David Baxter PhD
Late Founder
Like Mother, Like Daughter
by Michelle Roberts
esperanze Magazine,Winter 2010 Issue
The legacy of depression and anxiety disorders carries down through generations of women
Adopted as an infant, Kris didn?t meet her biological mother until she was in her 30s.
When she finally found her, the 43-year-old bartender also found out she has five full biological sisters?and a possible answer as to why she?s suffered from anxiety and depression since childhood.
?Every last one has been diagnosed with severe anxiety and depression,? says Kris, who lives in Carol Stream, Illinois. ?Finding all this out was a shock to me, but it made so much sense.?
It also helps explain why Kris's daughter has been treated for anxiety and suffers from panic attacks.
Children of parents diagnosed with an anxiety disorder are up to seven times more likely to develop an anxiety disorder themselves. Children of depressed parents, meanwhile, are two to three times as likely to develop depression, according to the National Institute of Mental Health (NIMH).
While studies generally focus on either depression or anxiety, in individuals the conditions are often intertwined.
?Parents in general, and mothers in particular, often have both anxiety and depression,? says Golda Ginsburg, PhD, a child psychologist at Johns Hopkins Children?s Center and associate professor at the Johns Hopkins School of Medicine. ?Many people believe that anxiety predates depression, and longitudinal studies have found that untreated anxiety can predict depression later. So obviously, when we talk about anxiety, we?re also often talking about depression.?
Statistics show that women experience depression and anxiety at twice the rate men do. Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent; approximately 40 million American adults, or about 18.1 percent, have an anxiety disorder.
In Canada, anxiety disorders are the most common mental health problem as well. The Statistics Canada Community Health Survey of Mental Health and Well-being found that 1,180,00 Canadians, or 4.7 percent, have an anxiety disorder (compared to 1,120,000 with major depression), and close to two-thirds are women.
?I would say that 90 percent of the inquiries I receive about anxiety disorders come from women,? says Genevieve Charette, executive director of the Anxiety Disorders Association of Canada. ?It?s usually the women who will make the call for themselves or their children.?
A mix of factors
Because of the heightened risks for children?up to 65 percent of children living with an anxious parent meet criteria for an anxiety disorder, according to Ginsburg?researchers are paying special attention to the phenomenon of how anxiety disorders transfer between mothers and daughters.
?We often think of mothers and daughters being at greater risk for transmission and more vulnerable for lots of reasons we don?t completely understand,? Ginsburg says. ?Those reasons may be biological, hormonal and even social.?
In Kris case, the heredity explanation seems to be the most obvious. She and her siblings were all given up for adoption as infants and raised by different families, so the only thing connecting them is their biology.
Still, environmental factors can?t be dismissed. A study of adopted children, published in the American Journal of Psychiatry in September 2008, found a significantly higher risk of adolescent depression if the adoptive mother had major depression. Depression in the adoptive father, however, was not associated with increased risk of adolescent depression.
?There are many different contributors to the links between parent and offspring anxiety, and they play out differently in each pair,? says Kimberly Wilson, PhD, a therapist in Oakland, California, who led a landmark 2004 study at Stanford University on the transmission of anxiety disorders between mothers and daughters.
Wilson says her research shows that transmission does occur, but that mothers shouldn?t blame themselves for something that is largely out of their control.
?Mothers are doing the best they can,? Wilson says, ?and there are many factors outside their control that contribute to whether a child will struggle with anxiety or depression, including their own life experiences, peers, a long history of genes, and even the random firing of neurotransmitters.?
Panic disorder, an anxiety disorder marked by repeated and unexpected attacks that include difficulty breathing, pounding heart or chest pain, dizziness, trembling or shaking and sweating, affects up to 5 percent of Americans or at least 2.4 million people. Statistics Canada's mental health survey found that 480,000 Canadians, or 1.5 percent, have panic disorder, and twice as many women as men are affected.
Panic disorder often runs in families. While researchers don?t know its physiological or psychological sources, they do know daughters are more likely to inherit the disorder.
?We studied daughters of women with panic disorder because they?re a high-risk group,? says Wilson. ?Females develop panic disorder twice as often as males, and panic disorder is highly familial. If you have a family member (with it)?including a mother, of course ?your likelihood of developing a panic disorder is as high as 41 percent. This figure contrasts with 8 percent for folks without such family members.?
Although researchers don?t yet know why women are more likely to develop panic disorder than men, many speculate that it is linked to cultural factors. In American culture, Wilson says, women are often taught to avoid confrontation. They are more likely to be anxious than men, have less self-esteem and suffer depression more often. All these factors can contribute to panic disorder.
