
Separation anxiety disorder might arise after a traumatic event in childhood which led to prolonged separation from a caregiver.
On the other hand, you might develop generalized anxiety far easier than other people because of a quirk of your genetic code which makes it hard for you to regulate stress hormones.
Many psychologists are also increasingly focusing on how behavior and lifestyle choices influence our predisposition to anxiety disorders.
I’m going to look at each of these causal factors in turn, highlighting some of the most interesting studies, and explaining the extent to which they cause or mitigate anxiety.
There are several ways in which your biology might affect the likelihood of you developing an anxiety disorder.
The first thing we’ll talk about is your limbic system.
The limbic system is the term we use to refer to a group of structures in the brain which are collectively responsible for the experience and expression of emotion. The limbic system is incredibly complex, both in structure and function. But we can say with certainty that it is deeply involved in regulating our survival-driven behavior, including your fight or flight response.
The experience of acute and lasting anxiety is thought to at least partly come from a disruption or imbalance in the emotional center of the brain. It is not a rational or executive problem – it is a breakdown in an individual’s ability to deal with negative emotion. As such, anxiety must in large part result from problems in the limbic system.
This paper, published in Psychiatric Clinics of North America, does a brilliant job of explaining the roles played by the different regions of the limbic system with regards to anxiety and other negative emotions:
“The hippocampus is another limbic system structure; it has tonic inhibitory control over the hypothalamic stress-response system and plays a role in negative feedback for the hypothalamic–pituitary–adrenal (HPA) axis. Hippocampal volume and neurogenesis (growth of new cells) in this structure have been implicated in stress sensitivity and resiliency in relationship to mood and anxiety disorders. An evolutionarily ancient limbic system structure, the amygdala, processes emotionally salient external stimuli and initiates the appropriate behavioral response. The amygdala is responsible for the expression of fear and aggression as well as species-specific defensive behavior, and it plays a role in the formation and retrieval of emotional and fear-related memories.”
The amygdala is responsible for producing a range of behaviors associated with feelings of anxiety. You can see just how much control this tiny brain region has over your physiological response to fear and panic:
You’ll notice how many of the physical responses triggered by the amygdala are symptoms of several anxiety disorders. This makes intuitive sense; anxiety disorder is when you are experiencing a serious fear response to stimuli that don’t require it, or for far longer than is necessary. An over-excited amygdala should logically produce excessive feelings of anxiety.
Brain imaging studies have found that this is exactly right; people with various anxiety disorders exhibit far higher activity levels in the amygdala than is normal. As Drs. Martin, Ressler, et al. noted in the above cited paper:
“As with Panic Disorder and PTSD, amygdala activation has been implicated in symptoms of Social Anxiety Disorder. Social-cue tasks, such as the viewing of harsh faces, were associated with hyperreactivity in the amygdala and other limbic areas in patients who had SAD. Similarly, in response to viewing negative (but not neutral or positive) affective faces, patients who have SAD exhibited bilateral amygdala activation, which positively correlated with symptom severity and which reversed upon successful treatment. In anticipation of public speaking, subcortical, limbic, and lateral paralimbic activity is increased in patients who have SAD, suggesting elevations in automatic emotional processing.”
It seems that if you are born with a larger or more active amygdala, an improperly functioning hippocampus, or an under-developed limbic system, then you are significantly more likely to experience acute, severe anxiety. The extent to which your amygdala is activated in stressful situations – and whether or not it is bilaterally activated – seems to in some way correlate to how severely you experience anxiety.
There are plenty of other candidates when trying to identify a genetic cause or risk factor for anxiety disorders.
An obvious one is your neurotransmitter activity.
A good example would be a decreased ability to synthesize or release the neuropeptide oxytocin. As Martin et al. note that “direct oxytocin administration to the amygdala in laboratory animals was shown to decrease activation in this region and to dampen amygdala–brainstem communications, which are known to play a role in the autonomic and behavioral components of fear.”
If you are not producing enough oxytocin, or your brain is not receiving the signals that some oxytocin is required, then you cannot utilize its amygdala-soothing effects to counter the physical symptoms of fear that often accompany things like public speaking or attending social events with strangers.
Other studies, such as this one, have noted that there seems to be a heavy serotonergic component to anxiety. The use of Selective Serotonin Reuptake Inhibitors (SSRIs) has been found to be an effective treatment for social anxiety disorder, panic disorder, generalized anxiety disorder, and some forms of obsessive compulsive disorder.
SSRIs work by increasing available serotonin. Normally, once serotonin has passed a message between two nerve cells, it is reabsorbed by one of the nerve cells (known as reuptake). As the name suggests, SSRIs stop this reuptake happening. The result is more serotonin being available between nerve cells for use as message carriers.
Your ability to make serotonin, and the prevalence of your serotonin receptors, is to some degree genetically determined.
It would be far too simplistic to say “you’ve been born with fewer serotonin receptors, therefore you’re going to develop anxiety”. However, it does seem to be true that lower serotonin levels makes you more likely to experience some form of anxiety throughout your life, all else being equal.
That is true of all neurobiological factors discussed here. It isn’t the case that a single gene mutation means you’re always going to suffer with severe anxiety. Not at all. The research I’ve laid out here is simply saying that there may be genetic predispositions to various kinds of anxiety disorder.
Whether or not you actually develop an anxiety disorder will depend on other factors. Namely, psychological and environmental factors.
There are several risk factors for anxiety disorders grounded in our environment, our childhood development, and our ability to properly understand and cope with our emotions. While there are strong genetic risk factors for the development of anxiety, I believe that it is a combination of psychological and environmental factors which determine whether or not your predisposition turns into full-blown anxiety disorder.
