The Biopsychosocial Model: Causes of Pathological Anxiety

Brindusa Vanta, MD, DHMHS
Medical editor

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What Is Pathological Anxiety?

Pathological anxiety differs from normal anxiety—which is a natural response to stress or a perceived threat—in its intensity, duration, and effect on functioning. Pathological anxiety involves excessive fear and worry that is disproportionate to the situation, persists despite no real dangers or threats, and interferes with daily activities. Key symptoms include restlessness, irritability, muscle tension, issues concentrating, intense and excessive worry, and physical symptoms like heart palpitations, sweating, and shortness of breath.[1],[2],[3] Professional treatment can help manage pathological anxiety, improve functioning, and equip the person with coping skills. >>>

Recognizing Pathological Anxiety


Pathological anxiety differs from typical anxiety in that it causes significant distress, is excessive and extreme, and persists beyond an acute stressor. For example, the criteria used to diagnose a type of pathological anxiety called generalized anxiety disorder include:[3]

  • Excessive worry and anxiety occurring for at least six months
  • Difficulty controlling the worry
  • The anxiety is associated with at least three of these symptoms:
  • Irritability
  • Muscle tension
  • Sleep disturbances
  • Restlessness
  • Easily fatigued
  • Difficulty concentrating

If you are concerned about your anxiety, here are some tips to help you assess your need for help:

  • Monitor your stress and anxiety symptoms on a daily basis.
  • Assess whether your symptoms are significantly affecting your daily life, relationships, and other important areas.
  • Seek professional treatment or therapy if your anxiety symptoms persist or worsen.

What Causes Anxiety?

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So, what causes anxiety 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 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.

Anxiety experts usually explain anxiety disorders using the biopsychosocial model. The biopsychosocial model proposes there are multiple and interrelated causes of pathological anxiety. 

These causes can be roughly categorized into three main groups:

  • Biological causes
  • Psychological causes
  • 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 triggers these vulnerabilities.

Biological Risk Factors

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, sensitive, and easily excitable in the presence of stress.

Psychological Risk Factors

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.

Environmental Influences

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 corrects 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 corrects her daughter's homework. 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 further strengthens her lack of confidence in herself.

Previously, we mentioned anxiety develops from the perceived gap between your 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.

The Social Component of Anxiety

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 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 everyone may not experience. 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 their peers accept, or at least not reject, them. 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.

Treatment Modalities for Pathological Anxiety

There are many evidence-based treatment modalities available for pathological anxiety, including medications and psychotherapies. Here are some of the most common therapies:[4],[5],[6],[7]

  • Cognitive behavioral therapy (CBT): CBT focuses on identifying and challenging negative thought patterns and behaviors associated with anxiety to improve functioning and change behavior.
  • Exposure therapy: Exposure therapy involves gradually exposing a person to feared objects or situations, helping them learn to cope with the anxiety in a safe, structured environment.
  • Acceptance and commitment therapy (ACT): ACT focuses on accepting challenging thoughts and feelings while committing to behaviors that align with the person’s individual values. 
  • Medications: Selective serotonin reuptake inhibitors (SSRIs) like Prozac, Zoloft, and Lexapro and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Effexor and Cymbalta, are commonly used in conjunction with talk therapy to treat pathological anxiety.

As Dr. Brindusa Vanta, MD, says, "Virtual reality exposure therapy (VRET) is an innovative approach for pathological anxiety. It involves immersive experiences in virtual environments to confront triggers, providing a safe method to alleviate anxiety symptoms."

When it comes to treating pathological anxiety, personalized treatment plans are essential in addressing the unique needs and preferences of the patient. Tailoring treatment approaches based on symptom severity, comorbid conditions, cultural background, and treatment history can enhance treatment efficacy and engagement. 

As Dr. Brindusa Vanta, MD, says, "If you experience pathological anxiety, consider mindfulness meditation. Research found that overactivity or dysregulation of the amygdala (a small almond-shaped brain region) leads to increased fear and anxiety symptoms. Mindfulness meditation has been found to reduce amygdala reactivity and improve anxiety."

Long-Term Risks of Untreated Pathological Anxiety

Getting timely and quality anxiety treatment is essential to preventing the risk of long-term consequences, including physical health issues. Anxiety can exacerbate or increase the risk of conditions like:[8],[9],[10]

  • Heart disease, stroke, and hypertension
  • Weakened immune system functioning
  • Irritable bowel syndrome (IBS)
  • Ulcers

Early intervention for pathological anxiety is crucial to prevent the progression of symptoms and reduce the risk of long-term complications. Untreated pathological anxiety can cause chronic illness and significantly affect quality of life and well-being. By addressing symptoms early on, people can learn coping strategies, access appropriate treatment, and improve functioning and mental well-being. Plus, early intervention may help prevent the development of co-occurring disorders, such as panic disorder, major depression disorder, eating disorders, or substance use disorders.[11]


  1. Rosen, J. B., & Schulkin, J. (1998). From normal fear to pathological anxiety. Psychological review, 105(2), 325–350.
  2. Chand SP, Marwaha R. Anxiety. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  4. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive therapy and research, 36(5), 427–440.
  5. American Psychological Association. (2017). What is exposure therapy? Retrieved from
  6. Hasheminasab, M., Babapour Kheiroddin, J., Mahmood Aliloo, M., & Fakhari, A. (2015). Acceptance and Commitment Therapy (ACT) For Generalized Anxiety Disorder. Iranian journal of public health, 44(5), 718–719.
  7. Farach, F. J., Pruitt, L. D., Jun, J. J., Jerud, A. B., Zoellner, L. A., & Roy-Byrne, P. P. (2012). Pharmacological treatment of anxiety disorders: current treatments and future directions. Journal of anxiety disorders, 26(8), 833–843.
  8. Roest, A. M., Martens, E. J., de Jonge, P., & Denollet, J. (2010). Anxiety and risk of incident coronary heart disease: a meta-analysis. Journal of the American College of Cardiology, 56(1), 38–46.
  9. Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2007). Psychological stress and disease. JAMA: Journal of the American Medical Association, 298(14), 1685–1687.
  10. Chang L. (2011). The role of stress on physiologic responses and clinical symptoms in irritable bowel syndrome. Gastroenterology, 140(3), 761–765.
  11. Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F., 3rd (2013). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World psychiatry : official journal of the World Psychiatric Association (WPA), 12(2), 137–148.

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