Anxiety Attack vs. Panic Attack

Often times, people use the terms panic attack and anxiety attack interchangeably. The truth is though, the two are different, and making a difference is essential, especially if you are suffering from one of these unpleasant conditions.

A panic attack is recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and is categorized into two types – expected and unexpected.

An anxiety attack, on the other hand, is not a diagnosable condition and is not recognized as a clinical condition by itself by the DSM-5. But anxiety itself is a feature that is included as a symptom of several known psychiatric disorders.

The main differences between the panic attack and the anxiety attack are in the severity of their symptoms, and in the way they occur.

A panic attack usually comes suddenly and unexpectedly, and very often – without an apparent reason. Its symptoms are very intense and include an overwhelming fear of imminent death and impending doom.

Although panic attacks typically last no longer than 30 minutes, they are often mistaken for heart attacks, and sometimes for strokes, and are a common reason for people ending up in the emergency room.

The expected panic attack may occur when somebody is faced with the trigger of their phobia or unexplained intense fear of something.

Having reoccurring panic attacks may be caused by panic disorder.

Anxiety attacks usually build-up gradually with the build-up of stress and worry.

Anxiety is the excessive and continuous worry about major and sometimes minor events with uncertain outcomes. In some cases, extreme anxiety can lead to a panic attack.

They are most commonly caused by the anticipation of a specific stressful situation, like making a public speech, going to an interview, and so on.  Although some of the symptoms of an anxiety attack resemble those of a panic attack, they are usually much less intense and terrifying.

Nevertheless, whether you are experiencing anxiety attacks or panic attacks, it is essential to know more about what causes them, how to treat them, and to take precautions before they lead to more serious disorders.

Read on to find out more about the differences between panic and anxiety attacks, how to recognize each of them, what the causes and risks are, how they can be treated, and what you can do to stop or to manage them.

The similarities between panic and anxiety attacks

It is not surprising that people often use the terms panic attack and anxiety attack, thinking that they are the same thing. There are quite a lot of similarities between these two conditions.

First and foremost, both trigger the instinctive “fight or flight” reaction of the body. This natural reaction of the human body is essential for survival. It causes the sympathetic nervous system to trigger the brain to release adrenaline and noradrenaline, which prepare the body for danger.

While this is a normal and sometimes life-saving reaction of the body, it can become problematic when triggered without an apparent reason, and when there is no actual risk.

A false fight or flight attack can cause several problems:

  • The alarm can be too loud – this means you can experience a full-blown panic attack with your heart racing, your body swimming in sweat, all trembling and wondering whether you are dying, without any danger or any other apparent reason to panic
  • The alarm is hard to switch off – even though panic attacks are over for about 30 minutes, you can be left exhausted and devastated by the experience for a long time. Also, when you are having an anxiety attack, it is very difficult to simply shrug it off and make it go away
  • There is no cause for the alarm – in most cases, anxiety attacks and panic attacks are caused by something which is not dangerous or so relevant at all

The problem with both types of episodes is that the physical symptoms and the mental state during the attacks can be so distressing, that the person affected may start making drastic changes to their everyday life and behavior in order to prevent the onset of a next attack. This can lead to more serious disorders, and can seriously disrupt one’s life, relationships, work, and everything else.

The main differences between panic and anxiety attacks

Anxiety is the emotions we experience when we are worried about a particular event in the future, and when we anticipate a bad outcome. Anxiety often causes a feeling of uneasiness, muscle tension, problems sleeping, and other unpleasant symptoms. It also usually creeps up on us gradually and intensifies over time.

With panic attacks, the experience is quite different. A panic attack usually comes out of the blue and causes a sudden feeling of intense fear and immediate danger. At the same time, all of the physical symptoms of the fight or flight mechanism start kicking in, making the situation even more terrifying.

