Childhood Experience and Adult Generalized Anxiety Disorder

Adult anxiety has many faces, manifestations and levels. The anxiety disorder I’ve had the most contact with in my experience as a therapist is Generalized Anxiety Disorder (GAD) and from here on when I speak of “anxiety” I will be referring to this. I work from a family of origin perspective, in that, I believe that people’s emotional and/or psychological distress as adults can partially be the result of problematic core beliefs developed in early childhood. A primary hallmark of GAD is pervasive worry. “Fear of the fear” is how some of my clients have described the feeling. If I look back far enough in a client’s history I’ve typically found a childhood experience laced with chaos, high expectations and/or a highly anxious parent.

When children are born into this world, they are physical beings with no developed sense of self. Young infants begin to develop their core self as they interact with their primary caretakers. Ideally, their nest is a safe, loving and attentive one. It’s in this nest they can begin to believe that they will get their needs met and they have value – what they do impacts the world. This is the beginning of a very healthy self concept – or relationship to self. If all things are right, the growing infant will also develop the idea that others can be trusted. Barring any seriously negative life experience along the way, the baby becomes a toddler who becomes a child who becomes an adult with good feelings about his place in the world. “I am lovable,” might be a core belief born out of this situation. Other possible healthy core beliefs are, “people can be trusted,” or, “the world is a safe place.”

Children who are raised in a physically, emotionally or sexually abusive environment live in a state of chaos. My clients have reported to feel like they were “walking on eggshells,” just waiting for the next event. This creates a pervasive fear or constant fight-or-flight response. A common core belief developed by children in this situation is, “something bad is going to happen.” Children are genius at finding ways to defend themselves psychologically from uncomfortable situations so they become hypervigilant, constantly scanning their environment for danger and adopt danger avoiding behaviors. This belief system can follow children as they develop into adults who then walk through my office door complaining of constant worry, rumination, sleep disturbances and trouble concentrating. They’re still operating under the belief system that “something bad” will happen to them! The belief system developed in their chaotic childhood environment has remained with them. Do they still need the protective shield they used as children? If the person is recapitulating the abusive dynamic in their current relationships, then maybe, “yes.” But I’ve found that more times than not, they are operating under a belief that no longer applies to their environment but is only causing them unnecessary distress.

People who’ve lived in a home with high expectations from their parents can also develop problematic core beliefs. Parents who push kids to achieve need to be careful not to be sending the message, “My love is conditional on what you do.” This can yield a child who believes that he/she must perform or do something really well to be accepted. After all, the most important people in the world to children are their parents. It would make perfect sense that they’d do anything they could do be loved and accepted! A core belief that the child can adopt and be distressing to them throughout their life is, “I am lovable for what I do not who I am.” What a set-up! How can anyone do things well enough constantly to get the validation they need under these circumstances? Adults who suffer anxiety symptoms often struggle with perfectionism, or the need to reach the highest possible bar. Clients I’ve had with this situation complain of feeling like they’re on a “hamster wheel” and that it’s never enough. Often they come to me physically and emotionally exhausted.

Children who grew up with anxious parents almost can’t help internalizing a certain amount of anxiety themselves. We model so much of the behaviors we see from our primary caretakers, learn about how to be in relationship, how to interact with others and the world. Those who had a highly anxious mother are particularly susceptible to having their own anxiety disorders. Infants are more tuned in to their mother’s state of being than we think – they can pick up information from the quality or quantity of touch, attention, energy in the room, etc.

Problematic belief systems developed in childhood can be challenged and the symptoms around them (anxiety) can be decreased and distinguished all together. The way that I’ve found that works for me is to understand the source (family of origin or other significant life events), develop empathy and validation for the adult’s experience at that time, normalize the defenses erected as protective measures in a vulnerable environment, reframe the core beliefs about self and teach cognitive-behavioral skills such as identifying and disrupting irrational thinking styles. A helpful way to conceptualize this is to separate the adult experience from the child’s – and identify the idea that they both reside within the client! I often will ask, “When you experiencing all that reactivity, who’s driving the bus, the adult or the child?” I’ve never heard anyone tell me that their adult rational mind was in charge at that moment. Honoring the child’s experience and normalizing the development of these unhelpful belief systems can also help lead to the resolution of anxiety. If symptoms are significantly impacting the client, medication management can be a good partner to the previously described therapy.n