What this newsletter was, and how to read it now.
This went out to the practice's mailing list on June 3, 2020, as the second issue of a short-lived newsletter. It was written alongside a video episode on childhood anxiety, and it pointed readers back to an earlier episode about the culture of fear. Those recordings are not reproduced or linked here — we have not confirmed who holds the rights to reuse them, so we are not republishing them on your behalf.
What survives is the written issue, and its subject still matters: parents who live with anxiety, or with an autoimmune condition, worrying about what their children inherit. That worry is real and it deserves a straight answer. The 2020 text answered it with more certainty than the science supports, so below we have kept the newsletter's questions and replaced its conclusions with sourced material.
For a current, fully sourced discussion of anxiety in adults, the condition guide on depression and anxiety is the better starting point. This page is history, not guidance.
COMT is a real gene, and here is what it actually does.
The newsletter's centerpiece was an enzyme with an unwieldy name: catechol-O-methyltransferase, or COMT. On that basic point it was right, and the National Library of Medicine describes the gene plainly. COMT produces an enzyme that helps break down chemical messengers called neurotransmitters, and it matters particularly for regulating dopamine and norepinephrine in the prefrontal cortex.
That region is worth knowing about. The prefrontal cortex organizes and coordinates information arriving from elsewhere in the brain, and it is involved in personality, planning, holding behavior in check, abstract thinking, emotion, and short-term working memory. The enzyme's job there is to help keep those messengers at appropriate levels.
The newsletter reached for Goldilocks to explain this — not too much, not too little, but just right — and that instinct holds up. Maintaining appropriate levels is genuinely what the enzyme helps do. Where the 2020 text went further than the evidence was in what it built on top of that image.
There is a common variation in this gene, known as Val158Met, that swaps one amino acid for another and affects how stable and how active the enzyme is. It has been linked to differences in thought processes, including working memory, inhibition of behavior, and attention. Variations in COMT have also been studied in connection with anxiety, panic disorder, and a range of other conditions — studied in connection with, which is not the same as shown to cause.
No single gene hands your child a personality.
Here is where we part company with our own 2020 newsletter. It sorted people into two types by their COMT status — an anxious type and a calm-under-pressure type — and treated one gene as the switch. That framing is popular, it is memorable, and it is not how temperament works.
The National Library of Medicine is direct about this. Temperament covers traits like sociability, emotionality, activity level, attention, and persistence. Scientists estimate that somewhere between 20 and 60 percent of it is determined by genetics. But temperament has no clear pattern of inheritance, and there are no specific genes that confer specific temperamental traits. Instead, many gene variations — perhaps thousands — combine to shape any one person's characteristics.
Environment is not a footnote to that story either. It shapes which genes are switched on. Children raised amid adversity may have genes associated with impulsive traits activated, while children in supportive settings may develop calmer temperaments partly because a different set of genes comes into play. Genes and circumstances are not two separate columns to be totaled up.
So the honest answer to the parent's question is less tidy than the one we published in 2020. You are not passing along a single anxiety gene, because there isn't one. What you pass along is a large number of common variations whose combined effect nobody can currently read off a chart, interacting with a childhood you are still in the middle of shaping.
What a genetic test can and cannot tell you.
The 2020 newsletter moved from explaining COMT to offering to test for it, and framed that testing as a way for parents to head off anxiety in their children years down the road. We are not carrying that forward. Nothing in the sources supports the idea that testing a gene prevents a future anxiety disorder, and we will not restate a promise we cannot stand behind.
It is worth knowing what these tests are limited to in general. The National Library of Medicine notes that direct-to-consumer genetic testing generally cannot predict with certainty whether you will develop a particular disease. These companies may test only a few of the many variants that contribute to a given disease or trait, and they may not have healthcare professionals available to answer questions about what came back. Results typically need confirming through additional testing ordered by a healthcare professional.
The underlying reason is the one from the section above: most health conditions come from a combination of genetic, lifestyle, and environmental factors, and a test that looks only at genes is looking at one part of a larger picture.
If you are actually worried about your child right now.
Genetics is an interesting conversation. It is also, for a parent watching a child struggle this week, entirely beside the point. If that is where you are, the National Institute of Mental Health offers a more useful threshold than any gene.
Consider seeking help if your child's behavior or emotions last for weeks or longer, cause distress for your child or your family, or interfere with how your child is doing at school, at home, or with friends. In younger children, anxiety can look like seeming fearful or worried much of the time, or complaining of frequent stomachaches or headaches that have no known medical cause.
The path forward is ordinary and it works: talk with the people who see your child regularly, such as teachers, then bring what you have noticed to your child's pediatrician or healthcare provider. They can refer you to a mental health professional with experience evaluating and treating children. An evaluation typically involves interviewing parents, gathering information from school, and talking with the child.
That is a referral we would make ourselves. Nothing on this page can assess a child, and no gene panel substitutes for someone qualified sitting down with your family.
- Write down what you have noticed and roughly when it started.
- Note whether it is affecting school, sleep, friendships, or home life.
- Ask a teacher or caregiver what they have seen.
- Start with your child's pediatrician and ask about a referral.
What we removed, and the recipe we kept.
We would rather say this plainly than quietly edit around it. Several things in the original issue are gone from this page: the two-personality-type reading of COMT and its genotype labels, a claim about elite fighters' genetics, an assertion that childhood trauma leaves the brain's fear center permanently switched on, the suggestion that COMT explains a reader's own anxious thoughts, and the offer of family genetic testing to prevent anxiety later in life. None of those could be supported by a government, board, or academic source, so they were dropped rather than softened. The newsletter also name-checked several other genes in passing; we have not carried claims about those either.
One thing we did keep, because it was the best part. The issue closed with a recipe from Laura, who worked at the practice, built around Palmini — a pasta substitute made from hearts of palm, which she was enthusiastic about and which she noted could be found at Sprouts and some Whole Foods locations. We are not reproducing the recipe or the dietary framing around it, but the fact that the second newsletter ended with an employee's pasta recommendation is exactly the kind of detail an archive should keep.
If a question about your own situation brought you here, call (775) 507-2000. The office answers Monday through Friday, 8:00 AM to 5:00 PM, and you can ask about weekend availability. Please keep medical details to the phone or an in-person visit rather than the website.