What causes anxiety disorders?

The exact causes of anxiety disorders are unknown. According to the National Institute of Mental Health (NIMH), a combination of genetic and environmental factors may play a role. Brain chemistry is also being studied as a possible cause. The areas of your brain that control your fear response may be involved.

Anxiety disorders often occur alongside other mental health conditions, such as substance abuse and depression. Many people try to ease the symptoms of anxiety by using alcohol or other drugs. The relief these substances provide is temporary. Alcohol, nicotine, caffeine, and other drugs can make an anxiety disorder worse.

Much research is being done into what causes anxiety disorders. Experts believe it involves a combination of factors, including genetic factors and social stress.

Studies of twins suggest that genetics may play a role. For example, a study reported in PloS ONE suggests the RBFOX1 gene may be involved in the development of anxiety-related conditions, such as generalized anxiety disorder. The authors believe that both genetic and nongenetic factors play a part.

Certain parts of the brain, such as the amygdala and hippocampus, are also being studied. Your amygdala is a small structure deep inside your brain that processes threats. It alerts the rest of your brain when there are signs of danger. It can trigger a fear and anxiety response. It seems to play a part in anxiety disorders that involve fear of specific things, such as cats, bees, or drowning.

Your hippocampus may also affect your risk of developing an anxiety disorder. It’s a region of your brain that’s involved in storing memories of threatening events. It appears to be smaller in people who’ve experienced childhood domestic abuse or served in combat.

Factors that can increase your risk of developing an anxiety disorder include the following.

Stress

Everyone encounters stress, but excessive or unresolved stress can increase your chances of developing chronic anxiety.

In 2019, the authors of a research review examined evidence of neurobiological links between stress and anxiety from various studies. They concluded that neural features in specific parts of the brain, such as the amygdala — which plays a role in processing fearful and threatening stimuli — may help explain how stress contributes to anxiety.

Genetic factors

If someone in your family has an anxiety disorder, you may have a greater risk of developing one too. Social and economic factors can play a role, but growing evidence suggests that genetic features might also contribute.

A 2019 study looked at links between genetic features and anxiety and stress-related disorders. The authors concluded that if you have specific genetic features, you might be more prone to anxiety. These features could be hereditary.

Personality type

Certain personality traits may affect your risk of developing anxiety and anxiety disorders.

A group of scientists followed 489 first-year university students for 6 years to see how certain outlooks — such as a tendency to experience negative feelings, extraversion, and introversion — might affect their risk of developing anxiety and depression.

They found that those who were hypocritical of themselves, had difficulty with criticism, or experienced a lot of negative thoughts and feelings as young adults were also more likely to develop panic disorder, agoraphobia, generalized anxiety disorder (GAD), and major depressive disorder over time.

Agoraphobia was also more common among those who scored high on a scale for introversion, rather than extroversion.

While these may act as “vulnerability factors,” the authors suggest that they are probably part of a far more complex picture.

Trauma

A recent or past traumatic event, such as experiencing abuse or participating in military combat, can increase your risk of developing anxiety. It can also happen if you are close to someone who’s the victim of trauma or have witnessed something traumatic.

Many people experience anxiety after a shocking or frightening incident; this is known as acute distress disorder (ASD). But ongoing symptoms could be a sign of post-traumatic stress disorder (PTSD). Symptoms usually start within 3 months of the event, but they can appear months or years later.

They include:

  • flashbacks
  • bad dreams
  • feeling constantly on edge
  • difficulty sleeping
  • angry outbursts
  • avoiding places or situations that could trigger stress symptoms

In some cases, ASD can become PTSD, but this does not always happen.

Racism

People who experience racial discrimination have a higher risk of developing anxiety and anxiety disorders, even after taking genetic factors into account.

Authors of a study published in 2021 concluded that discrimination is a risk factor for anxiety. The authors called for greater awareness of how racism and other forms of discrimination and social exclusion can affect people’s mental health.

Mental Health America (MHA) notes that, in the United States, Black people and Indigenous People of Color are at risk of race-based traumatic stress injury (RBTS).

