Is Anxiety Hereditary?
Barbara Heffernan • April 29, 2025
Do we, or can we, inherit anxiety?
Sometimes is seems that anxiety runs in families, but not everybody has it.
Other times, someone might have anxiety when no one else in their family does.
In this blog, I'll discuss the current state of research regarding whether anxiety is genetic and inherited. I will also address whether this knowledge matters, and if it does, why it matters.
Other times, someone might have anxiety when no one else in their family does.
In this blog, I'll discuss the current state of research regarding whether anxiety is genetic and inherited. I will also address whether this knowledge matters, and if it does, why it matters.
The role genetics plays varies by specific anxiety disorder. Toward the end of this article, I will provide a summary of current research findings for generalized anxiety disorder, panic disorder, specific phobias, agoraphobia, and social anxiety disorder (the five anxiety disorders that primarily apply to adults in the DSM-5-TR). I will also include obsessive-compulsive disorder because, while it's no longer classified as an anxiety disorder, many readers ask about OCD, and there is significant overlap.
Before examining specific disorders, it's important to understand the research methodology and findings in general terms. I'll break down concepts like "familial aggregation" and "concordance rates in twin studies" to provide an accessible and understandable overview.
The Science Behind Anxiety and Genetics
Anxiety is a common human experience. However, it becomes a disorder when it is excessive, interferes with daily life, or impacts overall functioning or happiness.
Anxiety disorders are prevalent—research shows that up to a third of the population will experience an anxiety disorder at some point in their life.
Family history and genetics are definite risk factors, but they are not determinants. There is no gene for any anxiety disorder that directly causes the condition.
Overall, family conditioning, family history, and genetics can be viewed as influences that increase the likelihood of developing a disorder, but they are not determinative.
Anxiety disorders are prevalent—research shows that up to a third of the population will experience an anxiety disorder at some point in their life.
Family history and genetics are definite risk factors, but they are not determinants. There is no gene for any anxiety disorder that directly causes the condition.
Overall, family conditioning, family history, and genetics can be viewed as influences that increase the likelihood of developing a disorder, but they are not determinative.
How Researchers Decide If There Is a Genetic Link
When anxiety disorders cluster within families, researchers call it "familial aggregation."
Research indicates that having anxiety in a first-degree relative can increase your risk of developing an anxiety disorder anywhere between three and 17 times compared to someone without that family history.
However, families influence us in many ways. We learn from our parents' behavior, we mimic others' coping mechanisms, and we adopt patterns of behavior from those around us. These behaviors can be passed down through generations without necessarily indicating a genetic link.
To determine whether anxiety truly has a genetic component, researchers often turn to twin studies. A common method involves comparing incidence rates between identical twins (who share exactly the same genetic structure) with fraternal twins (who are as genetically different as any two siblings). Most siblings share approximately 50% of the same genes, while identical twins share 100%.
For clarity when reading research, it's helpful to know that identical twins are called "monozygotic," and fraternal twins are called "dizygotic"—terminology that can make research studies confusing for non-specialists.
In research literature, you might encounter sentences like this regarding obsessive-compulsive disorder in twins:
"There is a concordance rate of 0.57 for monozygotic versus 0.22 for dizygotic twins."
To break this down for you, this sentence means that if you're an identical twin and your twin has OCD, you have a 57% chance of having that disorder, whereas if you're a fraternal twin and your twin has OCD, you have a 22% chance of having it.
"There is a concordance rate of 0.57 for monozygotic versus 0.22 for dizygotic twins."
To break this down for you, this sentence means that if you're an identical twin and your twin has OCD, you have a 57% chance of having that disorder, whereas if you're a fraternal twin and your twin has OCD, you have a 22% chance of having it.
The concordance rate represents the likelihood that one twin will have the anxiety disorder if the other twin has it.
Since OCD appears approximately twice as common in identical twins, this suggests a significant genetic contribution.
However, it's important to note that even in identical twins, there remains a 43% chance that the other twin won't develop OCD.
The Role of Epigenetics
To summarize, most anxiety disorders appear to have both genetic and familial links, yet other factors play a very important role.
