Severe anxiety is best understood as an interaction between three forces: (1) biological sensitivity, (2) psychological conditioning, and (3) stress. It is our view that individuals with severe anxiety usually have several important background factors and personal characteristics in common. These common features, combined with stress and their biological sensitivity, often place them at risk for developing the condition.

Once the anxiety patterns emerge, a cycle of fear and avoidance is learned. That learned pattern is then kept in motion by 'fear-enhancing" habits.

Generally, panic anxiety or agoraphobia syndromes occur during or after a prolonged period of stress. Typical stresses includes moving, having surgery or an illness, having a baby, having relationship problems, financial stress, a death in the family, general "changes", job changes, or other pressures. This stress will often precipitate bodily reactions. Many people recognize these body signs of stress and tension and will take steps to alleviate them and to obtain extra rest or relaxation. For panic sufferers however, perhaps due to a variety of specific background characteristics, biological sensitivity, etc., these bodily experiences are connected with very strong physical or "mental" reactions which become terrifying. Often, such individuals, due to their perfectionist and conscientious nature, tend to heap stress upon stress until the body reacts even more dramatically and a cycle of fear and restriction begins.

Individuals do not develop agoraphobia because they are unintelligent or "weak". In fact, the opposite is true. Studies have shown that agoraphobics are highly intelligent, highly sensitive people, who were generally brought up in a perfectionist way. Their rearing style usually included lots of rules, strong achievement needs, perhaps critical parents or school-teachers, and sometimes families living with an alcoholic. Other agoraphobics note that their families were uncomfortable talking openly about feelings and had an exaggerated need to be "in control". Many agoraphobics are frightened about "going crazy" and what that may mean. They usually do not clearly understand what is "normal" and are worried and frightened that they are somehow very abnormal and are either about to die or develop some serious form of psychiatric disturbance.

When the first or second panic attack occurs, all of this can become crucial in that the person has probably not been prepared to constructively understand what is happening, and tends to fear that he or she is having a heart attack, a stroke, or is somehow going insane. The agoraphobic condition escalates from there and some people begin to deal with anxious feelings by avoiding the places, things, situations, or people associated with those feelings.