An article in the January 2009 issue of Psychiatric Times evaluated recent research into the physiology of panic disorders and suggested that premenstrual hormonal fluctuations may also partially explain the increased incidence of panic disorder in women.
Wilson and her colleagues at Stanford focused on learned behaviors that might explain the mother-daughter transference. They explored one possible mechanism called ?attentional bias to threat,? or the tendency to notice threatening information in the environment to the exclusion of benign information. In other words, many anxious moms were more likely to zero in on an ambulance than a family-friendly minivan on the street.
?The trouble with this bias is that it sets a person up for attending to a disproportionate amount of danger in the world,? Wilson says, ?which makes it more likely that person will see the world as a dangerous place ? more dangerous than it really is. This is true of anxious folks in general, not just those with panic disorder.?
The researchers speculated that mothers with panic disorder would be more likely to transmit a tendency to notice potentially dangerous things in the environment as compared to mothers with no history of psychiatric problems.
?We?re right in the middle of data analysis,? Wilson says, ?so I can?t give the full story of our results yet. The early peeks at the data suggest, though, that although mothers with panic disorder are more likely to attend to threatening stimuli in the environment, in our sample, their daughters are not, unless they, too, struggle with anxiety already.?
Whatever the cause, Christine, 55, of Goshen, Indiana, says she is a living example of this complex mix of factors.
?My mom was always a worrier,? says Christine, ?and so am I. And I think, for me, it?s both biological and environmental.?
Christine says she grew up in the shadow of her mother?s anxiety and depression. So at least some of her own struggles, she says, ?come from a learned place.?
?We had no words for this in my growing-up years,? she says. ?Mom was a very well-liked person in the public arena, but she struggled with a lot of stuff that came out at home. She?d cry a lot. She?d hole up in her room. She and my dad would have long conversations in the bedroom and she?d come out tear-stained, or not come out for a couple of days. As a child, you couldn?t do anything right.?
Christine, who recently graduated from seminary school, says that she has been in intensive therapy for more than a dozen years to deal with her own depression and anxiety.
?My mother had this, and her mother had it, and I have it, too.?
Snipping the thread
Recent studies suggest that the transmission of depression and anxiety can be interrupted. One 2008 study, published in the American Journal of Psychiatry, found that children?s psychiatric symptoms decreased after their mothers were treated for depression.
Ginsburg and colleagues at Johns Hopkins Children?s Center conducted a study on preventing anxiety disorders in children of anxious parents. They found that a family-based program of cognitive behavioral therapy reduced anxiety symptoms and the risk of developing an anxiety disorder among participating children, who were between the ages of 7 and 12. Results were published in the June 2009 issue of the Journal of Consulting and Clinical Psychology.
Half the families in the study were assigned to a waiting list, and the other half attended weekly sessions designed to help parents identify and change behaviors believed to contribute to anxiety in the children, while also teaching children coping skills. Researchers saw a 40 percent drop in symptoms among children in the therapy group in the year following the intervention, and none developed an anxiety disorder. Children on the waiting list had no reduction in symptoms and 30 percent developed an anxiety disorder.
The study did not focus specifically on females, but the findings could certainly help mothers and daughters, Ginsburg says. She strongly urges all parents with anxiety disorders to be proactive to protect their children.
?Most of the parents I work with say, ?If I only could have gotten help when I was younger, I could have gotten back so many years of my life.? They don?t want their kids to experience the same thing,? she says.
Kris says her adoptive mother expressed similar regrets upon learning of the strong thread of anxiety and depression running through Kris?s biological family. Kris remembers having ?violent tempers? when she was young, as well as feeling very depressed and having severe insomnia.
?I was more sensitive and emotional than the average person,? she says. ?It just escalated into me being defiant and shutting down.? My (adoptive) mother didn?t know what to do, so she punished me.?
Now, Kris says, she is committed to helping her own daughter.
?It?s important to understand that if it does run in the family, or if you?re aware of any link, there?s a possibility of it being transferred and it shouldn?t be taken lightly,? she adds. ?My adoptive mom says that had she known what she knows now, she would have gotten me some early treatment and we could have dealt with it in a better manner. Well, that?s what I?m trying to do.?
It?s part of who we are
Wilson devotes her practice to treating people with anxiety disorders and depression, many of them mothers and daughters.
?I use evidence-based treatments in my practice,? Wilson says. ?My primary approach is cognitive-behavioral, which has the most data to support its effectiveness.?
Within that paradigm, Wilson teaches clients to attend objectively to their thoughts, and to become ?curious observers? of those thoughts.
