Although the exact causes of generalized anxiety disorder are still unknown, identifying and understanding them are crucial for effective treatment and recovery in the long run.
What Causes Generalized Anxiety Disorder?
Generalized Anxiety Disorder (GAD) is a psychiatric disorder marked by chronic worrying, accompanied by anxiety symptoms that may not be related to recent stressful occurrences. Experts have not been able to identify a single specific cause for the onset of generalized anxiety disorder. According to research, a number of different factors, such as genetic predisposition and environment, tend to influence the development of this condition. Moreover, brain structure and chemistry may also play a vital role as certain brain areas regulate our fear response 1 . Apart from these, comorbid conditions may be one of the leading causes of generalized anxiety disorder. Alcohol and substance abuse can also make the condition worse even though they may seem to provide temporary relief.
5 Causes Of Generalised Anxiety Disorder
According to experts, some of the most common causes that may lead to the development of GAD in a person may include the following factors –
A person’s genetics can significantly influence their chances of developing GAD. Similar to various medical and psychiatric conditions, genetic predisposition can lead to the onset of GAD symptoms. It means you are more likely to have GAD if it runs in your family. One 2008 study 2 suggests that “individuals with generalized anxiety disorder have a higher occurrence of anxiety problems among their relatives than do individuals without the disorder.” This goes to show that this disorder may be passed on in families with a history of GAD or other mental conditions. You are 5 times more likely to have GAD if a family member is affected by the condition. Another 2017 study 3 revealed that “GAD is a heritable condition with a moderate genetic risk (heritability of approximately 30%).” However, researchers are yet to identify any specific genes associated with causes of generalized anxiety disorder.
With the help of latest technological advances, researchers can further analyze the precise role of genetics in the onset of GAD. However, research is still limited due to certain factors. According to a 2012 study 4 , there are certain challenges in “gene finding for anxiety.” The following four challenges are considered to have prevented progress in gene finding for anxiety disorders –
- Etiological heterogeneity
- Small sample sizes
- Complex comorbidity profile
- Lack of clear distinction between normative & pathological anxiety
“Progress in anxiety genetics has lagged behind many of the other psychiatric disorders, in part because of a predominant focus on candidate genes and insufficient sample sizes,” add the researchers. However, one 2015 study 5 indicates “an involvement of the RBFOX1 gene in the development of anxiety-related conditions such as GAD.” Studies 5 have also found that first degree relatives, such as a parent, sibling, or child, of a person with GAD are more likely to suffer from mood & anxiety disorders and have higher risk of developing GAD. It was also observed that women are more prone to be affected by the condition.
2. Brain chemistry & structure
Our brain function is also one of the main causes of generalized anxiety disorder. Although the process through which generalized anxiety disorder is activated remains unknown, it has been found that brain circuitry related to anxiety and fear can contribute to someone having GAD. It is believed that when the areas of the brain that regulate behaviors and emotions are overactivated, then it may significantly contribute to the development of GAD. When there is an imbalance in certain brain chemicals, like noradrenaline and serotonin, it can lead to the development of such anxiety disorders as these chemicals help to regulate and control mood. According to a 2009 study 6 , “Mood and anxiety disorders are characterized by a variety of neuroendocrine, neurotransmitter, and neuroanatomical disruptions.”
Moreover, problems with particular nerve cell pathways, associated with certain areas of the brain related to thoughts and emotions, can also influence the onset of this disorder. It has been observed that different areas of the brain and biological processes 7 influence anxiety and fear. One 2015 study 8 by professor of psychiatry Dr. Philippe Nuss states “Lines of evidence coming from many branches of neuroscience indicate that anxiety disorders arise from a dysfunction in the modulation of brain circuits which regulate emotional responses to potentially threatening stimuli.” The limbic system, a set of structures in the brain, is involved in the regulation of our behavioral & emotional responses. Although it is typically controlled by the cerebrum, the limbic system can independently respond to stimuli.
Here are some other aspects that we need to consider as these can also be causes of generalized anxiety disorder:
A. The Amygdala
One 2016 study 9 found that apart from excessive worry and autonomic dysregulation, GAD is characterized by “functional amygdala dysconnectivity.” The amygdala 10 , a part of our limbic system, plays a role in the automatic fear response and the integration of emotion. In his research paper, Dr. Philippe Nuss explains “The brain circuits in the amygdala are thought to comprise inhibitory networks of γ-aminobutyric acid-ergic (GABAergic) interneurons and this neurotransmitter thus plays a key role in the modulation of anxiety responses both in the normal and pathological state.” As the amygdala is associated with our ability to recognize and experience fear, people suffering from generalized anxiety disorder tend to have higher amygdala activity 11 while processing negative emotions. It is believed that this elevated activity is related with incorrect interpretations of social behavior of sufferers. They tend to inaccurately believe that a social interaction or cue is threatening even when it is not.
