Not only what the poster above said about phobias, but she actually wasn't a full on killer. The movie reveals that it was Conrad her brother that did most of the killing. He killed the father that was raping his sister. And then he was obsessed with re-living that murder over and over. That is why in the basement, they re-created the sisters bedroom where she was raped, and where Conrad killed the father.
So basically, he dragged his sister into all this. She was already mentally broken from the rape and the witness of her dad being killed. But Conrad convinced her that the father had evil in him that had to be purged. So he then convinced her that all the "bad people" (who were sexual predators they would hunt down and lure into the house) also needed to be purged.
It's hard to say how much the brother believed it, or if he was just a serial killer that got off on reliving the murder of his father over and over. But he had convinced his mentally ill sister that this is what they were doing.
Point being, the girl wasn't a full on serial killer. She was extremely mentally ill, and seemed to be living in a fantasy that the brother had constructed. She was essentially forever trapped to the trauma her father caused her (hence why she could never leave the house), and the brother was making her relive it over and over - except they were "purging" evil and getting sexual predators (who basically were surrogates for their father) to "forgive and redeem themselves".
Plus the peeing was triggered to her phobia of being forced outside. She was having a complete mental break down and panic attack. She was terrified out of her mind being outside. Which also makes sense, because she's almost stunted as a person. She's almost like trapped as the little girl that was raped. And since she was completely depending on Conrad to deal with everything, she was very much a weak person.
To be fair, the film has some problems. I get the sense that you are supposed to walk away from the film not seeing Anna as a serial killer. However, the film has her act "dark" in parts, because they want to trick the audience into thinking she's a split personality killer that has a dark side to her. But the whole purpose of this, is to keep the audience guessing - so that the reveal later on is more surprising and interesting. The reveal of course being that it was Conrad that was setting it all up, and Anna was more passive (or someone that was more of a side to it).
So the film at times makes it seem like she's dark and crazy. Her line to Dan "you don't know who I am". But once you know the full story, you realize that she's really not so much a serial killer, but more of a mentally ill child, that was trapped in her father and brothers psychosis. This isn't to say she's not guilty. She helped murder people. She actually killed three people in the movie (although I would argue this was more self defense, or her trying to relive what Conrad would normally do). But based on the plot reveal, she's actually more of a passive side kick to Conrad.
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