?This approach to thoughts is quite a contrast to buying into the thoughts 100 percent and acting automatically as if all thoughts are true,? she says. ?It provides distance and loosens attachment to thoughts that are often overly influenced by bias.?
Wilson also helps clients practice mindfulness, which is a way to pay attention to the present moment without making judgments.
?Most anxious folks are spending too much time in the future, which doesn?t even exist yet,? she says.
Wilson encourages people to confront their fears in structured ways. ?We learn by watching ourselves, so if we see ourselves avoid, we learn there must be something to fear there. Acting the opposite, exposure to the things we fear, teaches an important lesson: that danger is less than imagined, that all is OK.?
Chynna, 39, of Edmonton, Alberta, uses many of the techniques Wilson teaches. She traces her own anxiety back to childhood?and to her own mother, who also suffered from severe anxiety and depression.
?My mother suffered with anxiety but she never got it treated,? Chynna says, ?and it made life very, very difficult. My sister and I both suffer from anxiety and depression. We still can?t figure out what we absorbed from our mother, or if we were born this way. We think it?s a combination.?
Chynna says her own growing-up years were marked by sadness, feeling like she had to be responsible for everything, ?an irritating perfectionism and a never-ending feeling of being overwhelmed.?
Chynna, the mother of four young children, worries that the condition will transfer. She already sees signs of high anxiety in her oldest daughter.
?Going into situations she doesn?t understand, transitions are very difficult for her,? Chynna says. ?So my ability to stay calm and deal with my own anxiety greatly impacts her because she sucks up everyone?s feelings and anxiety.?
Chynna says she has restructured her household to account for anxiety. Things are kept orderly and organized. Schedules are important. New things are tried, but only after lots of discussion and planning. Keeping things calm is a major priority.
?I have acknowledged that my mother had this, I do and now my daughter does,? Chynna says, ?I want to mitigate it for my children, especially my girls. There?s positive ways to deal with this. There?s no shame in it. It?s part of who we are.?
Michelle Roberts is a freelance writer based in St. Louis, Missouri. A recipient of a 2004-05 Rosalynn Carter Fellowship for Mental Health Journalism, she specializes in mental health and family issues.
Click here to buy one or more copies of the Winter 2010 issue.
Click here to subscribe to esperanza.
by Michelle Roberts
esperanze Magazine,Winter 2010 Issue
The legacy of depression and anxiety disorders carries down through generations of women
Adopted as an infant, Kris didn?t meet her biological mother until she was in her 30s.
When she finally found her, the 43-year-old bartender also found out she has five full biological sisters?and a possible answer as to why she?s suffered from anxiety and depression since childhood.
?Every last one has been diagnosed with severe anxiety and depression,? says Kris, who lives in Carol Stream, Illinois. ?Finding all this out was a shock to me, but it made so much sense.?
It also helps explain why Kris's daughter has been treated for anxiety and suffers from panic attacks.
Children of parents diagnosed with an anxiety disorder are up to seven times more likely to develop an anxiety disorder themselves. Children of depressed parents, meanwhile, are two to three times as likely to develop depression, according to the National Institute of Mental Health (NIMH).
While studies generally focus on either depression or anxiety, in individuals the conditions are often intertwined.
?Parents in general, and mothers in particular, often have both anxiety and depression,? says Golda Ginsburg, PhD, a child psychologist at Johns Hopkins Children?s Center and associate professor at the Johns Hopkins School of Medicine. ?Many people believe that anxiety predates depression, and longitudinal studies have found that untreated anxiety can predict depression later. So obviously, when we talk about anxiety, we?re also often talking about depression.?
Statistics show that women experience depression and anxiety at twice the rate men do. Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent; approximately 40 million American adults, or about 18.1 percent, have an anxiety disorder.
In Canada, anxiety disorders are the most common mental health problem as well. The Statistics Canada Community Health Survey of Mental Health and Well-being found that 1,180,00 Canadians, or 4.7 percent, have an anxiety disorder (compared to 1,120,000 with major depression), and close to two-thirds are women.
?I would say that 90 percent of the inquiries I receive about anxiety disorders come from women,? says Genevieve Charette, executive director of the Anxiety Disorders Association of Canada. ?It?s usually the women who will make the call for themselves or their children.?
A mix of factors
Because of the heightened risks for children?up to 65 percent of children living with an anxious parent meet criteria for an anxiety disorder, according to Ginsburg?researchers are paying special attention to the phenomenon of how anxiety disorders transfer between mothers and daughters.