In fact, hyper-activation of the amygdala to masked threats can also lead to the development of GAD in children and adolescents. According to a 2008 study 12 , “The amygdala and ventrolateral prefrontal cortex constitute a neural circuit that is responsible for detection of threats. Disturbed interactions between these structures may underlie pediatric anxiety.”
B. Gray Matter
The volume of gray matter in the brain is also one of the determining causes of generalized anxiety disorder. According to a 2015 study 13 , higher volumes of gray matter (GM) was observed in people with GAD, particularly in “ basal ganglia structures and less consistently in the superior temporal pole.” Moreover, white matter volume was found to be significantly lower in GAD patients. One of the most common areas of the brain to consistently show increased volumes of gray matter in GAD patients is the right putamen, the outermost portion of the basal ganglia. It has been observed that higher volumes of gray matter present in the right putamen is associated with childhood maltreatment. This shows that childhood maltreatment can cause increased gray matter volume in the brain leading to GAD. Evidence 14 indicates that reduced gray matter volumes in the amygdala and hippocampus have also been observed in pediatric anxiety, especially in social phobia.
Research 15 also indicates that gray matter volumes for certain areas of the brain are involved in anticipatory anxiety, worrying and emotion regulation. One 2017 study 16 found that gray matter changes are also associated with late-life generalized anxiety disorder more than changes in white matter. Another 2014 study 17 found that sufferers also “showed significant volume reductions in the hippocampus, midbrain, thalamus, insula, and superior temporal gyrus,” as compared to others.
Apart from biological and genetic factors, complex environmental 18 , psychological and social causes also play a vital role. Traumatic and stressful experiences can be significant causes of generalized anxiety disorder. Difficult life events may contribute to this condition. It may involve negative experiences like-
- Parental overprotection
- Loss of a loved one
- Long term illness
- Other adverse experiences
Experiencing a long-term painful medical condition or having a history of traumatic & stressful experiences like childhood abuse, maltreatment, abandonment or neglect, or domestic violence are common environmental factors 19 . Apart from this, alcohol or drug abuse and excessive caffeine or tobacco consumption can also worsen the condition. Moreover, other mental health disorders or medical illnesses may also increase risk. Let’s understand how some of these factors can affect the sufferer:
Research 20 reveals that childhood trauma can seriously increase the likelihood of someone being affected by GAD. Negative life experiences like physical and mental abuse often make the sufferers uncertain and apprehensive of others and this can lead to severe anxiety in future. “Uncertainty about a possible future threat disrupts our ability to avoid it or to mitigate its negative impact, and thus results in anxiety,” explains a 2013 study 21 . Patients often tend to misinterpret threats and incorrectly believe that certain interactions or experiences are dangerous and threatening, when in reality they are not. Negative experiences, difficult emotions and trauma can cause anxiety-producing symptoms in someone.
According to a scientific review 22 , trauma is one of the main factors for the onset of anxiety disorders. Moreover, one 2003 study 23 found that experiencing “one or more negative life events” in an unexpected way can significantly increase the risk of developing GAD. The researchers identified other environmental factors and chronic stress-inducing situations, such as “separation during childhood, role inversion during childhood, lack of social interactions, poor life satisfaction, and modeling of a relative having an anxiety disorder.” Another 2013 study 24 found that although genetics is a primary factor, environmental factors can also lead to GAD as “time-specific environmental influences on anxiety-related traits,” are significant. Furthermore, a 2018 study 25 found that the most common environmental risk factors for GAD include “Early Life Time Trauma (ELT) and Psychological Stressors in Adulthood (PSA).”
B. Learned behavior
Experts often believe that anxiety is a form of learned behavior. Hence, if the sufferer interacted with a caregiver, parent or family member with anxious behavior during childhood, then may have ‘learned’ the anxious behavior by mirroring their relative. Research 2 reveals that family history of psychological problems can also be considered as one of the causes of generalized anxiety disorder as it may influence the behavior of children and adolescents causing anxiety. The researchers conclude “Positive family history of anxiety disorders may represent an important environmental etiologic factor in the development of GAD.”
Caregivers and family members are often seen as role models by children as they learn various coping strategies from their loved ones while growing up. By modelling ineffective strategies of coping with stress and challenges, they may develop unhealthy stress management techniques. Early social learning experiences of children greatly influence the anxiety-related behavior of children well into their adulthood. A 2010 study 26 analyzed the influence of “parental modeling of anxious behaviors and cognitions” on their children’s degree of anxiety, anxious cognitions, objective performance and desired avoidance. It was observed that irrespective of the gender of the parent, children experienced higher anxiety levels in the presence of an anxious relative in a non-anxious environment. It was also observed that fathers tend to have a stronger impact on children’s anxiety and cognition than mothers. The study states “Results highlight the importance of parental modeling and the potential role of both mothers and fathers in prevention and treatment for child anxiety.”
