Causes and Risk Factors of Anxiety

Most people experience feelings of anxiety from time to time, but if these feelings are extreme, affect your daily life, and do not go away, they could be a symptom of an anxiety disorder.

There are several types of anxiety disorder, including generalized anxiety disorder (GAD), panic disorder, and phobia-related disorders.

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Though the exact cause of these disorders is unknown, certain risk factors are thought to be involved, such as genetic predisposition, brain structure, and stressful life experiences. These factors may differ for each type of anxiety disorder. 

Common Causes 

There is no known cause of anxiety disorders, but risk factors common to them include:

  • Stressful, negative life experiences or environmental factors in early childhood or adulthood: Mental health researchers have found that childhood trauma can increase a person's risk of developing anxiety disorders. These experiences can include physical and mental abuse, neglect, the death of a loved one, abandonment, divorce, and isolation.
  • Temperamental traits of shyness or behavioral inhibition in childhood: A child with behavioral inhibition will exhibit fearful, wary, and avoidant behavior when they are around unfamiliar people, objects, and situations.
  • A history of anxiety or other mental health conditions in biological relatives: You are more likely to develop anxiety disorders if a close family member, such as a parent, has one.
  • Some physical health conditions: Thyroid problems or heart arrhythmias are examples of medical conditions that can produce or aggravate anxiety symptoms.

If you have risk factors, it does not mean that you will develop an anxiety disorder. Risk factors increase the chance you will develop a condition, but they do not mean that you definitely will.

Genetics

As with many mental health and medical conditions, a person can be genetically predisposed to developing anxiety disorders. Studies have shown that first-degree relatives (the family members most closely related to you, such as a parent, sibling, or child) of a person with anxiety disorder are more likely to develop mood and anxiety disorders in general.

While research on genetics and anxiety disorders is still evolving, recent studies have found a link between the development of anxiety disorders and certain genetic markers—genes or sequences of DNA with a known physical location on a chromosome. The changes in these genes may make a person more likely to develop anxiety disorders. This is referred to as having a genetic predisposition or genetic vulnerability.

Genetic vulnerability, combined with certain environmental factors, is thought to trigger the development of anxiety disorder symptoms.  

Genome-wide association studies (GWAS) involve scanning genetic markers of many people who have a particular disease. A 2020 GWAS, the largest GWAS of anxiety to date, identified new genetic variants in and around several genes—some of which already had been suspected to be linked with anxiety.

These genes play important roles in the following areas:

  • Hypothalamic-pituitary-adrenal (HPA) axis (which affects how the body reacts to stress)
  • Neuronal development (the biological process that produces nerve cells)
  • Global regulation of gene expression (involved in controlling or maintaining certain characteristics of genes)

Research has also demonstrated that females are about twice as likely to develop fear- and anxiety-related disorders than males. Interestingly, one of the genes identified as being strongly associated with anxiety symptoms in the 2020 GWAS study was the estrogen receptor gene (ESR1). Estrogen affects fertility, sex-related functions, mood, bone strength, and even heart health.

Physical Development Risk Factors

People who have anxiety disorders can have changes in their brain structure and function. Some cardiovascular conditions are also associated with anxiety disorders.

Brain Structure

Differences in certain parts of the brain, as well as the volume of gray matter (which primarily consists of nerve cells), are thought to be linked to anxiety disorders. 

The limbic system is a collection of brain structures that, among other functions, are involved in the regulation of many basic emotional reactions. The amygdala, in particular, is the part of the limbic system that is involved in the automatic fear response, as well as in the integration of memory and emotion.

Differences in these areas have been linked to anxiety disorders. However, studies of the brain structures in those with anxiety disorders have generated inconsistent results about which areas are affected and the ways that they differ.

Cardiovascular

Medical conditions, such as thyroid problems or heart arrhythmias, are commonly associated with anxiety. Both of these conditions can have effects similar to those of anxiety and panic attacks and can aggravate symptoms of anxiety disorders.

The physical signs of anxiety and panic attacks can include:

  • Heart palpitations, a pounding heartbeat, or a fast heart rate
  • Sweating
  • Trembling or shaking
  • Shortness of breath and sensations of smothering or choking
  • Feelings of impending doom
  • Feelings of being out of control

There is a high prevalence of psychiatric symptoms and disorders associated with thyroid disease. Heart arrhythmias, or palpitations, can also be induced by stress.

