Table of Contents
Long-Term, Predisposing Causes
Heredity
Are anxiety disorders inherited? The limited evidence that exists to date would argue that they are—at least in part. For example, it is estimated that 15 to 25 percent of children growing up with at least one agoraphobic parent become agoraphobic themselves, while the rate of agoraphobia in the general population is only 5 percent. This fact in itself doesn’t prove that agoraphobia is inherited, however, because it could be argued that children learn from their parents to be agoraphobic.
More compelling evidence comes from studies of identical twins, who, of course, have exactly the same genetic makeup. If one identical twin has an anxiety disorder, the probability of the other identical twin having an anxiety disorder ranges from 31 to 88 percent, depending on the study you’re looking at. By comparison, when fraternal twins (whose genes are no more similar than those of siblings born at different times) are studied, the probability is much lower. If one fraternal twin has an anxiety disorder, the odds of the other having an anxiety disorder range from about 0 to 38 percent—again, depending on the study. Having the same genetic makeup as someone else with phobias or anxiety makes it more than twice as likely that you will have a similar problem. Interestingly, the percentages for fraternal twins are generally higher than the incidence of anxiety disorders in the population (about 8 to 10 percent). This would argue that growing up in the same family—having the same parenting—contributes at least something to the development of anxiety disorders. Both nature and nurture seem to have an impact.
What is it that is inherited? Based on what is known at this time, it seems that you don’t inherit agoraphobia, social phobia, or even panic attacks specifically from your parents. What is inherited seems to be a general personality type that predisposes you to be overly anxious. This is a volatile, excitable, reactive personality that is more easily set off by any slightly threatening stimulus than is the personality of individuals without anxiety disorders. Once you are born with this highly reactive personality, you might develop one or another anxiety disorder, depending on your particular environment and upbringing. For example, whether you develop agoraphobia or social phobia might depend on how much you learned to feel ashamed in situations where you were expected to perform. Whether you develop panic attacks or not might depend on the nature and degree of stress you’re exposed to during adolescence and early adulthood. In short, while heredity might cause you to be born with a more reactive, excitable‐ nervous system, childhood experiences, conditioning, and stress all serve to shape the particular type of anxiety disorder you subsequently develop.
Recent research in the field of behavior genetics has begun to hone in on specific genes associated with anxiety disorders. For example, the seventeenth chromosome (we all have 23) contains a gene known as SERT (serotonin transfer gene), which functions in the manufacture of the brain neurotransmitter serotonin. People with the “short” form of the gene tend to be more predisposed to develop anxiety disorders (as well as mood disorders such as depression), while people with the “long” form of the gene have a degree of protection, in spite of childhood and adult stress, from developing problems with anxiety.
Childhood Circumstances
What childhood experiences or family environments might predispose you to develop a particular anxiety disorder? Unfortunately, very little research on this topic has been done. Researchers have found that panic attacks and agoraphobia in adulthood are often preceded by separation anxiety disorder in childhood. This is a condition in which children experience anxiety, panic, or somatic symptoms when separated from their parents, as when going to school or even before going to sleep. Later on as adults, these same people experience anxiety when separated from a “safe” person or place. The conditions that might lead to separation anxiety disorder in the first place are matters for speculation.
What follows is a list of childhood circumstances that might predispose you to develop anxiety disorders. The list is based on my own experience with clients over several years. These factors are especially relevant if you are dealing with agoraphobia or social phobia, but may be applicable to other anxiety disorders as well.
Your Parents Communicate an Overly Cautious View of the World
Parents of people with phobias either tend to have phobias themselves or are more fearful and anxious than average. Often they are overly concerned about potential dangers to their child. They are likely to say things like “Don’t go out in the rain—you’ll catch a cold,” “Don’t watch TV so much. You’ll ruin your eyes,” or “Be very careful,” again and again. The more they communicate a fearful, overcautious attitude toward their child, the more that child comes to view the world as a “dangerous” place. When you learn that the outside world is threatening, you automatically restrict your exploration and risk taking. You grow up with a tendency to worry excessively and be overly concerned with safety.