These additional factors include the environment you grew up in, the environment you are in now, specific life experiences, and epigenetics.
Epigenetics refers to environmental factors or life experiences that trigger gene expression. Epigenetic factors play a crucial role in determining whether particular genes become activated. This principle applies across many conditions, not just mental health disorders. The developing field of epigenetics highlights an important truth: our genes do not determine our destiny.
Does It Matter If Anxiety Is Inherited?
This brings us to the question:
Does it matter whether anxiety was inherited through family behavior or genetics?
I believe this information can be a double-edged sword.
In my work as a psychotherapist, I've observed that when individuals focus on their belief that their disorder is genetic, they often believe nothing can be done about it. They adopt the mindset: "I inherited this; I will always have it."
If this belief prevents someone from seeking help, or doing the work needed to recover, then awareness of genetic components may not be beneficial... because
regardless of the cause, anxiety is treatable. Many people can achieve full recovery, and most others can experience significant improvement.
In terms of treatment approaches, the specific trigger or genetic predisposition matters less than commitment to recovery. While you might face additional challenges with family patterns of anxiety or intergenerational trauma, recovery remains possible. Whether the source was trauma or generational stress, effective tools and techniques exist.
On the positive side, understanding the inherited aspects of anxiety can help people avoid feeling defective. It reduces self-blame for having an anxiety disorder. When we understand anxiety in the context of its prevalence in the general population and its presence in family histories, this understanding fosters self-compassion. And self-compassion, in turn, aids healing.
An additional benefit of knowing about familial risk is the potential for earlier treatment seeking. Earlier intervention correlates with better outcomes.
An additional benefit of knowing about familial risk is the potential for earlier treatment seeking. Earlier intervention correlates with better outcomes.
Specific Anxiety Disorders and Their Genetic Components
Here's a summary of research findings for specific anxiety disorders:
**Generalized Anxiety Disorder: Research indicates approximately a six-fold increase in the likelihood of developing generalized anxiety disorder if you have a first-degree relative with the condition. Twin studies suggest genetics contribute about 30% to GAD development. Researchers exploring specific genes associated with anxiety disorders have identified a potential link to a gene called RBFOX1, though this research remains preliminary and inconclusive.
**Panic Disorder: Research shows a wide range in family aggregation odds ratios. If a family member has panic disorder, you are between three and 17 times more likely to develop it yourself. This wide range limits specific predictive value, but clearly indicates increased risk.
Some genetic studies have identified a possible link to the NPSR1 gene for panic disorder. However, anxiety disorders are generally considered polygenic, meaning they involve multiple genetic regions.
**Specific Phobias: Research on specific phobias varies considerably, with family influence accounting for approximately 30% to 60% of risk. This variability likely stems from the diversity of specific phobia types and triggers.
**Social Anxiety Disorder: Twin studies show an inheritability rate of around 27% due to genetic components. A family history of any
anxiety disorder increases the likelihood of developing social anxiety.
**Agoraphobia: Research indicates a person is 2-4x more likely to have agoraphobia if a close relative has it (as compared to someone without agoraphobia in the family). However, there is a high "co-morbidity" rate between agoraphobia and panic disorder: meaning that most people with agoraphobia also have panic disorder. There is research that shows that agoraphobia without panic disorder does not aggregate in families. This could indicate that the genetic link is actually that of panic disorder.
**Obsessive-Compulsive Disorder: As discussed previously, twin studies suggest a significant genetic component in OCD. The likelihood of developing OCD if a family member has the condition increases dramatically if that person developed OCD in childhood. Childhood onset of any anxiety disorder increases the chance of genetic transmission, but this effect is particularly pronounced with OCD.
Key Takeaways
* Family history increases risk of an anxiety disorder by 3-17 times but it doesn't guarantee anxiety.
* Twin studies demonstrate a genetic component to the inheritability of anxiety disorder. However, even with identical twins this is not determinative.
* Epigenetics matters—environment activates genetic predispositions.
* No gene has been found to determine any anxiety disorder
* Your genes are not your destiny— recovery is possible!