Here are some of the main differences which will help you tell apart a panic attack, an anxiety attack or simply freaking out:

  • A panic attack is truly an “attack” which is abrupt, intense, and brief, while anxiety is more persistent and has lower-level symptoms
  • The panic attack usually happens without a specific trigger, and without warning, while an anxiety attack is more likely to be the body’s response to a particular threat or stressor
  • The symptoms of a panic attack are very intense and disruptive. They often make the person feel detached from their body and from reality.

On the other hand, the symptoms of anxiety are unpleasant as well but they can vary between mild and severe, and rarely will cause you to think that you are actually dying

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  • anic attack will appear unexpectedly while the symptoms of an anxiety episode are more likely to build up for hours and even for days
  • The panic attack usually lasts for a few minutes of up to 30-60 min., while the anxiety attack can last for hours and days
  • The panic is short-lived while anxiety is continuous
  • People who suffer from anxiety attacks tend to have a higher than the normal level of anxiety during the rest of the time too
  • Panic attacks have more severe physical symptoms, while anxiety attacks have more emotional consequences and effects
  • Panic makes the physical sensations speed up, while anxiety slows them down
  • Anxiety can be severe, moderate or mild, while panic attacks are severe and disruptive
  • A panic attack will commonly trigger anxiety and fear of another attack, which can lead to changes in behavior and disruptions of everyday life, as people can avoid going to places or being in situations which they think may lead to another panic attack

The clinical differences between panic and anxiety attacks

A proper diagnosis of a panic attack or panic disorder can be made in accordance with the definitions from the latest fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Even though anxiety and panic can seem and feel the same, there are some clinical differences which are outlined in the Manual, and can help distinguish the two.

According to the DSM-5, a panic attack is the main feature defining the condition known as panic disorder.

But, it is not so simple, because panic attacks can be symptoms or results of other psychiatric disorders, and also it is possible for any healthy and normal person to have a panic attack without having any underlying disorder.

As for anxiety attacks, there is no definition in the DSM-5 for such a term. The Manual instead uses the term “anxiety” as a central feature of all anxiety disorders, PTSD and OCD.

So, actually, in clinical terms, according to the DSM-5, which is used by doctors for diagnosing mental illnesses, there is no such thing as an “anxiety attack.” Psychologists too do not use this term.

This makes it hard to pin an exact definition to the term “anxiety attack.”

This is most probably the reason why there is such confusion, and people often use the terms panic attack and anxiety attack interchangeably. And sometimes, anxiety attack is used to refer to the build-up of anxiety, nervousness, or shakiness, without experiencing an actual “attack.”

Biologically, a panic attack is caused by a reaction of the autonomic nervous system and the brain’s amygdala, which are responsible for detecting dangers and threats. Anxiety is caused by the prefrontal cortex of the brain which is responsible for the feeling of anticipation, as well as for planning.

The differences and similarities in the symptoms of panic attacks and anxiety attacks

As mentioned earlier, both panic attacks and anxiety attacks are associated with similar physical and emotional symptoms.

The fact is, you can have a panic attack and an anxiety attack simultaneously.

For example, if you are overly worried about an upcoming pubic speech, the anxiety may culminate in a panic attack when it comes time for the actual speech.

The main differences in the symptoms of panic and anxiety attacks are emotional. Take a look at the typical emotional symptoms of each one:

The emotional symptoms of anxiety attacks are:

  • Worry and apprehension
  • Restlessness
  • Fear
  • Distress

The emotional symptoms of panic attacks are:

  • Fear
  • Fear of loss of control or of dying
  • Derealization or depersonalization (a feeling of being detached from your surroundings or yourself)

The physical symptoms of anxiety attacks and panic attacks do overlap, which is probably the reason why people confuse the two.

Here are physical symptoms which are typical for both panic and anxiety attacks:

  • Accelerated heart rate and palpitations of the heart
  • Chest pain or discomfort
  • Shortness of breath
  • Dryness of the mouth
  • Sweating
  • Hot flashes or chills
  • Tightness of the throat, a choking feeling
  • Shaking or trembling
  • Tingling or numbness
  • Abdominal pain, nausea, stomach upset
  • Faintness, dizziness
  • Headache

Do I have an anxiety disorder or panic disorder?