Your Parents Are Overly Critical and Set Excessively High Standards
Children growing up with critical, perfectionist parents are never quite sure of their own acceptability. There is always some doubt about whether you are “good enough,” or sufficiently worthy. As a result, you are constantly striving to please your parents and maintain their approval. As an adult, you may be overly eager to please, “look good,” and “be nice” at the expense of your true feelings and capacity for assertiveness. Having grown up always feeling insecure, you may become very dependent on a safe person or safe place, and may restrict yourself from entering public or social situations where there is a risk of “losing face.” You often come to internalize your parents’ values, becoming exceptionally perfectionist and self-critical (as well as critical of others).
Emotional Insecurity and Dependence
Up to the age of four or five, children are utterly dependent on their parents, especially their mother. Any conditions that create insecurity during this time can lead to excessive dependency and clinging later on. Excessive criticism and perfectionist standards on the part of parents seem to be a common source of insecurity for people who later develop anxiety disorders. However, experiences of neglect, rejection, abandonment through divorce or death, and physical or sexual abuse can also produce the kind of basic insecurity (as well as emotional dependency) that forms a background for anxiety disorders.
Growing up in a family in which one or both parents are alcoholic is also a common contributing factor in 20 to 25 percent of the clients I’ve seen. As described in a number of popular books on the subject, adult children of alcoholics grow up with characteristics such as 1) obsession with control, 2) avoidance of feelings, 3) difficulty trusting others, 4) overresponsibility, 5) all-or-nothing thinking, and 6) excessive eagerness to please, at the expense of their own needs. Although not all adult children of alcoholics develop anxiety disorders, the above characteristics are commonly seen in many people who have problems with panic and/or phobias.
A common denominator in the background of adult children of alcoholics, adult survivors of other forms of abuse, and most people who develop anxiety disorders is a deep-seated sense of insecurity.‐ Perhaps the degree of insecurity and the way children respond to it will determine whether they later develop a specific type of anxiety disorder—as opposed to, say, an addictive personality or some other behavior disturbance. When children respond to insecurity with excessive dependency, the stage is set for overreliance on a safe person or safe place later in life. This is a common background for agoraphobia.
Your Parents Suppress Your Expression of Feelings and Self-Assertiveness
Parents not only may foster dependency but may suppress your innate capacity to express your feelings and assert yourself. For example, as a child you may have been continually reprimanded or punished for speaking out, acting impulsively, or getting angry. Subsequently you grew up exerting a restrictive, even punitive, attitude toward your own expression of impulses and feelings. If these impulses and feelings are suppressed over a long period of time, their sudden recurrence under stress may produce anxiety or even panic. Frequently, people who learned to bottle up their feelings and self-expression as children are tense, more prone to be anxious, and unable to express themselves as adults. Of course, this form of suppression in childhood can also lead to depression and passivity later on. In both cases, learning to express your feelings and becoming more assertive can have a very beneficial effect.
Reading about the four factors just discussed may have stimulated you to think about what happened in your own childhood. Use the Family Background Questionnaire on the next page to further explore what circumstances in your family may have contributed to your own problems with anxiety.
Family Background Questionnaire
Use the following questionnaire to reflect on your childhood. Can you identify what conditions might have contributed to your current problem with anxiety?
- Did either of your parents suffer from panic attacks or phobias?
- Did you have a brother, sister, grandparent, or other relative who had panic attacks or phobias?
- Did either of your parents seem excessively prone to worry?
- Did either of your parents seem overly concerned about potential dangers that could befall you or other family members?
- Did your parents encourage exploration of the outside world, or did they cultivate an attitude of caution, suspicion, or distrust?
- Do you feel that your parents were overly critical or demanding of you? If so, how did you feel in response to this criticism?
- As a child, did you feel free to express your feelings and impulses? How were feelings dealt with in your family?
- Was it okay for you to cry? How did your parents respond when you cried?
- Was it okay to express anger? How did your parents respond when you got angry?
- What was your role in the family? How were you perceived relative to other children in the family?
- Do you feel that you grew up feeling insecure? Which of the following might have contributed to your insecurity:
- Excessive criticism by your parents Excessive punishment
- Your parents made you feel ashamed Your parents made you feel guilty Your parents neglected you
- One or both parents abandoned you through death or divorce
- Physical abuse Sexual abuse Parental alcoholism
- If you grew up insecure, how did you respond to your feelings of insecurity?
- By becoming very dependent on your family (Did you have difficulty leaving home?)
- By becoming very independent of your family (Did you leave home early?)
- By becoming angry or rebellious