Major Causes of Anxiety Disorders

If you are dealing with one of the anxiety disorders, you are likely to be concerned with the causes of your problem. You probably ask yourself, “Why do I have panic attacks? Is it something hereditary, or is it the way I was brought up? What causes phobias to develop? Why am I afraid of something I know isn’t dangerous? What causes obsessions and compulsions?”

The symptoms of anxiety disorders often seem irrational and inexplicable: it is only natural to raise the question “Why?” But before considering in detail the various causes of anxiety disorders, there are two general points you should bear in mind. First, although learning about the causes of anxiety disorders can give you insight into how these problems develop, such knowledge is not necessary to overcome your particular difficulty. The various strategies for overcoming anxiety disorders presented in this workbook—such as relaxation, exercise, desensitization, changing self-talk and mistaken beliefs, or dealing with feelings—do not depend on a knowledge of underlying causes to be effective. However interesting the information in this chapter may be, it is not necessarily what “cures.” Second, be wary of the notion that there is one primary cause, or type of cause, for any of the anxiety disorders. Whether you are dealing with panic attacks, social phobia, generalized anxiety, or obsessive- compulsive disorder, recognize that there is no one cause which, if removed, would eliminate the problem. Anxiety problems are brought about by a variety of causes operating on numerous different levels: heredity, biology, family background and upbringing, conditioning, recent stressors, your self-talk and personal belief system, your ability to express feelings, and so on. The range of chapters in this book indicates the many different levels on which you can understand the causes of and the means of recovering from anxiety disorders.

Some experts in the field of anxiety disorders propose “single-cause” theories. Such theories tend to greatly oversimplify anxiety disorders and are susceptible to one of two mistaken lines of reasoning: the biological fallacy and the psychological fallacy. The biological fallacy assumes that a

particular type of anxiety disorder is caused solely by some biological or physiological imbalance in the brain or body. For example, there has recently been a tendency to reduce the causation of panic disorder, as well as obsessive-compulsive disorder, to a strictly biological level. Panic disorder is viewed as arising from a dysfunction in parts of the brain, such as the amygdala and the locus coeruleus. Obsessive-compulsive disorder is thought to be caused by a deficiency in a particular neurotransmitter substance in the brain called serotonin—or a dysregulation in the serotonin system of neurons in the brain. (A neurotransmitter is a chemical substance that allows nerve impulses to be transmitted from one nerve cell to another.)

It is helpful to know that there may be physiological dysfunctions involved in panic disorder and obsessive-compulsive disorder. This certainly has implications for treatment of these problems. But this does not mean that panic attacks and obsessive-compulsive disorder are physiological disturbances only. The question remains: What caused the physiological disturbance itself? Perhaps chronic stress due to psychological conflict causes the amygdala and locus coeruleus to mal‐ function in panic disorder. Or perhaps chronically suppressed anger sets up a disturbance in brain serotonin levels that is a contributing cause of obsessive-compulsive disorder. Psychological conflicts and repressed anger may, in turn, have been caused by a person’s upbringing. Because any particular physiological disturbance may have originally been set up by stress or other psychological factors, it is a fallacy to assume that anxiety disorders are solely (or even primarily) caused by physiological imbalances.

The psychological fallacy makes the same kind of mistake in the opposite direction. It assumes that, say, social phobia or generalized anxiety disorder is caused by having grown up with parents who neglected, abandoned, or abused you, resulting in a deep-seated sense of insecurity or shame that causes your current phobic avoidance and anxiety as an adult. While it may be true that your family background contributed in an important way to your current problems, is it reasonable to assume that this is the only cause? Again, not really. To do so overlooks the possible contributions of hereditary and biological factors. After all, not all children who grow up in‐ dysfunctional families develop anxiety disorders. It is more plausible to assume that your problem is a result of both 1) a hereditary predisposition toward anxiety (and possibly phobia) and 2) early childhood conditions that fostered a sense of shame and/or insecurity.

In sum, the idea that your particular difficulties are just a physiological disturbance or just a psychological disturbance neglects the fact that nature and nurture are interactive. Biological disturbances may be “set up” by stress or psychological factors; psychological problems, in turn, may be influenced by inborn biological disturbances. There is simply no way to say which came first or which is the so-called ultimate cause. By the same token, a comprehensive approach to recovery from panic, phobias, or‐ anxiety cannot restrict itself to treating physiological or psychological causes in isolation. A variety of strategies dealing with several different levels, including biological, behavioral, emotional, mental, interpersonal, and even spiritual factors, is necessary for a full and lasting recovery. This multidimensional approach to recovery is discussed in the next chapter and assumed throughout this book.

The causes of anxiety disorders vary not only according to the level at which they occur but also according to the time period over which they operate. Some are predisposing causes, which set you up from birth or childhood to develop panic or anxiety later on. Some are recent or short- term causes—circumstances that trigger the onset of, say, panic attacks or agoraphobia. Others are maintaining causes—factors in your current lifestyle, attitudes, and behavior that serve to keep anxiety disorders going once they have developed. The remainder of this chapter examines each of these types of causes in more detail. A section on biological causes is included to acquaint you with some of the better-known hypotheses about the role of the brain in causing panic attacks and anxiety.

An outline of the causes of anxiety disorders follows.

Causes of Anxiety Disorders

LONG-TERM, PREDISPOSING CAUSES

1. Heredity
2. Childhood Circumstances
   1. Your Parents Communicate an Overly Cautious View of the World
   2. Your Parents Are Overly Critical and Set Excessively High Standards
   3. Emotional Insecurity and Dependence Your Parents Suppress Your Expression of Feelings and Self-Assertiveness

3. Cumulative Stress over Time

BIOLOGICAL CAUSES

1. The physiology of Panic
2. Panic Attacks
3. Generalized Anxiety
4. Obsessive-Compulsive Disorder
5. Medical Conditions That Can Cause Panic Attacks or Anxiety

SHORT-TERM, TRIGGERING CAUSES

1. Stressors That Precipitate Panic Attacks Significant Personal Loss Significant Life Change Stimulants and Recreational Drugs
2. Conditioning and the Origin of Phobias
3. Trauma, Simple   Phobias,   and   Post-Traumatic  Stress Disorder

MAINTAINING CAUSES

1. Avoidance of Phobic Situations
2. Anxious Self-Talk
3. Mistaken Beliefs
4. Withheld Feelings
5. Lack of Assertiveness
6. Lack of Self-Nurturing Skills
7. Muscle Tension
8. Stimulants and Other Dietary Factors
9. High-Stress Lifestyle
10. Lack of Meaning or Sense of Purpose