Unraveling Anxiety: The Biological, Psychological, and Cultural Roots of GAD

Generalized Anxiety Disorder (GAD) is a chronic mental health condition characterized by excessive, persistent, and uncontrollable worry about various aspects of daily life, even when there is little or no apparent reason for concern. People with GAD often experience physical symptoms such as restlessness, fatigue, muscle tension, and difficulty concentrating. Unlike situational anxiety, which arises in response to specific stressors, GAD is a long-term condition that can interfere with daily functioning and overall well-being. The exact causes of GAD are complex and multifaceted, involving biological, psychological, and sociocultural factors.

Biological causes of General Anxiety Disorder

The biological markers for general anxiety disorder (GAD) are still somewhat unclear (Maron, 2017). While some might assume that since anxiety is related to the stress response there would be a strong impact of epinephrine, cortisol and norepinephrine on the development of anxiety. It would also be reasonable to assume that anxiety might be linked to dysfunction of the adrenal glands which play a key role in pursuit of allostasis through the hypothalamic-pituitary-adrenal (HPA) axis. Interestingly though, there is not strong or consistent evidence of this. For example, in several studies when groups of individuals with GAD were exposed to stress inducing activities such as administration of 7.5% carbon dioxide, their salivary epinephrine levels were similar to controls (Maron, 2017). Studies regarding waking and pre-sleep cortisol levels in children and older adults have mixed results when compared with controls (Maron, 2017). Interestingly, higher awakening cortisol levels have only been reported consistently in individuals who also suffer from major depressive disorder (MDD) (Maron, 2017). There has however, been some implication that elevated levels of brain-derived neurotrophic factor and C-reactive protein are present among those suffering from GAD (Maron, 2017). Additionally, it’s been observed that anxiety can be a heritable trait (Mayo Clinic, 2018). 

Psychological causes of General Anxiety Disorder

There are several known contributing psychological factors to developing GAD. According to an article published by the Mayo Clinic, anxiety can be caused by various life events and psychological states (Mayo Clinic, 2018). For example, children who have experienced traumatic events are at risk of developing anxiety as are adults who experience a traumatic event (Mayo Clinic, 2018). Stress due to an illness or a significant life event such as the loss of a close family member can also develop into anxiety (Mayo Clinic, 2018). In addition to more acute stressors such as those mentioned above, a burden of chronic stress can also turn to anxiety over time after the threshold of tolerance is surpassed (Mayo Clinic, 2018). Finally, a person’s personality or the presence of other mental disorders such as MDD can lead to the development of anxiety (Mayo Clinic, 2018).   

Social and cultural causes of General Anxiety Disorder

Many different cultures have unique expressions of GAD and associated unique causes. For example, in Cambodia the concept of “khyâl cap” or “wind attacks” relates directly to GAD (Hofmann, 2014). According to Cambodian culture, khyâl cap rises from a disturbed inner wind and is thought to be caused by standing up, worry, fear, exhaustion, tightness and soreness in the legs, “limb blockage” (a state arising from the blockage of believed inner channels of blood and wind), or poor sleep (Hofmann, 2014). In Puerto Rico and the Dominican Republic the concept of “ataque de nervios” includes the experience of a sense of heat in the body, impending loss of control, heart palpitations, chest tightness, the sense of an imminent fainting spell, and shaking in the arms and legs (Hofmann, 2014). The belief in these cultures is that strong negative feelings such as rage or fear cause “ataque de nervios” (Hofmann, 2014).  

The shared impact of biological, psychological and cultural realities

There are several shared veins that run through the biological, psychological and sociocultural factors of GAD. One of the strongest of these veins is the understanding that GAD is caused by or exists alongside stressful situations. There is a shared sense culturally, psychologically and biologically that anxiety does not occur frequently for people whose lives are free of challenges (be they environmental, mental or physical). Additionally, there is a shared understanding that GAD is a result of a complex interplay of many causal factors. There is no clear input-output relationship with GAD for any causal factor be it biological or psychological. 

Panic disorder and General Anxiety Disorder

GAD and panic disorder have many shared symptoms. Like GAD, panic disorder is a complex disorder that arises from many of the same causal factors (Kyriakoulis, 2023). This can make panic disorder challenging to differentiate from GAD because the causal factors are shared and many of the symptoms are similar. It requires deep listening and accurate diagnostic testing to clearly identify which disorder a person is experiencing. 

Resources: 

Hofmann, S. G., & Hinton, D. E. (2014). Cross-cultural aspects of anxiety disorders. Current psychiatry reports, 16(6), 450. https://doi.org/10.1007/s11920-014-0450-3 

Kyriakoulis, P., & Kyrios, M. (2023). Biological and cognitive theories explaining panic disorder: A narrative review. Frontiers in psychiatry, 14, 957515. https://doi.org/10.3389/fpsyt.2023.957515 

Maron, E., & Nutt, D. (2017). Biological markers of generalized anxiety disorder. Dialogues in clinical neuroscience, 19(2), 147–158. https://doi.org/10.31887/DCNS.2017.19.2/dnutt 

Mayo Clinic. (2018, May 4). Anxiety disorders. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961