Book Review: Born Anxious

The story of Daniel P. Keating’s new book, Born Anxious: The Lifelong Impact of Early Adversity – and How to Break the Cycle begins from the day we are conceived.

While previous research largely assumed that the year before a child is born didn’t have much impact on later life development, it is precisely this period, Keating argues, that creates the blueprint for how the child will respond to stress, interpret the intentions of others, manage relationships, learn and even raise children.

When expecting mothers undergo a high degree of stress – whether it be from financial concerns, divorce, moving or job loss – their stress is literally transferred onto the DNA of their child. The result is what is now known as social epigenetics. While epigenetics refers to changes in the gene expression that result from external factors, in social epigenetics, those factors are the relationships that we have, beginning with the very first one.

Social epigenetics explains how the stress of the mother can trigger a biological switch that effectively turns on the genes that regulate the stress response of the child. The outward signs of this are a child who is highly anxious, hard to comfort, often agitated and sometimes hyper-aggressive.

However, the causes for this behavior lie in the child’s biology. While other children may respond to stressors with some alert, this child’s alert never seems to go off, resulting in what Keating calls stress dysregulation.

“The triggering mechanism, as we discovered by putting together findings from many corners of the scientific enterprise involved a biological change made in response to an adverse social experience in very early life that altered the ability of that person to deal with stress,” writes Keating.

As the child with stress dysregulation enters school, not just do learning and behavior problems result, but also difficulty in relationships. He may appear overly sensitive to touch, sights, and sounds, difficult to soothe and highly irritable. All of this can cause a considerable strain on the parent-child bond.

Yet it is also at this age that biological repair – and perhaps even some reversal of the epigenetic changes – is possible. Keating points to the results of a very large study showing that children who were adopted from adverse circumstances, when exposed to an attentive caregiver were able to fully reverse the effects of a maladaptive stress system. Through a strong parental attachment, children with stress dysregulation can be provided a buffer against stress that aids in self-regulation, eventually leading to the ability to self-soothe.

Of particular importance, Keating notes, is a parent’s ability to help the child move toward independence by allowing them to make choices, talking them through difficult experiences, keeping communication open and sticking to a routine.

“Routines not only shape how we think and act, but also the amount of cortisol – or serotonin or oxytocin – that is produced. It is the balance between them that makes the lifelong difference,” writes Keating.

This difference often plays out in better impulse control, improved relationships and better physical health.  Of specific importance, Keating notes, are to reduce the “allostatic load” of stress, which is the physical load on the body occurring as a result of chronic stress, and to overcome the attractor states of hypervigilance, anger and anxiety.

By learning to slow down and think through decisions, we can learn to overcome default patterns of responding to stress. This is also what Daniel Kahneman calls the “dual process model,” which describes the difference between actions that are the result of epigenetic changes and a more mindful approach that results in better decisions and less stress.

One interesting connection Keating makes is that between stress dysregulation and consumption of sucrose, and the resulting obesity.

“Unfortunately, adults often fall back on the quick-fix mode of dealing with stress. One thing many do is turn repeatedly to food. This habit can begin very early on, when babies become quickly dependent on sucrose to soothe their emotions, a positive instinctual preference given that it counteracts cortisol,” writes Keating.

The astronomical rates of obesity are just one outcome of what Keating calls a “stress epidemic.” In the decade between 2000 and 2010, many stress-related diseases – from high blood pressure to insomnia and frequent mental distress – all rose sharply. Much of this stress reflects a larger social issue – rising inequality.

“If once, in our early history, tigers were the hunters that triggered our stress reactions, steep social inequality is the predator that has so many of us living with dread today,” writes Keating.

Keating recommends focusing on what he calls policies for the self: control, connection and consciousness. By finding a psychological sense of control (especially when our perceptions of the demands placed on us exceed our ability to deal with them), developing warm caring relationships and employing self-reflection, we can take important and necessary steps to break free from the cycle of stress and take our lives back from anxiety.

With Born Anxious, Keating has not just rewritten our understanding of stress, but the social mechanisms that drive it. Stress is an inescapable condition of life today, but Keating shows that we need not have our lives, and our DNA, dictated by stress. There is another way, and it starts with reading Born Anxious.

Born Anxious: The Lifelong Impact of Early Life Adversity – and How to Break the Cycle
Daniel Keating
St. Martin’s Press (2017)
Hardcover, 213 Pages

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