Lifestyle Risk Factors

A number of lifestyle risk factors have been linked to mood and anxiety disorders:

  • Diet: Certain foods may increase a person's symptoms of anxiety or depression. People may also experience anxiety as a withdrawal symptom if they stop consuming certain foods and drinks that contain substances like caffeine, alcohol, and sugar.
  • Exercise: The U.S. Physical Activity Guidelines for Americans recommends getting at least 150 minutes of moderate‐to‐vigorous exercise per week to reduce the risk of depression.
  • Smoking: Smoking has been linked to an increased risk of depression, anxiety, and other psychiatric disorders.

Anxiety Triggers 

There are several events, conditions, and substances that may trigger or aggravate symptoms of anxiety disorders, including:

  • Caffeine and other stimulants: Studies have found that caffeine precipitates panic attacks in adults who have been diagnosed with certain anxiety disorders, including panic disorder, GAD, and social anxiety disorder. Both consuming caffeine in excess and withdrawing from caffeine can cause or worsen anxiety in some people.
  • Substance use: There is a high comorbidity (relationship between diseases) between anxiety disorders and substance use disorders. While some substances may help with anxiety in the short term, the effects are only temporary. The use of substances can create a psychological or physiological dependence, which may worsen anxiety symptoms. Research has also found that the use of alcohol or drugs to cope with symptoms of anxiety can be particularly problematic as it can lead to the additional risk of developing a substance use disorder. As with caffeine, people may experience worse anxiety if they drink alcohol in excess, as well as when they stop drinking (withdrawal).
  • Stopping your medication suddenly: If you suddenly stop taking medications for anxiety disorders, such as antidepressants (like Prozac or Celexa) and benzodiazepines (like Xanax and Valium), you may experience withdrawal or the return of your anxiety symptoms. If your doctor determines that it is time to stop your medication, you will be guided through the process of gradually tapering your dosage to help avoid rebound anxiety or symptoms of withdrawal.

Summary

The exact cause of anxiety disorders is unknown. It's more likely that instead of there being a single cause, many different factors play a role in someone's risk of having an anxiety disorder, such as their genetics, the environment that they grew up in, their overall health, and whether they take certain medications or use substances.

For individuals, figuring out their personal risk factors as well as identifying the specific triggers that cause them anxiety is important to managing the condition.

A Word From Verywell

Some risk factors for anxiety, like having a family history or certain environmental exposures, are not things that you have control over, but there are other factors that you might be able to change.

For example, you can focus on making lifestyle changes like eating a nutritious diet, getting regular physical activity, quitting smoking or using substances, and seeking support from friends, family, and mental health professionals when you need it.

If someone that you care about has anxiety, one of the most important ways that you can help them is by being understanding. You can also encourage and support them in seeking help from a mental health professional.

Frequently Asked Questions

What causes an anxiety attack?

There is no one cause of anxiety attacks. The attacks may occur unexpectedly. They can also be brought on by a trigger (an object or situation that is linked to your anxiety), stress, caffeine, substance use (particularly of stimulants), and by stopping your medication suddenly.

What causes anxiety in children?

Anxiety in children is common and does not mean that they have an anxiety disorder. However, some anxiety disorders do develop during childhood—specifically phobia-related disorders, such as separation anxiety disorder, phobias to specific items or situations, and social phobia.

How do you ease anxiety?

If you are feeling anxious, there are some things that you can try to help with the symptoms, including:

  • Practicing relaxation exercises (such as deep breathing or meditation)
  • Exercising regularly
  • Eating nutritious, satisfying meals and snacks
  • Sticking to a sleep routine and getting enough sleep
  • Avoiding excess caffeine
  • Identifying and challenging your negative and unhelpful thoughts
  • Reaching out to your friends, family, and mental health professionals for support

How do you help someone with anxiety?

If you have a loved one who has anxiety, there are several things that you can do to support them, including:

  • Understanding their diagnosis and knowing the misconceptions that surround anxiety disorders
  • Being alert to any major changes and understanding what may trigger their symptoms 
  • Encouraging them to stay with their treatment 

One of the most important ways that you can support a loved one with anxiety is by encouraging them to take care of their mental and physical health.

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