Introduction:

Anxiety is a universal feeling without constituting a disease or even an abnormality. This can assume a pathological character when it functions inappropriately, conditioning maladaptive control, more precisely, an anxiety disorder. Increasingly, the genomic and environmental influences are recognized as important in its genesis and perpetuation. Therefore, for a more holistic understanding, of the presence of an anxiety disorder, it is fundamental to have the family context available through family assessment, a practice that is often forgotten in the routine of the family physician.

Case description:

In this family assessment, anxiety configures a multigenerational disorder with different expressions. This type of transmission supports the genetic and environmental components of an anxiety disorder. Three elements of a family household with anxiety disorder were evaluated: mother and two children. The genesis of the matriarch's anxiety disorder was possibly favored by a genetic predisposition, guessed by her family history, as well as by the confliction’s environment, recurrent episodes of verbal and physical violence by her husband, perpetuated by various anxiogenic events. The transmission of the anxiety disorder to the next generation would have been provided by the common environment of family violence, combined with the expression of maternal anxiety through the non-verbal component, by the physical expression of anxiety, instructional by the alarmism for the different situations of danger that operate throughout the day and behavioral by avoiding new situations. Interestingly, although the genesis of the anxiety disorder and the initial symptoms of both children were common, individual predisposition and subsequent anxiogenic events shaped them differently, both in the manifestation of anxiety and in its management.

Comments:

General and family medicine occupies a privileged position in the individual and family evaluation of this pathology. Like this family, it is considered that many Portuguese families have the same characteristics, and that proper attention is still not given to this chain of transmission of psychopathology. The active search for family factors that increase the risk of anxiety disorders and valuing anxiety disorders as psychopathologies with great individual, family, and social impact is essential. Appropriate treatment of anxiety disorders in one generation can reduce their prevalence in future generations.

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