An Imperfect Storm: How To Develop An Anxiety Disorder

Hello, and thank you for writing to me. I am so very sorry to hear of your longstanding distress, and am glad to hear that you are now motivated to heal.

Further, in sharing your experience with me (via Choose Help), you are indirectly assisting others who have suffered from anxiety in similar ways. 

I know that you have felt a great deal of shame, embarrassment and self-criticism as a result of your traumatic past. I also know that a significant portion of your pain has stemmed from the belief/fear that others will not believe you or sympathize with you, and that they might even somehow blame you for these experiences.

Therefore, in addition to the upsetting experiences themselves, you have also learned to internalize a view of yourself as weak, shameful, and untrustworthy, and have come to criticize yourself harshly for having these difficulties in the first place. I call this set of painful self-appraisals “Level 2” of the problem, “Level 1” being the simple facts of the traumatic episodes, and the impact they have had on you.

So, before I proceed, I would like to tell you that EVERYTHING YOU HAVE DESCRIBED MAKES COMPLETE SENSE TO ME. Based on the path you have traveled, these recurrent and upsetting thoughts, feelings, and behaviors are very logical consequences to what you have undergone, and they have sadly gotten significantly worse over time.

Despite the entrenched place in which you now find yourself, however, YOU CAN HEAL FULLY FROM YOUR ANXIETY. In fact, if you pursue a solid path of recovery, it is likely that you will emerge from treatment feeling even stronger and more confident than you ever have before. I make these positive statements because they are empirically supported facts, and because I know that being optimistic about recovery will be one of your greatest tools of recovery. So too will be compassion, for yourself.

Okay, so how to make sense of the ways in which the past has led you to where you now find yourself? Well, I think you’ll be glad to be reminded that you were not born this way, and that you never intentionally CHOSE to live this way. Experience has been your teacher, and it accounts for why you behave and think and feel as you do now.

I am now going to review what you told me, and point out some of the phenomena that have likely been responsible for the majority of your difficulties. My goal here is to help you understand yourself, and to also illuminate these concepts so that others can understand them as well. These principles play a primary role in the development and exacerbation of all anxiety disorders, whether one fears a home invasion or being confronted by a terrifying snake.

The first concept at work here is "Classical Conditioning" (CC). In CC, a previously conditioned stimulus (in this case, your difficult relationship with your parents) is paired with the previously neutral stimulus of being robbed. Yes, it might seem a stretch to describe having one’s home broken into as a “neutral” stimulus, since it would be extremely unpleasant for anybody. However, the majority of people who undergo such an experience will not go on to develop an anxiety disorder, such as post-traumatic stress disorder, and memories of the negative event will dissipate naturally over time.

In your case, however, the pairing of the conditioned stimulus (relationship with parents) and the neutral stimulus (experiencing a home invasion) led to the development of a powerfully negative higher order relationship, and this newly conditioned stimulus (the idea of being burglarized) and has taken on a life of its own.

Once this pairing occurred, at the time of the initial break-in, all of the negative aspects of your relationship with your parents came also to be associated with home invasion, making the latter so much more powerfully upsetting and influential for you. For clarity, here are several negative aspects of the pre-existing relationship with your parents (the conditioned stimulus):

1. You have long experienced your father as emotionally abusive, intrusive, controlling, and frightening.

2. You described feeling financially dependent on your father.

3. You described feeling “awful and angry and guilty” about your anger at your parents, due to your financial dependency on them.

4. You felt self-critical after your parents initially forced their way into your apartment, because you believed that you were unable “to fix yourself.” This suggests that you have long expected yourself to sustain the hurt from that relationship but not let it bother you (yet another example of Level 1 and Level 2 thinking).

5. You described your mother as someone you could not rely upon as an ally in the conflict with your father, perhaps because of her own anxiety.

