What causes anxiety and depressive disorders?
The causes of anxiety and depressive disorders are multifactorial, meaning that multiple causes all add up to create a risk of developing an anxiety or depressive disorder. The causes for most disorders include genetic influences, environmental influences within the family and environmental influences outside the family. It is important to realize that, although genetic influences are contributory, anxiety and depressive disorders are not inherited in the same manner as eye color. Evidence suggests that there is unlikely to be a single gene that causes these disorders; rather, many genes “add up” to increase the risk of developing an anxiety or depressive disorder, with any single gene having a very small effect. Moreover, these genes may not be specific to one disorder. For example, if you have generalized anxiety disorder, you may have a close relative with depression or another anxiety disorder. What is inherited is likely a vulnerability factor. This means that—even if you have genetic risk factors for a disorder—you are not guaranteed of developing that disorder.
What Maintains Anxiety and Depressive Disorders?
In other words, what keeps the symptoms going once they develop? We know that certain patterns of thinking and behaving are involved in perpetuating the symptoms of these disorders. This is not to say that you are choosing to stay stuck. These patterns of thinking and behaving can be quite automatic and are not the same as choosing to be symptomatic. In anxiety disorders, a bias to view situations as more threatening than they really are may contribute to the maintenance of the disorder. Avoiding things that you are afraid of is also important, as it may keep you from finding out that what you are afraid of will not really happen and that you can tolerate your fear. In depression, a bias to view yourself negatively and situations as more hopeless than they really are is important. Withdrawing from activities that were once enjoyable or gave a sense of satisfaction is also important.
If genetic or biological factors contribute to anxiety and depressive disorders, don’t I need medication rather than therapy?
You don’t have to identify the root cause of your problem in order for us to effectively treat it. We can treat the factors that are maintaining your problem (i.e., thinking and behavior patterns) and you will see improvement even though we haven’t changed all of the factors that caused the problem to develop in the first place. Moreover, behavioral treatments can affect the body. Phenylketonuria is an example of a genetic medical disorder that can be managed behaviorally—by making different food choices. The mind and body are intertwined, and studies have shown that psychotherapy can lead to changes in brain functioning!