?We often think of mothers and daughters being at greater risk for transmission and more vulnerable for lots of reasons we don?t completely understand,? Ginsburg says. ?Those reasons may be biological, hormonal and even social.?
In Kris case, the heredity explanation seems to be the most obvious. She and her siblings were all given up for adoption as infants and raised by different families, so the only thing connecting them is their biology.
Still, environmental factors can?t be dismissed. A study of adopted children, published in the American Journal of Psychiatry in September 2008, found a significantly higher risk of adolescent depression if the adoptive mother had major depression. Depression in the adoptive father, however, was not associated with increased risk of adolescent depression.
?There are many different contributors to the links between parent and offspring anxiety, and they play out differently in each pair,? says Kimberly Wilson, PhD, a therapist in Oakland, California, who led a landmark 2004 study at Stanford University on the transmission of anxiety disorders between mothers and daughters.
Wilson says her research shows that transmission does occur, but that mothers shouldn?t blame themselves for something that is largely out of their control.
?Mothers are doing the best they can,? Wilson says, ?and there are many factors outside their control that contribute to whether a child will struggle with anxiety or depression, including their own life experiences, peers, a long history of genes, and even the random firing of neurotransmitters.?
Panic disorder, an anxiety disorder marked by repeated and unexpected attacks that include difficulty breathing, pounding heart or chest pain, dizziness, trembling or shaking and sweating, affects up to 5 percent of Americans or at least 2.4 million people. Statistics Canada's mental health survey found that 480,000 Canadians, or 1.5 percent, have panic disorder, and twice as many women as men are affected.
Panic disorder often runs in families. While researchers don?t know its physiological or psychological sources, they do know daughters are more likely to inherit the disorder.
?We studied daughters of women with panic disorder because they?re a high-risk group,? says Wilson. ?Females develop panic disorder twice as often as males, and panic disorder is highly familial. If you have a family member (with it)?including a mother, of course ?your likelihood of developing a panic disorder is as high as 41 percent. This figure contrasts with 8 percent for folks without such family members.?
Although researchers don?t yet know why women are more likely to develop panic disorder than men, many speculate that it is linked to cultural factors. In American culture, Wilson says, women are often taught to avoid confrontation. They are more likely to be anxious than men, have less self-esteem and suffer depression more often. All these factors can contribute to panic disorder.
An article in the January 2009 issue of Psychiatric Times evaluated recent research into the physiology of panic disorders and suggested that premenstrual hormonal fluctuations may also partially explain the increased incidence of panic disorder in women.
Wilson and her colleagues at Stanford focused on learned behaviors that might explain the mother-daughter transference. They explored one possible mechanism called ?attentional bias to threat,? or the tendency to notice threatening information in the environment to the exclusion of benign information. In other words, many anxious moms were more likely to zero in on an ambulance than a family-friendly minivan on the street.
?The trouble with this bias is that it sets a person up for attending to a disproportionate amount of danger in the world,? Wilson says, ?which makes it more likely that person will see the world as a dangerous place ? more dangerous than it really is. This is true of anxious folks in general, not just those with panic disorder.?
The researchers speculated that mothers with panic disorder would be more likely to transmit a tendency to notice potentially dangerous things in the environment as compared to mothers with no history of psychiatric problems.
?We?re right in the middle of data analysis,? Wilson says, ?so I can?t give the full story of our results yet. The early peeks at the data suggest, though, that although mothers with panic disorder are more likely to attend to threatening stimuli in the environment, in our sample, their daughters are not, unless they, too, struggle with anxiety already.?
Whatever the cause, Christine, 55, of Goshen, Indiana, says she is a living example of this complex mix of factors.
?My mom was always a worrier,? says Christine, ?and so am I. And I think, for me, it?s both biological and environmental.?
Christine says she grew up in the shadow of her mother?s anxiety and depression. So at least some of her own struggles, she says, ?come from a learned place.?
?We had no words for this in my growing-up years,? she says. ?Mom was a very well-liked person in the public arena, but she struggled with a lot of stuff that came out at home. She?d cry a lot. She?d hole up in her room. She and my dad would have long conversations in the bedroom and she?d come out tear-stained, or not come out for a couple of days. As a child, you couldn?t do anything right.?
Christine, who recently graduated from seminary school, says that she has been in intensive therapy for more than a dozen years to deal with her own depression and anxiety.
?My mother had this, and her mother had it, and I have it, too.?
Snipping the thread
Recent studies suggest that the transmission of depression and anxiety can be interrupted. One 2008 study, published in the American Journal of Psychiatry, found that children?s psychiatric symptoms decreased after their mothers were treated for depression.
