Underlying Causes of TCK Anxiety

Contributed by Lauren Wells

There’s a conversation that seems to keep repeating; a training that has been continually requested in the past couple of years. It’s on a topic that we recognize is a growing global challenge, but in our Third Culture Kid community seems to be even more weighty. 


As practitioners, we know how anxiety presents and often how to treat it. However, at TCK Training we’ve found underlying causes that are more unique to the TCK community. We believe understanding those causes can help implement an effective treatment plan. At the very least, it can help the TCKs we’re serving to have language for and understanding of the anxiety they’re facing. 

We’re not entirely surprised by the growing rates of anxiety in TCKs. Our 2021 research study on Adverse Childhood Experiences (ACEs) in the TCK population surveyed 1,904 Adult TCKs. In that data set, we found 21% of ATCKs had high ACE scores (four or more out of ten). That’s in contrast to 12.5% of the American control group (a CDC Kaiser study). For highly mobile TCKs who moved locations more than 10 times, the number increased to 32%.

Higher ACE scores are associated with higher rates of mental illness. It was found that “…an ACE score of four or greater was associated with 7.3 higher odds of anxiety or depression compared to those with less than four ACEs.” (Elmore AL, Crouch E.)

So the fact that TCKs experience higher rates of anxiety is not a surprise, but why might this be the case? What about those high ACE scores and the TCK life might lead to the symptoms of anxiety? 

We’ve noticed three trends. 

  1. Settling feels unfamiliar and thus breeds anxiety. We’ve found that TCK anxiety tends to increase when their highly mobile life is halted and they are in one place, with the same people for a longer period of time. This may make it difficult for a practitioner to find a source of anxiety because it might appear that everything is finally settling down in the TCK’s life. There may be more predictability, consistent relationships, opportunity to maintain hobbies, etc. However, for TCKs who have been highly mobile (either they relocated often or the people around them constantly came and went) it is that stable feeling that feels so uncomfortable and that uncomfort can present in feelings of anxiety. The adrenaline that they frequently experienced from huge life upheavals feels familiar, even if they express that they despised the constant change. Their body is used to it and their body responds when the familiarity of upheaval is gone. The COVID pandemic also made this settledness a forced experience for many TCKs and their families and that brought in additional emotions because it was unexpected, laced in fear, and often filled with many unknowns. 
  1. Close, long-term relationships. Even if the TCK you’re working with didn’t relocate frequently, it’s likely that there was a revolving door of people coming in and out of their life because of the transient nature of the expatriate community. This means that TCKs become experts at the first stage of a relationship. They’re often very good at getting to know people and are experts at navigating the getting-to-know you phase. Because of this rhythm, they get used to short-term relationships being the norm and with every new relationship a mental alarm clock begins to tick. When the relationship begins to have longevity, anxiety often surfaces. Sometimes, this anxiety leads them to subconsciously sabotage the relationship. Other times, they’ve come to you because of anxiety and haven’t been able to pinpoint a cause. If they’ve had longer term friends, or have been in a romantic relationship longer than past relationships have typically lasted, that could be an underlying source of anxiety. 
  1. A tall Grief Tower. I’ve written about the compounding nature of TCK grief in my books The Grief Tower and Unstacking Your Grief Tower. We see that TCKs who don’t “unstack” losses and traumatic experiences along the way through processing, often come to a point when they begin to experience symptoms of a tall or crashed Grief Tower. This most often presents as Complex PTSD. They may not have any major big “T” traumas in their life, but instead have a constant stream of losses and grief-inducing experiences that have stacked up. One of the body’s responses to this is often anxiety. In the two books mentioned, I walk through the methodology of creating a Grief Tower Timeline. Many practitioners have found that process to be a very effective way to reduce the symptoms of unprocessed grief, including anxiety. 

How you treat TCK anxiety may not differ significantly from how you would treat non-TCK’s anxiety, but we’ve found that it can be soothing and normalizing for TCKs to have a better understanding of how their unique life could be connected to how their body is emoting. Most importantly, they need to hear that the cause of their anxiety is not their fault AND the management of it is their responsibility. It is unhelpful to look at the TCK life, blame it as the source of anxiety, and stay stuck in the anxiety. But it can be so healing to help your TCK client understand their anxiety, come to terms with how their upbringing may have impacted them, and learn tools for how to live into the wonderful parts of their TCK upbring while managing anxiety in healthy ways. 


Elmore AL, Crouch E. The Association of Adverse Childhood Experiences With Anxiety and Depression for Children and Youth, 8 to 17 Years of Age. Acad Pediatr. 2020 Jul;20(5):600-608. doi: 10.1016/j.acap.2020.02.012. Epub 2020 Feb 22. PMID: 32092442; PMCID: PMC7340577.

Recorded Workshops: 

TCKs and Anxiety

Understanding Your Anxiety as an Adult TCK

Our Counseling TCKs Therapist Training is offered online each spring and fall and is eligible for 6 NBCC CEUs. 

Author: Lauren Wells

Lauren Wells is the founder and CEO of TCK Training and author of Raising Up a Generation of Healthy Third Culture Kids, The Grief Tower, and Unstacking Your Grief Tower. She is an Adult TCK/MK who spent her teenage years in Tanzania, East Africa. She sits on the board of the TCK Care Accreditation as Vice Chair and is part of the TCK Training Research Team focusing on preventive care research in the TCK population. She lives in Georgia, USA with her husband and two daughters.