Anxiety disorders place a considerable burden on individuals and society in many ways. They are reported to cost the U.S. as much as one third of their total mental health bill; and more than half of those costs are related to the repeated use of healthcare services because those with anxiety disorders tend to frequently seek assistance for symptoms associated with physical illnesses. For example, those with an anxiety disorder are three-to-five times more likely to visit the doctor and six times more likely to be hospitalized for mental health issues than non-sufferers. Therefore scientists have long been interested in identifying risk factors that might predispose someone to developing anxiety as part of public health prevention. Research has indicated a number of key areas by which your risk for developing an anxiety disorder may be increased.
Genetics play a role in anxiety so if you have a parent who suffers from anxiety, the chance of you also experiencing it yourself is increased by approximately one third.
Whilst genetics are not solely responsible for personality development, many traits have a strong genetic basis. There are a number of personality traits associated with increased likelihood of anxiety: overthinking; perfectionism; resistance to change/being open to experience; being highly empathic; a tendency to irritability and neuroticism; vivid imagination; and avoidant temperament. In addition, studies exploring personality types, the Type D “distressed” personality (the tendency to experience both negative affect and social inhibition, leading to a high level of emotional distress that is consciously suppressed) is strongly associated with increased incidence of anxiety.
There may also be inherited biological traits: it has been hypothesized that an inherited neurochemical dysfunction may be to blame for panic disorder, for example.
2. Familial links
Anxiety disorders tend to run in families however the influence of nature over nurture (that is, genetics versus life experience, especially in the family environment) remains unclear. The figures are high: for example, studies indicate that someone with obsessive compulsive disorder (OCD) is as many as four times more likely to have another family member with OCD than someone who does not.
Acquisition of an anxiety disorder is often due to family dynamics or “scripts” that become learned behavior; this might include the failure to learn effective coping strategies; a prevalence of associated personality traits in parents; or overprotective parental behaviors, for example.
3. Biological sex
Women are more likely to have anxiety disorders. A number of studies seem to reach this conclusion, time and time again: for example, a recent large-scale, worldwide study found that women were almost twice as likely to experience anxiety. Again, the extent to which this is environmental or innate is unclear but research does seem to find differences between how men and women think about anxiety, even in childhood: for example, it has been shown that girls have more metacognitive beliefs about worry being uncontrollable (meaning they are more likely to worry about worrying) and believe that worry must be avoided, than boys. It is worth bearing in mind however that women are more likely to seek help for mental health issues, therefore, there may actually be higher levels of anxiety in males. It may also be the case that anxiety presents differently in males, therefore, they are less likely to be diagnosed.
4. Physical health and current medications
There are a number of physical health conditions associated with an increased incidence of anxiety. For example, heart disease, respiratory conditions, multiple sclerosis, hyperthyroidism, irritable bowel syndrome, chronic pain, diabetes, rare form of cancer and joint hypermobility syndrome, to name a few.
The use of or withdrawal from certain substances can also cause anxiety, therefore, substance use considerably increases the risk of development of the disorder. In addition, there are a number of prescribed medications or therapies that unfortunately include anxiety in their lists of side effects.
Previous mental health state also determines risk for anxiety – pre-existing mental health or anxiety disorder considerably increases the risk of developing subsequent disorders.
5. Neuro-biological factors
There are thought to be neuro-biological factors that influence the risk of developing anxiety disorders. For example, generalized anxiety disorder has been associated with certain nerve cell pathways dysfunction; if the pathways that connect particular brain regions do not function efficiently then problems related to mood or anxiety may result. This may manifest itself by affecting how people regulate their emotional reactions to potentially threatening stimuli.
Some people may also just respond differently physically. It is thought that a proportion of people with panic disorder may suffer from an autonomic (physical) over-reaction to normal events which leads to inaccurate cognitive attributions: this means that when they experience a raised heart rate in response to a stressful event, an excessive release of stress hormones is triggered, which leads to an attack.
Differences in the brain have also been noticed in those with anxiety disorders. Post-traumatic stress disorder is one example where research shows that the experience of trauma causes lasting changes to the brain including the volume of certain areas as well as increased and/or decreased functions in others. Brain-imaging studies show altered circuitry in many areas, but the amygdala, hippocampus, and prefrontal cortex seem to be particularly involved in the stress response; as do neuro-chemicals such as cortisol and norepinephrine.
6. Lifestyle issues
Substance use (including caffeine) increases the risk of developing an anxiety disorder. This may in part be neuro-bio-chemical in etiology; but also the risk of the person being exposed to risky, dangerous situations is also increased by the very nature of the lifestyle that tends to be associated with problematic substance use.
7. Psychosocial issues
Psychosocial is a term used to describe the interrelationship between social factors and individuals and how they think and feel. Therefore social, economic and environmental factors can be regarded as psychosocial issues when considered the extent to which they influence people's wellbeing.
Members of impoverished minority groups, particularly immigrants, tend to be at greater risk for developing anxiety, which may be as a result of displacement, isolation, loss, trauma, amongst many other things. Generally, people tend to be more transient and less connected within communities and this may well go along way towards explaining the increase in anxiety disorders in society in general.
Studies have also found that those who are divorced or widowed, and also those with few economic resources (may explain increased rates in women who tend to be more economically deprived) are also more likely to experience anxiety. Furthermore, anxiety rates among children and adolescents have increased significantly since the 1950's and especially since the 1980's, which again seems to be down to increasing levels of isolation but also changes in lifestyle such as greater pressure and less free, outdoor play.
The increase in the use of social media may also be a factor in the development of anxiety: whilst it can be of great assistance to those who are socially isolated; it can also lead to an increase in mental “ill-being” and lead to increased levels of anxiety and depression, according to a recent study.
8. Life experiences
It is not surprising perhaps that life experiences can significantly increase the risk of developing an anxiety disorder. Specific phobias often tend to present in childhood or can at least be traced back to that time and often persist into adulthood.
GAD often presents itself initially follows a highly stressful event: such as a life-threatening health event; bereavement or other interpersonal loss, change of life circumstances beyond your control such as loss of employment, or being a victim of a crime.
Serious sexual assault is a key risk factor for subsequent development of an anxiety disorder. For example, studies suggest that more than two-thirds of men and nearly half of all women who are raped will go on to develop post-traumatic stress disorder. Childhood sexual trauma is a key indicator of the likelihood of future PTSD.
Early-life trauma is a key risk factor for a number of mental health issues, including anxiety. Adolescents who self-harm are at a higher risk for an anxiety diagnosis by young adulthood and especially those who experienced suicidal ideation.