Both panic attacks and anxiety attacks can develop into disorders if left untreated if they are severe and frequent.

A panic disorder is actually a type of anxiety disorder. It is described as the “fear of fear.” People with this disorder fear the physical symptoms of the panic attack, the fear associated with it, as well as the implications of having another panic attack.

Panic disorder can affect people who have experienced more than one attack, or have frequent panic attacks, and are terrified and will do anything possible to avoid another panic attack. This can mean avoiding going to certain places, getting into certain situations, and doing certain things. This type of avoidance leads to even more anxiety.  Thankfully, statistics show that only 2-3% of the people develop panic disorder.

Panic disorder is just one of the anxiety disorders defined by the DSM-5.

Here are all of the different types of anxiety disorders:

  • Generalized anxiety disorder (GAD)- a chronic disorder which causes ongoing uncontrollable worrying, fear and anxiety without a specific stressor or trigger, insomnia, difficulty concentrating, restlessness, feeling on edge and more
  • Phobias (irrational fears) – feeling extreme anxiety and irrational fear of a specific thing, animal, situation, or another stressor
  • Panic disorder – the fear of having another panic attack, which can lead to avoidance of different types of settings, situations, and others
  • Agoraphobia – the fear of being trapped with no one to come to rescue you, which in extreme cases, may lead to a person becoming completely housebound refusing to go out in order to avoid the triggers
  • Social anxiety disorder – the irrational fear of being judged, embarrassed or viewed negatively by others
  • Separation anxiety disorder – in children and in adults, irrational fear of being separated from a specific person or people, and worrying that something terrible will happen to him or her
  • Selective mutism – a rare anxiety disorder which causes a young child not to be able to speak outside of its family or circle of friends

What is a panic attack?

A panic attack just like its name suggests is an “attack” over your body and mind which in most cases happens suddenly and without any apparent reason. In most cases, the physical symptoms and the feeling of impending doom and fear of dying are so intense during a panic attack, that the person affected may feel the after effects for days and even for weeks.

In other cases, the panic attack can be expected, if it happens as a result of coming into contact with a known stressor, or with a trigger of one’s phobia.

A panic attack can occur even when a person is sleeping or is completely calm or doing something else like driving.

The symptoms of a panic attack are abrupt and severe. They will usually peak after about 10 minutes, and then will begin to subside.

Unfortunately, in some cases, a panic attack can last longer, or may be followed up with another one or a series of panic attacks.

According to the DSM-5, the main symptoms for diagnosing a panic attack are:

  • A racing heart, a pounding heart or heart palpitations
  • Shaking or trembling
  • Excessive sweating without an apparent reason
  • Chest discomfort or pain
  • A feeling that you are being smothered or are choking
  • Nausea or abdominal discomfort
  • Lightheadedness, faintness, dizziness
  • Hot flashes or unexplained chills
  • Tingling and numbness
  • A feeling of being detached from the surroundings or oneself
  • The fear of going crazy and losing control
  • A strong fear that you are dying

What is anxiety?

Unlike a panic attack, an anxiety attack will build up and intensify over time. It is usually caused by anxiety and excessive worrying about a particular upcoming event perceived as a “danger.”

When an anxiety attack occurs, the symptoms will intensify for several minutes, but the attack can last for hours too.

Overall, the symptoms of an anxiety attack are less severe than those of a panic attack.

Here are the most common symptoms of an anxiety attack:

  • Tense muscles or muscle pain
  • Insomnia or trouble falling asleep
  • Problems with concentration
  • Restlessness
  • Fatigue
  • Increased irritability
  • Easy startling
  • An increased heart rate
  • Shortness of breath
  • Chest pain
  • Dizziness
  • Dryness of the mouth
  • A need to go to the bathroom more frequently

As you can see from the symptoms, some of the symptoms are very similar and even overlap with those of a panic attack. But in general, both the physical and emotional symptoms of a panic attack are much more severe than those of an anxiety attack.