RBTS can affect you if you have experienced an “emotionally painful, sudden, and uncontrollable racist encounter.” Symptoms are similar to those of PTSD and can affect a wider community. MHA points out that, unlike PTSD, RBTS refers to a mental injury rather than a mental health disorder.

Here, learn more about how to recognize and cope with racial trauma.

Sex

Studies suggest that females are more likely than males to experience anxiety and develop an anxiety disorder, although this may depend to some extent on the disorder.

Rates of the following appear to be higher among females than males:

  • panic disorder
  • agoraphobia
  • generalized anxiety disorder
  • phobias
  • separation anxiety
  • post-traumatic stress disorder (PTSD)

However, males and females may be equally prone to social anxiety disorder (SAD) and obsessive-compulsive disorder (OCD). OCD and SAD are also the most likely anxiety disorders to affect males.

The reason is likely to be a combination of biological and social or cultural factors, and there is still more work to do to find out how each contributes, say the experts.

Concerns about sexual performance can also lead to anxiety. Here, find out about the link between erectile dysfunction and performance anxiety.

Gender dysphoria

For people with gender dysphoria, the gender people assigned them at birth does not match with the gender they identify with.

This can lead to turmoil and anxiety, but it can also increase your risk of conflict with people around you, especially if those around you have rigid perceptions of male and female roles.

Statistics show that many people with gender dysphoria are at risk of:

  • anxiety and anxiety disorders
  • depression
  • thoughts of suicide
  • substance use

Learn more about how gender dysphoria can affect anxiety levels and other aspects of mental health.

Medical causes

There are various ways in which a person’s health can contribute to stress, such as:

  • past and present experience of mental and physical well-being
  • having a chronic illness that poses challenges to daily living
  • having a disease that causes very challenging symptoms, such as palpitations
  • having a condition where anxiety is a symptom, such as a hormonal imbalance

These will not necessarily lead to an anxiety disorder.

Life events

As with trauma, life events can increase your risk of stress and anxiety, according to the American Institute of Stress.

Examples include:

  • losing a loved one
  • divorce or separation
  • spending time in the criminal justice system
  • injury or illness
  • financial pressures or a loss of employment
  • major changes, such as moving in a new house or getting married

A person can experience these events without developing an anxiety disorder, although some may do so.

Medications

Some drugs can cause anxiety as a side effect, or they may cause symptoms that feel like anxiety.

Examples include:

Triggers for anxiety vary widely between individuals. Different anxiety disorders will also have different triggers. Things that can cause feelings of anxiety in some people include:

  • health issues
  • the use of some substances, such as drugs or caffeine
  • lifestyle factors, such as financial worries
  • either being alone or being with a lot of people
  • conflict
  • reminders of past trauma

Here, find out more about what can trigger feelings of anxiety.

Many factors can increase the severity of anxiety symptoms. Some may be specific to an anxiety disorder, but risk factors overall can include the following, according to the NIMH:

  • personality traits, such as shyness in childhood
  • past experience of traumatic events
  • a family history of mental health challenges
  • some physical conditions, such as a thyroid disorder

Anxiety affects everyone from time to time, but if you find it does not go away or is affecting you severely, it might be time to seek help.

Signs that it’s a good idea to see a doctor include the following:

  • Anxiety is affecting your work, studies, or other aspects of daily life.
  • You feel worried or distressed about your symptoms or anxiety levels.
  • You are using alcohol or other substances to manage anxiety.
  • You think there may be an underlying mental health problem.
  • You are having suicidal thoughts.
  • You have had treatment for anxiety before, and now it has come back.

Here, learn more about anxiety, when to seek support, and how to find help in your area.

Experts don’t know the exact causes of anxiety disorders. Genetics, environment, and personal history likely play a part.

If you have symptoms of anxiety that are worrying you or are not going away, make an appointment with your doctor.

They can help diagnose it and create a treatment plan to address your symptoms. They may recommend lifestyle changes, counseling, medications, or other interventions.

Some medical conditions and medications can produce symptoms similar to anxiety. In these cases, your doctor will likely treat your underlying condition or adjust your medication regimen.