How Did I Get This Way?
How Anxiety Disorders Start
and Take Over
Two coworkers arrive at their office building on a Monday morning. As they approach the elevators, they notice a sign taped to the wall:
ELEVATOR TEMPORARILY MALFUNCTIONING
Oddly, people are still riding the elevator. Both glance at the sign again and feel a little uneasy. They both wonder, “What if it gets stuck?” The man shrugs and steps into the elevator. The woman decides not to risk it.
“I’ll just take the stairs.” It’s only four flights. No big deal.
At the end of the workday, the man takes the elevator down and the woman takes the stairs, “just in case.” The next morning, the sign remains. Once again, he rides the elevator and she takes the stairs.
Then something interesting happens. The following day, the sign is gone.
She pauses. “Did they really fix it completely? What if it malfunctions and I get stuck?” She takes the stairs once again. At the end of the long day, however, she feels too tired to walk the stairs and decides to take it. “Others are riding it. It’s probably fine.”
She steps in and immediately feels some anxiety. Three others follow her inside. It feels crowded. As the doors close, a surge of adrenaline rushes through her body. Her heart begins to race. The air seems stuffy. She smells the strong scent of perfume. She suddenly feels trapped.
Her breathing becomes shallow and she doesn’t realize she’s holding her breath. She notices every sound the elevator makes. Every vibration. Every creak.
She pushes the button for the third floor to escape but she’s too late. It keeps going.
“OMG. What’s happening?”
She feels lightheaded. Her chest tightens. She frantically pushes floor two. The elevator stops but the doors don’t open immediately. The delay lasts only several seconds but to her, it feels like an eternity.
“Oh my God. I’m trapped.”
Then the doors slide open.
She rushes out and takes a deep breath. Relief!
Over the next several weeks she avoids the elevator at work.
One morning in mid-December she and her husband arrive at a mall to do some holiday shopping. The mall is crowded and she insists they take the stairs. This pattern continues wherever she goes: Hotels. Parking structures. Medical offices.
She finds herself thinking: “I have a fear of elevators.”
But the fear didn’t begin with elevators. It began with a thought: What if something goes wrong?
Anxiety Is Learned
Most anxiety disorders begin in a surprisingly ordinary way. A person encounters a situation. A frightening possibility enters their mind. Anxiety appears. To reduce their discomfort, they avoid the situation or do something that makes them feel safer. The anxiety decreases. Relief.
That relief feels good, really good. And that’s where the problem begins. The brain starts connecting the dots. It concludes:
“The elevator was dangerous.”
“I escaped just in time.”
“Taking the stairs kept me safe.”
But are those conclusions true?
What actually happened is that she experienced anxiety, escaped the situation, and immediately felt relief. Her brain mistakenly credited the escape for making her feel better. People want to feel comfortable, certain, and safe. Riding elevators makes her feel uncomfortable, uncertain, and unsafe. It makes sense to avoid them.
The problem is that every time she avoids an elevator, her fear worsens and she misses an opportunity to learn something important: Elevators are generally safe, they won’t malfunction, and she could probably handle her anxiety. She never learns that she can tolerate feeling anxious. She never learns that even if an elevator stopped temporarily, she could likely cope with the situation.
Because she keeps avoiding elevators, the fear never gets challenged. Instead, it grows. The more she avoids elevators, the scarier elevators become. Eventually she’s not only avoiding elevators because they’re dangerous, she’s avoiding them because they make her anxious.
Soon she beings to avoid any situation where she believes she might be trapped or where escape might be difficult.
This process is called generalization. What started as concern about one elevator becomes fear of all elevators and then other situations: flying, underground parking, amusement park rides, even the middle of a theater away from the aisle and sitting in a hair salon.
Although the specifics differ, many anxiety disorders develop in a similar fashion.
A person experiences fear, anxiety, or uncertainty. They naturally try to reduce their discomfort by avoiding the situation, escaping it, or relying on something that makes them feel safer. The anxiety decreases and they feel relief. Unfortunately, the brain often misinterprets what happened. Instead of learning, “I can handle this,” it learns, “I need to avoid this.”
The cycle repeats and the fear grows.
Social Anxiety Disorder often develops this way. A teenager speaks in class and notices her voice shaking and that she is blushing. She imagines everyone can see how nervous she is. Afterward, she avoids speaking up in class whenever possible. The avoidance brings relief, but it also prevents her from learning that most people weren’t paying nearly as much attention as she thought. Over time, the fear spreads from presentations to meetings, parties, dating, and other social situations.
Generalized Anxiety Disorder (GAD) follows a similar pattern, although the avoidance is often mental rather than physical. A person worries about their finances, health, children, or future because worrying feels like preparation. They believe that if they think through every possible problem, they will be ready for whatever happens. The temporary sense of control reinforces the worrying. Over time, worry becomes the brain’s default response to uncertainty.
Post-Traumatic Stress Disorder (PTSD) often begins after a frightening or traumatic experience. After a serious car accident, for example, a person may avoid driving on freeways. They may then avoid driving altogether, or avoid anything that reminds them of the accident. The avoidance provides temporary relief, but it also prevents the brain from learning that the danger is no longer present. As a result, the fear remains stuck in the nervous system long after the traumatic event has ended.
Panic Disorder can develop in a similar way. A person experiences an unexpected panic attack while driving, shopping, exercising, or sitting in a meeting. The panic attack feels terrifying, so they begin avoiding places where another attack might occur. Eventually, they are no longer afraid of the location itself. They are afraid of feeling panic. Their world becomes smaller as more and more situations are avoided.
While learning plays a powerful role in the development of anxiety disorders, it is only part of the story. Genetics matter too. Anxiety tends to run in families. Some people are born with nervous systems that are more sensitive to uncertainty, stress, and perceived danger. They may be naturally cautious, vigilant, or emotionally reactive from an early age.
This doesn’t mean anxiety is inevitable. It simply means some people start with a more sensitive alarm system than others.
Anxiety disorders rarely appear overnight. They usually develop gradually through a combination of genetic vulnerability, life experiences, and learned patterns of avoidance. What begins as a reasonable attempt to feel safe can slowly evolve into a pattern that restricts freedom and takes over a person’s life.
Understanding how anxiety develops is often the first step toward understanding how it can be overcome.