Also, a panic attack comes abruptly but usually lasts for 10 to 30 minutes, while an anxiety attack can persist for hours, days and even for months.

The causes of panic or anxiety

Different types of emotions and causes trigger panic attacks and anxiety.

An anxiety attack is associated with excessive worrying and stressing about a future event or a potential future “danger.”

A panic attack is more likely to be caused by the body’s natural reaction to imminent danger, but often without an actual danger being present.

In many cases, people can develop anticipatory anxiety after having a panic attack. This is a fear of having to go through another such episode. The fear of fear can lead to anxiety and even to the development of an anxiety disorder, known as panic disorder, agoraphobia, phobia, or others.

This is the reason why people who suffer from such feelings of anxiety following a panic attack should seek timely professional treatment.

In other cases, anxiety or panic attacks can be caused by an underlying health condition or medical cause. This is another reason why people suffering from either should get themselves checked out. Often, when the underlying cause is treated, the anxiety and the panic will go away as well.

Causes for anxiety and anxiety attacks

Here are some of the medical conditions which can lead to anxiety or anxiety attacks:

  • Hyperthyroidism – an overactive thyroid
  • Heart conditions like arrhythmia
  • COPD, or other respiratory diseases
  • IBS
  • Chronic, persistent pain from another condition, injury or other
  • An imbalance of the hormones, or overproduction of adrenaline caused by a tumor
  • Another preexisting serious medical condition which can lead to constant anxiety regarding the treatment and the outcome
  • Specific chemical changes in the brain causing the anxiety

Some of the non-medical conditions which can be causing the anxiety or anxiety attacks, include:

  • Growing up with somebody who worries excessively, or having a close relative with anxiety
  • Experiencing a life-threatening event or trauma
  • Increased stress at work, school or in a relationship
  • A sudden significant transition in life
  • The loss of a partner by death, divorce or separation
  • Having a new baby
  • Alcohol or drug abuse or withdrawal
  • Using certain medications – OTC or prescription
  • Consuming too much caffeine
  • Having OCD or suffering from PTSD

An anxiety attack can also be caused by a specific trigger, such as:

  • Coming into contact with a phobia trigger
  • Continually worrying about suffering from another panic attack
  • Experiencing stage fright
  • Being fearful of embarrassing yourself before a particular event

Causes for a panic attack

Here is a list of some pre-existing medical conditions which may cause a person to suffer from panic attacks:

  • Overactive thyroid (Hypothyroidism)
  • Lowered blood sugar (Hypoglycemia)
  • A heart condition, like a mitral valve prolapse
  • Use and abuse of stimulants like caffeine, cocaine, amphetamines
  • Withdrawing from alcohol, drugs, and certain addictive medications

Other possible underlying causes for panic attacks:

  • Genes – it is believed that proneness to panic attacks can run in the family
  • A major milestone or change in one’s life like having a child, getting a new job, graduating, and others
  • Stress from the passing of a loved one, divorce or separation
  • Having a more sensitive temperament

What are the risks of having a panic attack or an anxiety attack?

Most of the risks associated with having a panic or anxiety attack are the same. Here are some of the most common ones:

  • Being an overly anxious person
  • Having other close family members who suffer from anxiety and panic disorders (anxiety and uncontrollable worrying can actually be learned)
  • Being under severe stress from a significant event or other reason
  • Going through a significant transition in life like starting a new job, getting married, having a baby
  • Experiencing or witnessing a traumatic or life-threatening event, including childhood abuse, sexual assault, an accident, terrorist attack, military experience and others
  • Abuse of alcohol, drugs, medication, caffeine, as well as withdrawal from either of them
  • Experiencing ongoing worrying and stress from work, family issues or financial problems
  • Having an underlying chronic or life-threatening illness or suffering from chronic pain

What should I do if I am experiencing a panic or an anxiety attack?

If you are suddenly overcome by the physical and emotional symptoms of a panic or anxiety attack, or you are feeling one creeping up on you, you can try one or more of the following in order to subdue the symptoms and to make the experience more tolerable.

