In view of the intimate connection between things physical and mental, we may look forward to the day when paths of knowledge will be opened up leading from organic biology and chemistry to the field of neurotic phenomena.
—SIGMUND FREUD
Recent scientific research suggests that anxiety is the result of a biochemical imbalance in the brain’s alarm center—the amygdala—and a psychological imbalance in thinking. The combination of a biochemically overreactive amygdala and fearful, worrisome thinking causes an exaggerated and persistent stress response. As to which comes first, this is a little like the chicken-or-the-egg question. The answer is both, in a circular pattern of causation. This is the mind-body principle: every change in the mind (anxiety) produces a corresponding change in the body (alarm) and vice versa.
While treatment of a biochemical imbalance solely with drugs is often assumed to be successful, research has shown that cognitive psychotherapy (correcting distorted thinking) can also cause an immediate and lasting correction in brain chemistry. This has been illustrated by brain imagery studies performed at major medical centers.
Anxiety can be the result of a number of factors—genetic predisposition, a painful childhood, major stress or trauma, medical illness, alcohol or drug abuse—and can also occur for no obvious or apparent reason.
THE AMYGDALA—THE BRAIN’S ALARM CENTER
Located in the emotional center of the brain, the amygdala signals trouble instantaneously, like a neural tripwire. It telegraphs a message of crisis before the cortex, the thinking area of your brain, is able to check whether or not the threat is real. The amygdala alarm center has proven to be lifesaving throughout the primeval dangers of humanity’s evolution, but it can also produce false alarms—unnecessary fear, anxiety, and worry. Experiences that frighten us the most produce high arousal in the amygdala, imprinting indelible emotional memories. Anything remotely similar to a past trauma can trigger an emergency response in the amygdala. An adjacent area, the caudate nucleus, has been shown to be overactive in obsessive-compulsive disorder.
A hypersensitive amygdala can lead to worry run amok. Overstimulation of the amygdala through chronic repetitive stress or an acute major trauma can cause it to remain excessively aroused and overreactive. As a result, the amygdala can trigger a five-alarm fire in response to a little bit of smoke or no threat at all. The lower alarm threshold can trigger a panic reaction to any arousal, whether physical (as from exercising) or emotional (hearing news of an accident involving a loved one). Even awakening to an alarm clock can be so jarring that it triggers anxiety.
NEUROTRANSMITTERS—THE MESSENGERS OF THE BRAIN
The human brain is the most complex, intricate communication center known to us, transmitting billions of messages each second without our thinking about it. The biochemical messengers of this communication are known as neurotransmitters. (Neuro refers to the brain and transmitter to sending and receiving information.)
When neurotransmitters are at appropriate levels, the brain functions harmoniously and the overall mood is one of well-being, confidence, and ease. Serotonin is an especially important neurotransmitter that can act as the brain’s own tranquilizer and antidepressant. Low serotonin levels have been implicated in anxiety, worry, panic, premenstrual syndrome (PMS), social phobia, depression, and impulsive disorders (such as violence, stealing, shopping, gambling, and overeating). Anxiety disorders may reflect serotonin deficits in the amygdala. The reason selective serotonin reuptake inhibitors (SSRIs) and the herb Saint-John’s-wort (see chapter 13) are effective in treating anxiety is that they correct serotonin imbalances in the amygdala.
There is also significant evidence associating anxiety (panic) attacks with another neurotransmitter, norepinephrine, which is released by the brain in emergencies. Impaired balance of norepinephrine and serotonin can cause a panic attack. Many high-strung, fearful people have low levels of another neurotransmitter, gamma-aminobutyric acid (GABA). The herbs valerian and kava can enhance the action of GABA, thereby reducing anxiety and nervous tension.