Ginsburg and colleagues at Johns Hopkins Children?s Center conducted a study on preventing anxiety disorders in children of anxious parents. They found that a family-based program of cognitive behavioral therapy reduced anxiety symptoms and the risk of developing an anxiety disorder among participating children, who were between the ages of 7 and 12. Results were published in the June 2009 issue of the Journal of Consulting and Clinical Psychology.
Half the families in the study were assigned to a waiting list, and the other half attended weekly sessions designed to help parents identify and change behaviors believed to contribute to anxiety in the children, while also teaching children coping skills. Researchers saw a 40 percent drop in symptoms among children in the therapy group in the year following the intervention, and none developed an anxiety disorder. Children on the waiting list had no reduction in symptoms and 30 percent developed an anxiety disorder.
The study did not focus specifically on females, but the findings could certainly help mothers and daughters, Ginsburg says. She strongly urges all parents with anxiety disorders to be proactive to protect their children.
?Most of the parents I work with say, ?If I only could have gotten help when I was younger, I could have gotten back so many years of my life.? They don?t want their kids to experience the same thing,? she says.
Kris says her adoptive mother expressed similar regrets upon learning of the strong thread of anxiety and depression running through Kris?s biological family. Kris remembers having ?violent tempers? when she was young, as well as feeling very depressed and having severe insomnia.
?I was more sensitive and emotional than the average person,? she says. ?It just escalated into me being defiant and shutting down.? My (adoptive) mother didn?t know what to do, so she punished me.?
Now, Kris says, she is committed to helping her own daughter.
?It?s important to understand that if it does run in the family, or if you?re aware of any link, there?s a possibility of it being transferred and it shouldn?t be taken lightly,? she adds. ?My adoptive mom says that had she known what she knows now, she would have gotten me some early treatment and we could have dealt with it in a better manner. Well, that?s what I?m trying to do.?
It?s part of who we are
Wilson devotes her practice to treating people with anxiety disorders and depression, many of them mothers and daughters.
?I use evidence-based treatments in my practice,? Wilson says. ?My primary approach is cognitive-behavioral, which has the most data to support its effectiveness.?
Within that paradigm, Wilson teaches clients to attend objectively to their thoughts, and to become ?curious observers? of those thoughts.
?This approach to thoughts is quite a contrast to buying into the thoughts 100 percent and acting automatically as if all thoughts are true,? she says. ?It provides distance and loosens attachment to thoughts that are often overly influenced by bias.?
Wilson also helps clients practice mindfulness, which is a way to pay attention to the present moment without making judgments.
?Most anxious folks are spending too much time in the future, which doesn?t even exist yet,? she says.
Wilson encourages people to confront their fears in structured ways. ?We learn by watching ourselves, so if we see ourselves avoid, we learn there must be something to fear there. Acting the opposite, exposure to the things we fear, teaches an important lesson: that danger is less than imagined, that all is OK.?
Chynna, 39, of Edmonton, Alberta, uses many of the techniques Wilson teaches. She traces her own anxiety back to childhood?and to her own mother, who also suffered from severe anxiety and depression.
?My mother suffered with anxiety but she never got it treated,? Chynna says, ?and it made life very, very difficult. My sister and I both suffer from anxiety and depression. We still can?t figure out what we absorbed from our mother, or if we were born this way. We think it?s a combination.?
Chynna says her own growing-up years were marked by sadness, feeling like she had to be responsible for everything, ?an irritating perfectionism and a never-ending feeling of being overwhelmed.?
Chynna, the mother of four young children, worries that the condition will transfer. She already sees signs of high anxiety in her oldest daughter.
?Going into situations she doesn?t understand, transitions are very difficult for her,? Chynna says. ?So my ability to stay calm and deal with my own anxiety greatly impacts her because she sucks up everyone?s feelings and anxiety.?
Chynna says she has restructured her household to account for anxiety. Things are kept orderly and organized. Schedules are important. New things are tried, but only after lots of discussion and planning. Keeping things calm is a major priority.
?I have acknowledged that my mother had this, I do and now my daughter does,? Chynna says, ?I want to mitigate it for my children, especially my girls. There?s positive ways to deal with this. There?s no shame in it. It?s part of who we are.?
Michelle Roberts is a freelance writer based in St. Louis, Missouri. A recipient of a 2004-05 Rosalynn Carter Fellowship for Mental Health Journalism, she specializes in mental health and family issues.
Click here to buy one or more copies of the Winter 2010 issue.
Click here to subscribe to esperanza.