Developmental psychologists are pretty much in unanimous agreement that a common cause of anxiety disorders later in life is parental behaviors. Children tend to model their behavior on their parents’, so a parent can quite easily pass on their pathologies to their children without ever realizing it.
A child will see their parent displaying anxious behavior when it isn’t warranted, and they’ll start to mirror that behavior when they’re in the same situation. Watching your mother have a panic attack because there’s a traffic jam will set you up to experience traffic jams as a major source of stress. Listening to your father talk about parties as “terrifying” and watching him do everything he can to avoid them will teach you that social gatherings are something to fear.
Serious childhood trauma can also leave a lasting scar on your psyche, not least with regards to your ability to deal with stress. Whether this is a painful period of separation or a nasty divorce, being persistently worried as a child may make you more likely to experience serious anxiety in adulthood.
The same goes for serious and prolonged periods of stress in adulthood. Feeling stressed for long stretches of time significantly raises the probability that you’ll experience some kind of anxiety syndrome later on. Some people find that stress at work ‘rolls over’ into a generalized anxiety disorder, where they struggle to calm down and every little problem feels like the end of the world. They struggle to differentiate between major and minor issues – a flat tire or a late train feels the same as when their company almost went bankrupt.
There are lots of other environmental factors which contribute to the development of anxiety disorders. It is such a complicated issue that we can’t possibly cover it in any detail here. However, these are some of the most common and well-understood environmental causes of anxiety disorders.
There are also a number of behavioral traits which correlate with anxiety.
It has long been posited that chronic caffeine consumption makes you feel generally more anxious.
I would be very cautious when reading popular articles on this topic, however.
Some articles, such as this one, try to suggest that quitting coffee can rid your life of anxiety. However, if you actually read how the author went about kicking caffeine, it isn’t hard to figure out why she suddenly felt so stress-free: “I quit caffeine and soon after, went on a weeklong yoga retreat in Mexico that involved daily intense three-hour yoga classes, eating tons of fresh fruits and vegetables, and sipping smoothies on the beach.”
People can call yoga classes “intense”, but they are not intense beyond the point of recovery regardless of how long they last. Three hours of yoga per day is going to leave you feeling exercised and ready for a good night’s sleep, not beaten up and struggling to drift off.
However, some studies have found a positive correlation between caffeine intake and stress levels. The relationship is often strong in these studies, but their sample sizes are never very large and there are usually conflating factors.
A more robust relationship is the one between feelings of anxiety and smoking.
You probably know that anxious people are more likely to smoke than others – the idea that a cigarette calms the nerves is pretty ingrained into our cultural psyche, even if it isn’t 100% accurate (or a good cure for nerves).
Well, recent studies have shown that the relationship may work both ways: smoking might make you more susceptible to anxiety (as well as a range of other mental disorders).
This study, published in Addiction in 2007, found that smoking was associated both with lifetime prevalence of mental disorders and with first-ever incidence of mental disorders, including anxiety-related disorders.
Another study, published in 2003, revealed a “fairly unique and specific, unidirectional relationship between prior smoking and increased risk for subsequent panic attacks/disorder”.
The mechanism behind this relationship is unclear, but there are plenty of obvious suspects; smoking negatively impacts neurotransmitter regulation, autonomic nervous system function, and respiratory health.
If you want to do everything you can to reduce your feelings of anxiety, then it might be a good idea to cut back on the coffee and leave the cigarettes well alone!
There’s an important point I want you to take away from this. I just laid out some of the most important risk factors and triggers for anxiety disorders.
But if you understand how these things contribute to the development of anxiety, you can use that information to build a resilience to anxiety.
Controlling your behavior as a parent, being conscious of how you socialize your children, and helping them to cope with anxious feelings can go a long way to ensuring that they never experience any kind of clinically significant anxiety disorder.
Understanding how lifestyle can influence your susceptibility to serious anxiety can also help you avoid ever developing a clinically significant disorder. You can avoid things like smoking, excessive caffeine consumption, and alcohol abuse. You could also try to reduce stress in your life; work reasonable hours, get plenty of sleep, and dedicate time to relaxation each day.
Genetic factors too can be as much of a shield as they can be a serious weakness. This is a burgeoning field, and as the biological markers for anxiety disorders are yet to be properly identified, the best way to identify an inherited risk for anxiety disorder development is to look at family history.
However, it is clear that just as some people are predisposed to poor stress hormone regulation and poor emotion processing, some people are born with good stress hormone management and a fully functioning limbic system.
What Do You Do About It?
Some of you reading this might recognize many of the signs and symptoms of anxiety in your own feelings and behaviors. You might already be convinced that you have some kind of anxiety-related disorder.
So what do you do about it?
The best thing to do, without question, is to talk to someone about your concerns.
You wont believe how helpful it is to unburden yourself to somebody else.
Ideally, it would be a mental health professional or someone with some understanding of anxiety and experience dealing with it.
But if for some reason you’re uncomfortable going to talk to a therapist, counselor or doctor, simply talking to someone you’re close to about your worries can be an enormous help. They can help you process your feelings, put things into perspective, and advise you on how to cope. At the very least, they can just be a sounding board for you to air your problems – often people find that the thing that’s been keeping them up at night sounds like a small issue once they say it out loud!
Luke is our Editor in Chief. He is the main driving force behind NaturalNootropic.com, and he creates most of our most important content. He is extremely passionate about enhancing human cognition; he has experimented with many different nootropic substances over the years, sometimes with negative results. He wants to help people get more out of performance-enhancing supplements, and he is fascinated by recent advances in longevity research. He can be contacted by email at firstname.lastname@example.org.