According to another 2013 study 27 , parents with anxiety, especially those who are suffering from social anxiety disorder, “may exhibit a unique pattern of behaviors when interacting with their children.” This can involve lower levels of warmth and higher occurrences of criticism. Such parenting style involving ‘affectionless control’ has been found to be associated with a higher likelihood of developing GAD. Another study 28 revealed that parents with GAD tend to manipulate the ability of their children to identify “potential threats in the environment by conveying the message that the world is not safe.” They may bias their children’s belief that difficult emotions must be avoided, uncertainty should not be tolerated and worry helps us to prepare for uncertainty. This can significantly alter their cognitive styles leading to GAD.
4. Societal factors
Studies 29 have found that the use of social media, particularly uncontrolled and excessive use, can substantially affect our mental health. This can also be one of the major causes of generalized anxiety disorder and even depression 30 . Social media interactions can often be challenging and negative in nature which can result in various psychological issues 31 and feelings of humiliation, rejection, loneliness and even abandonment. Individuals affected with GAD are usually unable to interpret social cues & interactions accurately, whether online or in real life. Hence, they tend to feel a higher degree of rejection or danger, even in the absence of such experiences.
5. Lifestyle factors
Apart from the potential causes of generalized anxiety disorder mentioned above, certain lifestyle related factors can also influence the onset of this condition. Here are some possible factors to consider:
A. Substance use
According to a scientific analysis 32 , substance abuse is one of the main etiological factors for GAD. Anxiety symptoms tend to worsen with the use of substances like alcohol and drugs. Studies 33 show that comorbid generalized anxiety disorder (GAD) and alcohol use disorders (AUD) are prevalent among many patients. Alcohol use can not only increase anxiety levels but also lead to worry which may interfere with the treatment of substance abuse in comorbid patients. GAD has been found to be a major factor in people with AUD seeking treatment for substance abuse.
Moreover, regular addictive substances like caffeine and nicotine can also increase feelings of worry, nervousness and anxiety. According to a 2015 study 34 , weekly consumption of caffeine through coffee, tea, cola and energy drinks can significantly influence the development of stress, anxiety and depression, even in children. However, the effects tend to vary among men and women. Another 2013 study 35 found that “The risk of nicotine dependence is significantly higher among individuals with an anxiety disorder, and conversely, smoking has been found to be associated with trait anxiety and anxiety disorders.”
B. Relationship issues
Chronic relationship problems can also be one of the causes of generalized anxiety disorder as they can lead to severe emotional and mental distress. Relationships can be a prominent factor for GAD, especially in case of women. Research shows that women have a higher risk of developing GAD and this is why girls over the age of 13 should be diagnosed frequently for anxiety. The researchers found that women are more vulnerable to worry about being humiliated or afraid of their romantic partner, whether a spouse or an ex. Moreover, relationship abuse can also cause chronic anxiety. According to a 2010 study 36 , “Analyses revealed significant associations between wives’ daily anxiety and both partners’ perceptions of relationship quality.” One 2007 study 37 found a strong link between couple functioning and onset and treatment of GAD. The researchers explain “Generalized anxiety disorder was significantly associated with the likelihood of entry into a marriage-like relationship.”
However, development of GAD is not limited to intimate relationships only as the quality of relationship with friends, family and relatives has also been found to be associated with a number of anxiety disorders, like generalized anxiety disorder, social phobia and agoraphobia. A 2013 study 38 found that for married individuals, relationship quality with partners, friends and relatives was related to GAD and posttraumatic stress disorder (PTSD). “Given that those with anxiety disorders have higher rates of divorce and are more likely to be single, examining the relationship quality with relatives and friends, in addition to romantic partners, may be important for understanding the onset and course of anxiety disorders,” explains the study.
C. Work-related stress
Job stress can lead to chronic anxiety and can be one of the causes of generalized anxiety disorder. Certain work environments and cultures can demand high levels of performance and productivity causing severe mental pressure, threatening their sense of job security and severe stress. Such high degrees of stress caused due to job and career, especially the fear of unemployment, can significantly heighten a person’s anxiety. Research 39 shows that there is a strong association between work stress and “diagnosable depression and anxiety” in young workers who were previously mentally healthy.
“Workplace phobic anxiety is a specific concept and an important issue in organizations for both workers’ health and the organizational costs linked to absenteeism,” states a 2017 study 40 . Researchers 41 have also observed that work stress, coupled with ‘home stress’ can lead to psychological distress, including anxiety and depression, in the working population, whether men or women. However, apart from job stress, other worries related to career, like unemployment can also be considered as one of the causes of generalized anxiety disorder. One 2014 study 42 has found that ‘career unreadiness’ can increase anxiety levels in university students.
Apart from these there can be several other causes of generalized anxiety disorder such as personality (neuroticism), gender, age etc.
Dealing With GAD Symptoms
We may not be able control the various external factors that may influence the onset of GAD. However, we can take certain steps to cope with the symptoms and make the condition more manageable so that we can effectively overcome it in the long run. If you think you are suffering from GAD, then make sure to consult a doctor or a mental health professional immediately. With accurate diagnosis and treatment you can live a healthier, anxiety-free life.
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