* Many people achieve complete relief from anxiety symptoms and most others experience significant improvement with treatment, whether there is a genetic component or not.
* Neuroplasticity allows your brain to create new, healthier patterns.
* Early treatment leads to better outcomes.
If you haven't yet viewed my free webinar, "Rewire Your Brain for Joy and Confidence," I encourage you to explore it. I discuss how our brains become wired when we repeatedly connect thoughts and behaviors with specific feelings. This contributes to anxiety, negative self-talk and destructive thought patterns. While these patterns often develop early in life, neuroplasticity allows us to change our brain wiring. We can alter which brain regions activate and which neurochemicals are produced. By changing behaviors, we can transform our environments, and even deeply ingrained patterns can be rewired.
I encourage you to watch the webinar and seek help if you're struggling with anxiety — effective treatments exist.
This article covers more technical material than my usual content, so I am interested in your feedback. My next video and article with address "Why do I have anxiety?"—a common question I receive. Many wonder why they experience anxiety while their siblings don't, whether it's genetic or behavioral. That forthcoming article will explore the various causes of anxiety beyond heretability.
How has understanding the genetic components of anxiety affected your perspective on your own experience? I'd appreciate hearing your thoughts in the comments below.
Blog Author: Barbara Heffernan, LCSW, MBA. Barbara is a licensed psychotherapist and specialist in anxiety, trauma, and healthy boundaries. She had a private practice in Connecticut for twenty years before starting her popular YouTube channel designed to help people around the world live a more joyful life. Barbara has a BA from Yale University, an MBA from Columbia University and an MSW from SCSU. More info on Barbara can be found on her bio page.
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You can probably recall a time when you were with someone who was intensely anxious—and within minutes, you began to feel anxious yourself. Perhaps your heart rate increased. Your breathing became shallow. The knot in your stomach tightened. Or maybe you remember the opposite: a time when you were with someone who was truly grounded and calm, and their presence actually calmed you down. Your shoulders dropped. Your breathing deepened. The tension you had been carrying began to dissipate. This is not your imagination. This is emotional contagion, and it is scientifically proven. Understanding how your own emotional regulation—or lack thereof—impacts other people, and how other people's emotional states impact you, is essential for healthy relationships. Learning emotional regulation tools can improve your relationships significantly. Learning how to lower your susceptibility to emotional contagion can help as well. In this article, I will explain what emotional contagion is, how it impacts relationships, and provide five specific strategies for improving regulation in your own relationships. What Is Emotional Contagion? Emotions are contagious. Extensive research—both behavioral research and neuroscience—shows that we pick up the emotions of the people around us. The closer our relationship with them and the more invested we are in that relationship, the more this phenomenon occurs. This may not always feel accurate because we also tend to balance each other out. If someone is very upset, we might suppress our own emotions in response. But as I will explain, that suppression is actually part of the same dynamic. Three Pathways to Emotional Contagion There are three pathways that lead to emotional contagion: Pathway 1: Automatic Mimicry Unconsciously, when we see facial expressions in another person, we mimic them. If someone smiles, we tend to smile immediately. If someone frowns, we might make the same expression. This happens not just with facial expressions but also with voice, tone and body posture. Pathway 2: Autonomic Mimicry This involves our autonomic physiological system which works in synchrony with other people. Our heart rate, our breathing rhythm, and even our pupil dilation tend to mimic each other. Our nervous systems influence each other constantly. Pathway 3: Affective Convergence This is the convergence of feelings. When our facial expressions and body posture mimic another person's, and our physiological system aligns with theirs, we develop the same affective feelings. We end up experiencing a version of that emotion ourselves. The Suppression Trap: Why "Staying Calm" Can Make Things Worse If someone is extremely upset, you might calm way down. If this happens almost automatically, you are probably suppressing your emotions rather than regulating them. Extensive research shows that when one person suppresses their emotions, it actually makes the other person more anxious. And the person who is suppressing—while they might appear calm externally - is experiencing all the physiological signs and symptoms of anxiety or a heightened emotional state. Even when we are trying to be the balance in the room, we might actually be escalating the emotions present. This is particularly true for those who grew up parentified. Adults who were