A Multicultural Perspective on Generalized Anxiety Disorder

"Human beings are neither blank slates nor slaves to their biology. What makes us human is our capacity to create culture, to build social worlds that reflect our values, identities, and needs — including how we express gender." — Susan T. Fiske.

Gender and Generalized Anxiety

Gender has emerged as a significant factor in research on the prevalence and manifestation of generalized anxiety disorder (GAD). GAD is characterized by excessive and persistent worry that is difficult to control, often accompanied by symptoms such as fatigue, difficulty concentrating, tension, restlessness, irritability, and sleep disturbances (American Psychiatric Association [APA], 2022; Zhang, 2024). It is a chronic condition that can impair occupational, social, and other important areas of functioning, and is often exacerbated by stress and environmental demands (APA, 2022; Zhang, 2024). Research demonstrates that females consistently report higher rates of GAD than males, a finding attributed to biological and sociocultural influences (Helgeson, 2015; Smith et al., 2022; South et al., 2018). Theories grounded in gender role socialization suggest that females are more likely to internalize emotional distress, a pattern that predisposes them to anxiety-related conditions (Helgeson, 2015; Cervone & Pervin, 2023; Su et al., 2024). Biological explanations that include hormonal influences on stress reactivity further complicate the gender-based experience of anxiety (Berk, 2023; South et al., 2018). The convergence of sociocultural expectations and biological vulnerabilities generates a tiered understanding of why GAD may be more prevalent among women (Aronson et al., 2019; Cervone & Pervin, 2023; Su et al., 2024). This interaction highlights how gender-based personality traits like heightened tendency toward relational sensitivity and worry may amplify vulnerability to GAD symptoms under sociocultural stressors (Cervone & Pervin, 2023; Helgeson, 2015; Smith et al., 2022; South et al., 2018; Su et al., 2024). Gender-based expectations around emotional expression and caregiving roles may also amplify feelings of worry and perceived responsibility that are central components of GAD (Aronson et al., 2019: Ghaed & Gallo, 2006; Berk, 2023; Zhang, 2024).

Influences of Gender upon Developmental Dynamics and Manifestation of GAD

A closer examination of development patterns reveals that gender differences in anxiety symptoms appear early and persist into adulthood (Bleidorn et al., 2022; Soto & John, 2014; Su et al., 2024; Zhang, 2024). Early environmental influences like parental reinforcement of gender-based emotional behaviors may shape this differential vulnerability to GAD (Cervone & Pervin, 2023; Kwan & Herrmann, 2015). Though adaptive in many contexts, females are often socialized to prioritize communion and relational sensitivity, which may contribute to heightened vigilance and worry under stress (Aronson et al., 2019; Ghaed & Gallo, 2006; Helgeson, 2015; Dugas et al., 2007). This dynamic between gender-based emotional development and cultural stress environments may notably shape the onset and persistence of generalized anxiety symptoms of an individual’s personality (Bornstein et al., 2020; Cervone & Pervin, 2023; Helgeson, 2015; Smith et al., 2022; Su et al., 2024). Socioeconomic and cultural pressures disproportionately concerning women, like caregiving responsibilities and economic marginalization, are also further associated with increased anxiety risk (Cervone & Pervin, 2023; Bornstein et al., 2020; Smith et al., 2022). Cross-cultural research highlights that while gender differences in anxiety are comparatively mutual, the severity varies depending on societal gender norms and suggests that cultural factors may modulate inherent biological predispositions (Allik & Realo, 2018; Kwan & Herrmann, 2015). These observations suggest the clinical manifestation for this disorder emerges not solely from individual personality dispositions or sociocultural pressures but from the dynamic interaction wherein culturally conditioned traits such as relational vigilance and emotional reactivity develop through sustained environmental reinforcement to shape the course and intensity of symptom expression (Aronson et al., 2019; Berk, 2023; Bornstein et al., 2020; Cervone & Pervin, 2023; Helgeson, 2015; Kwan & Herrmann, 2015; Su et al., 2024). This complex perspective emphasizes that neither gender nor culture alone can account for the complexity of the development or presentation of GAD (Allik & Realo, 2018; Bornstein et al., 2020; Cervone & Pervin, 2023; Kwan & Herrmann, 2015; Su et al., 2024).

Considerations for Clinical Management and Therapeutic Care

Integrating developmental and multicultural understanding into clinical care may enhance diagnostic accuracy and treatment outcomes for GAD (Bornstein et al., 2020; Cervone & Pervin, 2023; Dugas et al., 2007; Helgeson, 2015; Kwan & Herrmann, 2015). Understanding how gender socialization influences symptom expression within cultural contexts may permit clinicians to differentiate between normative emotional patterns and pathological anxiety symptomologies (Aronson et al., 2019; Helgeson, 2015; Cervone & Pervin, 2023; Su et al., 2024). Also, recognizing how socioeconomic and cultural factors exacerbate anxiety symptoms may reduce or prevent misdiagnosis and further inform individualized care strategies (Bornstein et al., 2020; Kwan & Herrmann, 2015). Adapting interventions to account for gender-based experiences by targeting maladaptive relational schemas or inclinations towards perfectionism may improve therapeutic engagement and clinical efficacy (Aronson et al., 2019; Dugas et al., 2007; Ghaed & Gallo, 2006; Helgeson, 2015). This suggests that an integrative perspective that considers both developmental and cultural dimensions is essential for effective management of GAD (Bornstein et al., 2020; Cervone & Pervin, 2023; Helgeson, 2015; Kwan & Herrmann, 2015; Su et al., 2024). Culturally sensitive approaches that engage with diverse emotional expressions and recognize structural stressors of personality and behavior at a gender level may further advance mental health benefits for individuals with GAD, along with progress towards recovery goals and outcomes (Allik & Realo, 2018; Bornstein et al., 2020). Symptom manifestation of this disorder reflects the interactions between culturally shaped personality development and sociocultural environments and highlights the importance of an integrative clinical approach (Bornstein et al., 2020; Cervone & Pervin, 2023; Kwan & Herrmann, 2015). It is suggested for GAD that effective management approaches target symptom reduction and the underlying developmental and cultural processes that sustain vulnerability (Dugas et al., 2007; Helgeson, 2015; Su et al., 2024).

