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The Biopsychosocial Model: Causes of Pathological Anxiety

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.

What Causes Anxiety?

So what causes anxiety and anxiety disorders anyway? According to Edmund Bourne (2000), author of the highly popular The Anxiety & Phobia Workbook, people often offer single cause explanations for anxiety disorders, including professionals. Many people will often offer simplistic explanations of anxiety disorders. Common "explanations" include: 1) brain imbalances, 2) traumatic episodes from childhood, or catchall blame…3) poor parenting. Each of these explanations does have some merit. However, anxiety disorders are much more complex. Anxiety disorders result from a multitude of biological, psychological, and social factors that all interact to create and maintain these disorders.

magnifying glass on question markAnxiety experts usually explain anxiety and anxiety disorders using the biopsychosocial model. The biopsychosocial model proposes there are multiple, and inter-related causes of pathological anxiety. These causes can be roughly categorized into three main groups:

1. biological causes,
2. psychological causes, and
3. environmental or social causes.

When psychologists use the word "environment," they mean all the things that are happening around us. Used in this way, environment references our life experiences, particularly social interactions with other people, especially caregivers, family members, etc. Theoretically, people develop an anxiety disorder when they possess both biological and psychological "vulnerabilities," coupled with a social environment that set-off, or trigger these vulnerabilities.

The biological aspect of the biopsychosocial model refers to the body's physiological, adaptive responses to fear. It also refers to genetic traits, and the brain functioning that we "inherit." More specifically, what is passed down is a genetic vulnerability expressed as a "personality type" (Bourne, 2000). This personality type describes a person who is more reactive, more sensitive, and/or more easily excitable in the presence of stress.

Although we may be born with a biologically determined, heightened sensitivity to stress, this fact alone is insufficient to create an anxiety disorder. The psychological factors in the biopsychosocial model refer to our thoughts, beliefs, and perceptions about our experiences, our environment, and ourselves. These cognitive patterns affect our perceived sense of control over our environment. These cognitive patterns also influence how we assess and interpret events in our environment as either threatening or non-threatening.

These thoughts (cognitions) about our environment, and ourselves, play a key role in the formation of an anxiety disorder. For instance, one child's mother makes a correction to her son's homework. He interprets this as helpful and indicative of his parent's confidence in his ability to learn. Another child's mother makes a correction to her daughter's homework, and instead of interpreting this as helpful, the daughter interprets this as an indication of her limitations, and her parent's lack of confidence in her abilities. This furthers strengthens her own lack of confidence in herself.

Previously, we mentioned anxiety develops from the perceived gap between one's estimated ability to cope with a challenge, and the estimated difficulty of the task itself. From the example of the two children described above, you can imagine how the son might grow up to become a man who has confidence in his skills when faced with a challenging task. Thus, when estimating the perceived gap between his abilities and a challenging task, he will be less likely to experience anxiety. In contrast, the daughter may grow up to be a woman who lacks this self-confidence. When she is faced with a challenging task, she is more likely to experience anxiety. This is because she is likely to overestimate the perceived gap between her abilities and the task itself. Thus, because of these differences in their psychological make-up, the daughter would be at greater risk for developing an anxiety disorder.

According to Barlow (2002), once the biological and psychological vulnerabilities are in place, an individual may then "learn," from their social environment (such as their family), to focus their anxiety on specific objects, or situations in their environment. Thus, the social component of the model refers to environmental factors that may trigger, shape, and strengthen the biological and psychological vulnerabilities. Environmental factors can include stressors that commonly affect everyone, such as the tragic events of 9-11. They can also be more individualized stressors that may not be experienced by everyone. This might include financial stress, loss of a loved one, or pet loss.

Our social environment includes different role-models that can have a significant influence on any preexisting vulnerabilities. To illustrate the influence of role models in the formation of anxiety disorders, consider adolescent peer groups. These peer groups often contribute strong opinions about what behaviors will help, or hurt, someone's chances of gaining entrance into the "in crowd." Subsequently, by observing how their peers behave, adolescents learn what behaviors and attitudes will help them become accepted, or at least, not rejected by their peers. Although a certain amount of concern over peers' opinions is developmentally normal, some teens are particularly sensitive to their peers' opinions. They may have a tendency to become excessively preoccupied with their peers' evaluations. Ironically, this excessive preoccupation interferes with the very relationships and peer approval they are so desperately trying to obtain. Unfortunately for these youth, this preoccupation often results in clinical levels of worry, avoidance behavior, and feelings of anxiety.

Now let's examine the biopsychosocial model in more detail to more fully understand the biological, psychological, and social causes of anxiety disorders.