parentified as children often feel their emotional regulation is better than anyone else's in their families. While that might be true to some extent, without substantial self-awareness and genuine emotional regulation tools, you are likely using emotional suppression, not regulation. Where Emotional Regulation Patterns Come From The means by which you emotionally regulate—and whether you are highly regulated or highly dysregulated—is largely due to how you were raised. I am not saying this to assign blame, nor do I want you to spiral into worry about what you may have done to your own children. These are intergenerational patterns, and all we can do is work with the present. However, it can help to recognize that if you feel your own emotional regulation is lacking, you probably learned from dysregulated caregivers. If you have a partner who is very dysregulated, the same is likely true for them. This understanding allows us to remove blame and accusation from the discussion. We can approach this with compassion, recognizing that these are skills that should perhaps be taught in school or more seriously in our society—but they are not. The good news is that you can learn them now. Five Practical Tools to Improve Emotional Regulation in Your Relationships It truly is possible to improve your own emotional regulation and have a postiive impact on your relationships. These tools are helpful even for the partner that feels they are the one who is more emotionally regulated. And as a heads up, Tools 1 and 5 require substantial work - but gradual improvement is helpful! Tools 2, 3, and 4 are easier to implement immediately. Tool 1: Develop Your Emotional Boundaries Because emotional contagion is so strong—particularly if you grew up in a caretaker role in your family—it is important to begin recognizing when the emotions you are feeling are the ones you are absorbing from someone else. Begin to visualize a see-through bubble around you which represents you and your emotional boundary. Begin to think of your emotions as existing within that bubble. And picture another bubble around the other person - give it a light, see-through color. Picture that all their emotions are within their bubble. Differentiate between what you are feeling and what they are feeling. Bring in your observer brain to look at what you are feeling. For example... "Wait a second. I am feeling anxious because my partner is anxious about their interview tomorrow. What is my anxiety about?" You can begin to see whether your anxiety is about getting them to calm down so they can perform well in their interview. Perhaps you don't want them to be disappointed, or you have a vested interest in them getting a job. Once you understand why you are feeling anxious, you can apply tools to reduce your own anxiety, rather than focus on theirs. Because if we get anxious about making sure someone else is not anxious, it simply escalates the anxiety in the room. Part of developing emotional boundaries is understanding that other people's emotions are not ours to solve. We can be empathetic without feeling responsible for calming the other person down or changing their emotional state. Your observer brain can help you think through, "I do not have to convince them. I can recognize the impact their emotional state has on me, but I do not have to spiral into desperately trying to fix something I cannot fix." Tool 2: Use Your Breathing Deliberately If you learn diaphragmatic breathing and use it during difficult moments in relationships, you can keep your physiology within a tolerable range. In EMDR therapy, there is a concept of keeping your emotions within a "window of tolerance." They can still fluctuate, but you remain relatively regulated throughout. Diaphragmatic breathing is a powerful way to help yourself do that. When you breathe in a calm, regular manner, it is actually helpful to the other person as well. Your regulated physiology can support theirs. Tool 3: Establish a Guideline for Taking Breaks Put in place for yourself a boundary about taking a break from a conversation if you become too emotionally dysregulated. What typically happens in couple relationships (and I saw this extensively during 20 years of couples counseling) is that one person is visibly out of control upset, and the other says, "We need to take a break until you calm down" (and there's usually a finger point that goes along with the "you"). Generally, this escalates the emotions in the room. In actuality, even if you are the one who appears less upset externally, you are probably very physiologically activated internally. There is a marriage and family therapist and researcher who has a rule: if your pulse rate is 10% above its normal resting rate ), you need to take a break. ( John Gottman, PhD, Seven Principles for Making Marriage Work ) The problem with telling the other person they need a break to calm down is that it will make things worse. It feels like criticism and attack. It makes someone defensive. It increases their fight-flight-freeze response. Instead, say: "I am having a hard time regulating myself in this moment. Can we take a 10-minute break? I will be right back. I just need 10 minutes to do some slow breathing. We can set our alarm." You must put a time frame on it. Take a five-minute break, a 10-minute break, or if you are extremely