Closing Thoughts

As observed, a comprehensive understanding of generalized anxiety disorder requires studying the relationship between enduring personality traits and the shaping influence of multicultural contexts across development. Future discussions will explore similar interpretations for additional clinical diagnoses, extending the understanding of our relationship with psychopathology and personality theory.

I invite readers to join this progressing conversation.

References:

Allik, J., & Realo, A. (2018). Cross-cultural perspectives on personality and individual differences. In V. Zeigler-Hill & T. K. Shackelford (Eds.), The SAGE handbook of personality and individual differences: Volume II: Origins of personality and individual differences (pp. 303–322). SAGE Publications. https://doi.org/10.4135/9781526470317.n17

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR).

Aronson, E., Wilson, T. D., Akert, R. M., & Sommers, S. R. (Eds.). (2019). Social psychology (10th ed.). Pearson.

Berk, L. E. (2023). Development through the lifespan (7th ed.). Sage.

Bleidorn, W., Schwaba, T., Zheng, A., Hopwood, C. J., Sosa, S. S., Roberts, B. W., & Briley, D. A. (2022). Personality stability and change: A meta-analysis of longitudinal studies. Psychological Bulletin, 148(7–8), 588–619. https://doi.org/10.1037/bul0000365

Bornstein, M. H., Jager, J., & Putnick, D. L. (2020). The convergence between cultural psychology and developmental science: Acculturation as an exemplar. Child Development Perspectives, 14(1), 12–17. https://doi.org/10.1111/cdep.12352

Cervone, D., & Pervin, L. A. (2023). Personality: Theory and research (14th ed.). Wiley.

Dugas, M. J., Savard, P., Gaudet, A., Turcotte, J., Laugesen, N., Robichaud, M., Francis, K., & Koerner, N. (2007). Can the components of a cognitive model predict the severity of generalized anxiety disorder? Behavior Therapy, 38(2), 169–178. https://doi.org/10.1016/j.beth.2006.07.002

Ghaed, S. G., & Gallo, L. C. (2006). Distinctions among agency, communion, and unmitigated agency and communion according to the interpersonal circumplex, five-factor model, and social-emotional correlates. Journal of Personality Assessment, 86(1), 77–88. https://doi.org/10.1207/s15327752jpa8601_09

Helgeson, V. S. (2015). Gender and personality. In M. Mikulincer, P. R. Shaver, M. L. Cooper, & R. J. Larsen (Eds.), APA handbook of personality and social psychology: Vol. 4. Personality processes and individual differences (pp. 515–536). American Psychological Association. https://doi.org/10.1037/14343-023

Kwan, V. S. Y., & Herrmann, S. D. (2015). The interplay between culture and personality. In M. Mikulincer, P. R. Shaver, M. L. Cooper, & R. J. Larsen (Eds.), APA handbook of personality and social psychology: Vol. 4. Personality processes and individual differences (pp. 553–574). American Psychological Association. https://doi.org/10.1037/14343-025

Smith, H. L., Sriken, J., Sherman, M., Erford, B. T., & Beck, S. K. (2022). Furthering the clinical and research utility of the Highly Sensitive Person scale: Cluster analysis of gender differences and risks for depression and anxiety. Journal of Mental Health Counseling, 44(3), 245–265. https://doi.org/10.17744/mehc.44.3.04

Soto, C. J., & John, O. P. (2014). Traits in transition: The structure of parent-reported personality traits from early childhood to early adulthood. Journal of Personality, 82(3), 182–199. https://doi.org/10.1111/jopy.12044

South, S. C., Jarnecke, A. M., & Vize, C. E. (2018). Sex differences in the Big Five model personality traits: A behavior genetics exploration. Journal of Research in Personality, 74, 158–165. https://doi.org/10.1016/j.jrp.2018.03.002

Su, Z., Yang, X., Hou, J., Liu, S., Wang, Y., & Chen, Z. (2024). Gender differences in the co-occurrence of anxiety and depressive symptoms among early adolescents: A network approach. Journal of Psychiatric Research, 179, 300–305. https://doi.org/10.1016/j.jpsychires.2024.09.024

Zhang, Z. (2024). A comprehensive overview on the generalized anxiety disorder – etiology and treatment. SHS Web of Conferences, 193, 03008. https://doi.org/10.1051/shsconf/202419303008