6. You have a history of tiptoeing around your parents’ personalities.

7. You learned to take your parents’ power over you very seriously.

8. You had already learned to be vigilant to risk and possible danger.

At the time of the second invasion, 7 years later, the following beliefs, feelings and behaviors also became associated with your reaction to being burglarized.

                “I won't be heard.”

                “I won't be understood.”

                “I won’t be believed.”

                “I will be frozen in terror, and unable to speak out.”

                “I will be killed.”

                “Symptoms of panic will prevent me from protecting myself.”

                “Law enforcement will fail to help me because of their own errors.”

With the subsequent break-in and robbery,four months later, the following thoughts and feelings also emerged:

                “Law enforcement (by now, a proxy for male authority figures, such as your father), are                               “horrible, brutal, and dishonest.”

                “Authority figures are fed up with my sobbing.”

                “Authority figures care only about my tangible losses, not my emotional ones.”

                “Authority figures are more concerned about covering their errors than they are about the losses I have sustained.”

Following that episode, you were advised by your physician to take some time off of work so that you could recover from the emotional trauma you had undergone. This suggestion did not sit well with you, as it seemed to trigger a view of yourself as “weak, inefficient, a bit dead, ashamed, and not strong enough.” You were therefore motivated to relieve these unpleasant thoughts.

At that point in time, it appears that another fundamental psychological concept came into play, this being “Negative Reinforcement.” Based on principles of operant conditioning, the law of negative reinforcement states that “any behavior which leads to the termination or avoidance of an unpleasant stimulus will be repeated.” In this case, the unpleasant stimulus was the view of yourself as “weak and inefficient,” and the avoidance behavior (also known as a “safety behavior”) was to force yourself back to work.

Although this action may have very temporarily reduced your discomfort of feeling weak, the truth is that you simply were not ready to return to your job (and that you were badly in need of psychological treatment). Thus, the decision to promptly return to work actually set you back in the mid to long term, because you ended up losing the job. This unpleasant outcome then strengthened the following beliefs, feelings, and behaviors:

                “I desperately needed to hang on and I failed.”

                “I hate myself so much.”

                “I am so ashamed.”

                “I am obviously unable to master my difficult emotions and thoughts.”

At that point, you elected to move out of your flat. Again, Negative Reinforcement came into play, as “feeling unsafe” was temporarily reduced by the safety behavior of moving, although the ongoing, underlying anxiety-driven beliefs remained unaddressed. So, the engagement in safety or avoidance behaviors, which allow for the temporary reduction of distress, are actually the very behaviors that facilitate the perpetuation of the difficult thoughts, feelings, and additional avoidance behaviors. This is the vicious, downward spiral present in almost all anxiety disorders.

“We get better at whatever we practice and we are always practicing something.”

By then, several new painful thoughts and feelings had also been added to the scenario:

                “My symptoms of anxiety prevent me from going on job interviews.”

                “Anxiety is severely limiting my functioning. I am powerless against it.”

                “I am not ‘me’ anymore, and am thus unemployable.”

At this point, things became a bit more complicated, and the idea of returning to work had itself become an aversive stimulus. Perhaps because it was associated with the previous return to work, or perhaps due to the fear of “betraying” a potential employer (I am assuming you believed it would be dishonest to present yourself as a “capable worker”?). As you felt you “had to do something” (either because you needed to occupy your anxious mind, or because you were feeling unproductive), the re-enrollment in school had now become a safety behavior designed to reduce the power of these unpleasant thoughts and anxiety-driven needs.

As the model would predict, your return to school did indeed provide a temporary, safe-haven “bump” from the previously negative thoughts and feelings. Although you effectively reduced your comfort zone ongoing, you were able to briefly increase a sense of control over yourself and your environment. In addition, as a student, you saw yourself as a bit more anonymous, in a desirable way, and believed that you would not be as closely focused upon, evaluated interpersonally, or criticized for the being the “empty shell” you actually felt like.

