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There are no clear-cut answers as to why some people develop an anxiety disorder, although research suggests that a number of factors may be involved. Like most mental health problems, anxiety disorders appear to be caused by a combination of biological factors, psychological factors and challenging life experiences, including:
• stressful or traumatic life events
• a family history of anxiety disorders
• childhood development issues
• alcohol, medications or illicit substances
• other medical or psychiatric problems.
The two main schools of thought that attempt to explain the psychological influences on anxiety disorders are the cognitive and behavioural theories. The ideas expressed by these theories help us to understand cognitive-behavioral treatment.
A third way of looking at the psychological causes of anxiety is the developmental theory, which seeks to understand our experience of anxiety as adults by looking at what we learn as children. of conscious control. The fear is felt before there is time to tell if danger is near. Such cues may be external or internal.
An example of an external cue might be a certain smell that occurred at the time of the stressful event. When this smell occurs again, even at a time when there is no danger present, the person is reminded of the event and becomes fearful.
Internal cues, such as a rapid heart rate, may also provoke fear if the person’s heart raced during the actual threat. Later, when the person’s heart beats rapidly during a workout routine, he or she may become fearful.
People with anxiety disorders may go to extreme lengths to avoid such cues.
The original cues may even generalize to other similar cues, such as a bad encounter with a bulldog leading to the avoidance of all dogs. When people avoid such cues, they may feel more secure, but in the long run, these avoidance behaviours actually increase the anxiety associated with the cues.
Avoidance prevents the person from “unlearning” the association, which can only be done when the person is exposed to such cues in a safe situation.
According to developmental theory, the way in which children learn to predict and interpret life events contributes to the amount of anxiety they experience later in life. The amount of control people feel over their own lives is strongly related to the amount of anxiety they experience.
A person’s sense of control can range from confidence that whatever happens is entirely in his or her hands, to feeling complete uncertainty and helplessness over upcoming life events. People who feel that life is out of their control are likely to feel more fear and anxiety.
For example, these people may feel that no amount of preparation or qualifications will give them any control over the outcome of an upcoming job interview, and they arrive at the interview fearing rejection.
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The biological causes and effects of anxiety disorders include problems with brain chemistry and brain activity; genetics; and medical, psychiatric and substance use issues.
Regulation of brain chemistry
Research has revealed a link between anxiety and problems with the regulation of various neurotransmitters—the brain’s chemical messengers that transmit signals between brain cells. Three major neurotransmitters are involved in anxiety: serotonin, norepinephrine and gamma-aminobutyric acid (gaba).
Serotonin plays a role in the regulation of mood, aggression, impulses, sleep, appetite, body temperature and pain. A number of medications used to treat anxiety disorders raise the level of serotonin available to transmit messages.
Norepinephrine is involved in the fight or flight response and in the regulation of sleep, mood and blood pressure. Acute stress increases the release of norepinephrine. In people with anxiety disorders, especially those with panic disorder, the system controlling the release of norepinephrine appears to be poorly regulated.
Some medications help to stabilize the amount of norepinephrine available to transmit messages.
Gaba plays a role in helping to induce relaxation and sleep, and in preventing overexcitation. Medications known as benzodiazepines enhance the activity of gaba, producing a calming effect.
Changes in brain activity
Modern brain-imaging techniques have allowed researchers to study the activity of specific areas of the brain in people with anxiety disorders. Such studies have found, for example:
• abnormalities in cerebral blood flow and metabolism, and also structural anomalies (e.g., atrophy) in the frontal, occipital and temporal lobes of the brain.
• that serotonin, norepinephrine and gaba activity in the limbic system, which controls memory and anxiety and fear responses, is most likely responsible for anxiety about the future.
• that activity in the locus ceruleus (with a high number of norepinephrine/neurons) and the median raphe nucleus (with a high number of serotonin neurons) appears to be involved in the production of panic attacks.
• that activity in the norepinephrine systems in the body and the brain produces physical symptoms of anxiety, such as blushing, sweating and palpitations, which may cause people to become alarmed; these systems have also been linked to the production of flashbacks in people with posttraumatic stress disorder.
Research confirms that genetic factors play a role in the development of anxiety disorders. People are more likely to have an anxiety disorder if they have a relative who also has an anxiety disorder. The incidence is highest in families of people with panic disorder, where almost half have at least one relative who also has the disorder.
alcohol, medications and illicit substances Substance use may induce anxiety symptoms, either while the
person is intoxicated or when the person is in withdrawal. The substances most often associated with generalized anxiety or panic symptoms are stimulants, including caffeine, illicit drugs such as cocaine, and prescription drugs such as methylphenidate (e.g., Ritalin).
A range of medical conditions can cause anxiety symptoms and result in anxiety disorders. For example, both panic and generalized anxiety symptoms can result from medical conditions, especially those of the glands, heart, lungs or brain.
Most often, treatment of the medical condition reduces symptoms of anxiety. Obsessive-compulsive symptoms in children may occur following strep infections. Obsessive-compulsive symptoms may also result from other infectious and degenerative syndromes affecting the central nervous system, but this is rare.
Mitral valve prolapse (a heart condition in which a heart valve is not working properly) has been associated with panic disorder, but there is no evidence supporting this link.
People with other psychiatric disorders often also have symptoms of anxiety. Sometimes it is the symptoms of the other disorder, such as depression or psychosis, that heighten a person’s anxiety. In such cases the person may not be diagnosed as having an anxiety disorder.
People who are diagnosed with anxiety disorders may also have other psychiatric disorders; most often, these are other types of anxiety disorders, or substance use disorders or depression. Two out of three people with panic disorder will have a major depressive episode at some point in their lifetime.
When depression occurs in someone with an anxiety disorder, it is of particular concern since these two problems in combination increase the person’s risk for suicide.
Studies show that people who are anxious tend to have an irregular pattern of breathing, alternating from hyperventilation to holding their breath. This pattern of breathing contributes to further symptoms (e.g., lightheadedness, dizziness and possibly fainting) and increases the feelings of anxiety. Breathing retraining
techniques can help these people cope or manage anxiety symptoms.
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