dysregulated, revisit the conversation in the morning. Without a time frame, the other person will feel abandoned, which escalates their emotional dysregulation. You may also be feeding into your flight mode—your reactive pattern of running away from conflict. Set the boundary for yourself, not for the other person: "If I get too upset, I will take a mini timeout to calm myself down." I recognize this does not work in every situation. You cannot simply walk away from a young child. But you can incorporate this thinking to develop creative strategies of your own. Tool 4: Validate Before You Fix or Problem-Solve One of the most regulating things you can do for someone else is help them feel truly heard. Acknowledging their emotional experience before moving to "let's fix this and problem-solve" will de-escalate their emotional response and prevent the conversation from escalating out of control. I know I said you are not in charge of their emotional regulation—and you are not. However, knowing strategies that benefit the relationship benefits you. These are basic relational tools. If you have a partner who has difficulty validating your emotions, and you are emotionally regulated, you can say: "I am very upset about this, but I do not want to jump into problem-solving. I simply want to feel heard." There is an element where we sometimes have to help train people how to be in relationship with us. If you are in couples counseling with a therapist facilitating this, excellent. But if you are not, sometimes it helps to explain these concepts to your partner. Let them know what will help you calm down when you are upset. You might have to remind them, and I know that takes substantial emotional regulation on your part. But honestly, that is the big picture here: the best thing you can do for your relationships with others—as well as your relationship with yourself—is learn emotional regulation tools. Tool 5: Practice Honest, Regulated Communication This can be understood as assertive communication that is also compassionate. If you are feeling overwhelmed, I understand. These concepts can seem complex and somewhat unattainable. I have an online boundary program that addresses emotional regulation as the foundation for healthy boundaries. It includes an exercise on visualizing emotional boundaries to strengthen that skill, and an entire section on assertive communication so you can set and maintain boundaries. Healthy boundaries are not about keeping people away or controlling other people's behavior. Healthy relationships actually require good boundaries. Good boundaries are about knowing yourself—where you end and the other person begins—and knowing it is acceptable for you to have needs. Compassionate, assertive expression of whatever needs to be communicated will help the relationship. It can be done in a way that supports your own emotional regulation and possibly helps the other person—or at minimum, does not contribute to escalation. Suppressing your own emotions and needs will escalate the negative cycle of conversation. This is not about suppression. It is definitely not about lashing out, exploding, or releasing everything you have been suppressing because you are angry and frustrated. If you have taken that timeout when needed, if you have been aware ("my heart rate is way up; I am in fight-flight-freeze mode"), you will not reach that explosion point because you will have taken your break and calmed down. All these steps are interrelated. Expressing what you feel in a regulated manner keeps you in connection with the other person. Remember: it is not just what you say but how you say it, and even how you are feeling when you say it. A statement like "I am feeling overwhelmed right now with too much to do" will enable you to stay in connection far more effectively than exploding because your partner has not done what they were supposed to do. Anytime we explode with attack or criticism, we contribute to emotional dysregulation in the room. Bringing It All Together Consciously keep track of your own emotional regulation Visualize your emotional boundary Use breathing techniques to stay within your window of tolerance, aware that you might need to take a mini timeout for yourself if you cannot stay within that window Validate the other person's feelings, emotions, and experience. Pay attention to: "This is me and my emotions, and that is them and theirs." Practice assertive communication which includes compassion for yourself and the other person This is not easy work. I know that. But what I want you to understand is that emotional contagion is real, and there are tools you can use to work with it. You can understand the other person without fully absorbing their emotional state. We are not individual emotional islands. Each one of us impacts those around us. Let me be very clear: Impacting others is not the same as causing their emotions or being responsible for their emotions. They are not responsible for ours. We are responsible for our own emotions and what we do with them. Yet there is this framework of interconnectedness among us, and knowing how to work with it can improve your life and your relationships significantly. Please share in the comments if you found this valuable. What resonated with you? What questions do you have?
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