In some cases, you may even be able to stop your panic attack, especially if you have practiced the following strategies and exercises:

Acknowledge that you are having an anxiety or a panic attack

Since experiencing a panic or an anxiety attack can be e truly terrifying situation, you can help reduce your fear of dying, going crazy, or being out of control by acknowledging what is really happening to you.

Neither panic nor anxiety attacks are life-threatening, so if you manage to reason with yourself and accept the fact that you are having a panic or anxiety attack, you can through either much easier, and can help control your fear and anxiety.

Practice deep breathing techniques

By practicing slow breathing during a panic or anxiety attack, you can stop some of the most frightening symptoms which are hyperventilation and trouble breathing.

Deep and controlled breathing will also help restore the oxygen and CO2 balance in your body and will also help reduce the other symptoms like a racing heart or excessive sweating which people suffering from panic or anxiety attacks often experience.

Try closing your eyes, placing the palm of your hand on your abdomen below the ribs and inhaling slowly and deeply through the nose while counting to four. After you inhale, hold the air in your lungs for a second and then proceed to exhale slowly through the mouth while counting to four again.

Continue doing this until your breathing returns to normal, and the hyperventilation is resolved as well as the fear that you cannot breathe.

Use a relaxation technique

There are various types of relaxation techniques that you can practice and perfect so that you can resort to them in case a panic or anxiety attack happens. Some of these techniques include muscle relaxation exercises, mentally going to your safe place, focusing on a particular object and examining it, trying to find certain objects in your surroundings and so on.

You can learn such techniques by resorting to a therapist, and even online from the various video and other courses available.

Resort to mindfulness

Mindfulness can help prevent the hopeless feeling of losing control or of being detached from yourself or from reality, which can occur during a panic attack.

Mindfulness is especially useful for people who tend to worry excessively and for those suffering from some form of anxiety or an anxiety disorder.

You can practice mindfulness by noticing your emotions, thoughts, or sensations but without reacting to them and without judging them.

Mindfulness is something that you can learn by practicing and can be incredibly useful if you are prone to suffering from panic or anxiety attacks.

How are panic and anxiety diagnosed?

Doctors and trained mental health professionals can diagnose anxiety, a panic attack, or a panic disorder by referring to the guidelines in the latest 5th edition of the Diagnostic and Statistical Manual of Mental Disorders known as DSM-5.

Since the term “anxiety attack” is not defined by the DSM-5, it cannot be diagnosed, but your doctor will be able to determine whether you are suffering from anxiety or have panic disorder or suffer from panic attacks.

In order to provide you with the correct diagnosis, your doctor will perform a physical exam to find out whether you have an underlying medical condition causing the symptoms. The physical examination may include a general examination, a heart test like an ECG or EKG, and some blood tests.

If other health conditions are overruled, then the doctor will ask you questions regarding your specific symptoms and any life events which may be causing them.

You may be asked to fill out a psychological questionnaire or get a psychological evaluation as well.

How are anxiety and panic attacks treated?

Even though the majority of the people suffering from anxiety and panic attacks do not seek professional treatment, these conditions can be treated or managed successfully.

With proper treatment and management, your life can get back to normal.

Depending on your specific case, you may be assigned psychological therapy, medication, and may need to make some lifestyle changes.

Therapy

Therapy is one of the most effective ways to manage and treat anxiety and panic attacks and disorders. Your doctor may recommend that you go to individual or group cognitive therapy sessions, or exposure therapy sessions.

Cognitive therapy will help you learn to recognize the symptoms of the anxiety or panic attack, learn how to acknowledge them, and thus control them. Successful cognitive therapy will teach you to stop fearing the symptoms, control them, and hopefully to eliminate them altogether.

Exposure therapy is useful for treating agoraphobia or panic disorder, or both. Your therapist will assign certain exercises and will ask you to face your fears, but in safe and controlled conditions, until you learn how to take control over the fear of a specific stressor, phobia or other triggers, and to overcome it altogether.