ANXIETY CAN BE HEREDITARY AND CONTAGIOUS
A predisposition to anxiety can be hereditary. Serotonin and other brain chemicals are affected by our genes, as well as by our attitudes, experiences, and spirit. The risk of panic attacks is about eight times higher among close relatives than in the general population. Life is full of stressful events, many of which cannot and should not be avoided, which can trigger anxiety in those who are susceptible. As with many illnesses, such as heart disease and diabetes, anxiety disorders can run in the family. Children who receive the affected gene are more vulnerable to anxiety than others.
What makes people susceptible to a hypersensitive amygdala is complex, but genetics can play a role. Research has identified a gene on chromosome 17 that contributes to neuroticism and a gene on chromosome 22 appears to be linked to obsessive-compulsive disorder. About 40 percent of people with agoraphobia have a relative with an anxiety disorder. Also, if one of a pair of identical twins suffers from panic disorder, there is a 40 percent chance the other suffers as well.
Having the genes for an anxiety disorder does not mean that heredity is destiny. Environmental factors and a resilient spirit are just as important. Many people with a genetic predisposition do not develop an anxiety disorder, while others without a family history do so. An interplay of biological, behavioral, and psychosocial factors determines whether or not anxiety becomes a problem. Of course, as Vladimir Nabokov writes, “Neither in environment nor in heredity can I find the exact instrument that fashioned me.”
Physical, emotional, and sexual abuse are known precipitants of anxiety. If guilt, shame, fear, and hostility were regularly used by parents to control a child’s behavior, that child is more likely to grow up fearful and lacking in confidence. Family-of-origin difficulties can be a cause of unconscious conflict and chronic anxiety.
Increased irritability is a hallmark of anxiety. The smallest incidents, such as a misplaced phone message or spilled milk on the kitchen floor, can lead to a tirade or temper outburst. Perhaps as a result of this emotional instability and unpredictability, an anxious person who is married has a much greater likelihood of having an anxious spouse. Is it assortive mating (the tendency to pair off with someone who has the same problem) or is it that the anxiety of an anxious spouse can be “contagious”? In either case, it seems that misery does love company.
Studies indicate that anxious people are very susceptible to taking on the negative emotions of those around them. Whenever you feel anxious, check to see if you are in the presence of a complainer. When you can’t move away or find a more positive conversational focus, you might put on an imaginary emotional raincoat, or create a picture of protecting yourself from the energy-depleting rain of stressful words. In this way you are likely to be less vulnerable to contagious negativity. The other person’s mood has little or nothing to do with you. When you allow hurtful or irritating words to get inside you and fester, you are torturing yourself needlessly.
CHILDHOOD ANXIETY AND ATTENTION DEFICIT DISORDER
About one in five infants is born with a timid temperament. These infants are fearful and overly sensitive, which makes them vulnerable to developing persistent separation anxiety—a fear of being separated from parents or being away from home. They cry, beg, and cling whenever left alone. In grade school, timid children talk less, are shy in social situations, and are terrified of choking up for a class speech or school performance. Research indicates that shyness, fear of strangers, social introversion, and excessive fear of embarrassment are personality traits that can be inherited.
Attention deficit disorder (ADD)—being easily distracted and having difficulty paying attention—and attention deficit hyperactivity disorder (ADHD)—also being fidgety, aggressive, and “bouncing off the walls”—may overlap with anxiety and depression. There are probably multiple causes of these symptom complexes—genetic, neurological, temperamental, nutritional, and social. ADD/ADHD is the most common psychiatric diagnosis in childhood. About 50 percent of these children continue to have attention and behavioral problems in adolescence (such as juvenile delinquency, drug abuse, and school difficulties), and 25 percent continue to have persistent symptoms into adulthood.
Specialized education, behavioral strategies, dietary changes, and synthetic drugs can be of benefit. Herbal remedies can be helpful in the treatment of ADD/ADHD when used with other supportive measures (see chapter 14). Certainly more natural medicines should be considered before automatically dosing a child or adolescent with Ritalin (methylphenidate), an addictive drug that can have significant side effects and unknown long-term consequences.