Note that the relief in this case came NOT from feeling particularly confident about yourself, but from believing that your negative internal experiences and struggles would not be VISIBLE to others. As predicted by your baseline intellectually ability, in the relative absence of anxiety, you performed unsurprisingly well. You were probably also beginning to have a little hope that life might actually be getting better, and that your condition was improving.

Unfortunately, as noted, none of the underlying trauma-driven beliefs had ever been directly addressed. They were simply avoided. So, while the “house” appeared to be getting stronger, its foundation was actually continuing to weaken.

Then you get to your second year of school, and the worst happens. You are shocked by a surprise visit from an “old friend,” a home invasion. It happens while you are napping and “expecting no one,” similar to the occasion on which you were invaded while reading Jane Austen.

This time, it is reportedly the landlord’s doing, and not a burglar, per se, or your father. Thus, the already negative view of male authority figures as “unsafe” was strengthened further, as was the belief that:

                “Being a coward has become a habit for me.”

It may also be important to note the similarity of this landlord situation to the very first invasion, by your father and mother. Just like then, an air of anger emanated from the man, while “the wife/mother” served as an idle accomplice. These similarities further explain how trauma of the past can be triggered by specific events of the present.

Although you were at that time quite strongly motivated to again contact the authorities, you had also come to believe they were not trustworthy. You were therefore negatively reinforced for AVOIDING the police. As expected, this also further fueled your unsafe feelings, and the manifestation of other safety behaviors such as keeping the blinds closed, and applying toothpaste to the lighting switchplates. As for your view of yourself, witnessing this behavior, you began thinking:

                “I’ve gone mad.”

Again, please notice the internal consistency of your thoughts, feelings and behavior as they cluster around an intense focus on potential threats. More and more, the triggers are everywhere, within and without, and there is no safe haven. They are all aligned to paint a very scary, malevolent and dangerous picture of the world in general, and a very inefficient, “weak,” and “mad” view of yourself. It’s impossible to imagine that being in a place such as this would feel anything other than scary and depressing, and that there would also be much anger, toward self and others.

Your behavior had become virtually ruled by your fear, to the point at which you elected not to even act in response to actual signs of intrusion (toothpaste smears). My guess is that you had become increasingly self-doubting by that point, which of course goes along with “feeling mad,” and that you would have also commonly ruminated about your judgment and decisions, and been very careful about disclosing it to others. This would have only increased your sense of social isolation.

At this point, your self-image was notably and negatively distorted, described by the word “lifeless.” Yet the anxiety cycle continued. To ease the unpleasant thought of feeling “exposed” and “completely naked all the time,” you withdrew from the world even further, to stand guard over your apartment. You dropped out of school, believed you had no control over anything (except MAYBE a home invasion), and you felt like an animal.

Then a shift occurred, and you begin avoiding your own apartment in favor of your boyfriend’s place. Another negatively reinforced bump. Although the assistance of a social worker friend temporarily promised to get you justice, the angry landlord just got even angrier and then suddenly and forcibly evicted you and your possessions.

At last, you described seeing yourself as a pathetic, ashamed, dirty, inefficient, soulless, dead, naked and exposed woman who has been violated and defeated by one or more disgusting, sadistic men.

And with that recount of your saga, and an attempt to explain the progression of your symptoms, from a cognitive-behavioral psychological perspective, I will pause in my reply to you. I will provide the rest of my reply in an edited addition to this post.

I am doing this so that you can take a little time to understand and digest what I have written thus far, and so that I too can continue to refine my formulation of this case. In the next installment, I will describe the ideal treatment approach suited to your recovery.

Of course, should you wish to provide me with any additional detail, or even interim feedback on my accuracy in understanding your story, please do comment upon this post. I thank you again for your amazing openness, and for your willingness to reach out for assistance.

Sincerely,

Richard E. Schultz, Ph.D.

www.drschultz.org

www.mindsetdoc.com

@mindsetdoc