With the proper type of therapy, you can learn how to control the worrying and thus reduce the anxiety. Also, if you suffer from anxiety, you can learn how to tolerate uncertainty as well as to challenge the unrealistic distressing thoughts, which are a major part of anxiety and anxiety attacks.

Also, by learning more about how the fight or flight mechanism works, you can learn and understand that it is a natural reaction, and that your body is actually trying to protect and help you during a panic attack, rather than be a threat to your life.

Some exercises which can lead to symptoms mimicking those during an anxiety and panic attack can also help you understand how your body works and reduce the fear caused by them.

Eventually, you can learn how to stop avoiding certain situations, events or other stressors and go on with your normal life without constantly worrying about unexisting dangers or unrealistic dangers.

Medication

Apart from the therapy, you may be prescribed medication that will help you manage, reduce or eliminate the symptoms of anxiety or panic attacks.

It is important to note, that medication alone cannot cure anxiety or panic, so it should be combined with therapy.

You may be prescribed antidepressants like SSRIs or SNRIs, antianxiety drugs, or benzodiazepines, which are fast-acting sedatives that can subdue the symptoms of anxiety or an upcoming panic attack. There are also other medications that you may need to take in order to alleviate the physical or emotional symptoms of these conditions too.

It is essential to be monitored when taking any type of medication for your anxiety or panic and to follow the orders of your doctor closely when administering them, as well as when stopping them.

Also, you should always tell your doctor about any other medications, and supplements even herbal or dietary ones and vitamins you are taking because some of them may interfere with the prescribed medication.

Lifestyle changes

In most cases, you will need to make some lifestyle changes as well, to help subdue your anxiety and to prevent the occurrence of future panic attacks. Some of the changes you may need to make include:

  • Eat a healthy and balanced diet
  • Get moderate daily exercise (at least 30 minutes a day)
  • Practice yoga, meditation or other relaxation techniques
  • Practice deep breathing techniques
  • Learn how to manage the stress at work or in your life by applying stress management skills
  • Limit the use of alcohol, drugs, certain medications, nicotine and caffeine
  • Finding a new or old hobby which you enjoy and practice it as often as possible
  • Getting at least 8 hours of sleep
  • Trying to maintain a positive attitude by keeping a journal, or other
  • Aromatherapy with soothing and relaxing essential oils such as lavender
  • Build a reliable support network of relatives, friends or other people suffering from anxiety and panic
  • Educate yourself about the causes and the effects of anxiety and panic attacks
  • Make sure you see your friends, your family or other people, even if you do not feel like meeting other people or going out
  • Join a support group – online or offline
  • Set a specific worry time, when you can take time to ponder on all current worries, and after the time is up, stop worrying
  • Practice mindfulness techniques which will help you keep your mind under control during a panic attack
  • Practice muscle relaxation, which can also help alleviate the symptoms of an impending panic or anxiety attack
  • Try to replace the constant “what if?” questions passing through your mind with the phrase “so what!” – this can significantly reduce your anxiety caused by upcoming events, situation and others

Final words

Although they may feel similar and may sound the same, panic attacks and anxiety attacks are different conditions and terms.

Their symptoms can differ by type and intensity, and so can the causes and risks for them occurring.

It is essential that you seek professional help and treatment after such an episode. This will help your doctor find any underlying health conditions which can be causing the symptoms and also prescribe you the appropriate treatment if you are suffering from anxiety, an anxiety disorder, or panic attacks.

Remember, anxiety and panic are not life-threatening. These conditions are treatable, and even if you cannot get rid of anxiety completely you can learn how to manage such attacks, keep them under control and stop fearing them.

Getting treatment is vital if you want to go on with your life without the behavioral changes and other problems that can occur if your anxiety or panic turns into a disorder that left untreated can disrupt your life, your relationships, your work and everything else.

So, instead of sitting and worrying and putting a stop to your everyday life, you should go to the doctor. You are not alone. There are millions of people affected by these conditions, and there is treatment available for keeping the anxiety and panic under control, and for eliminating any future attacks!

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