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If you’re dealing with a sudden, intense bout of anxiety, you may describe it as an “attack.” But are anxiety attacks and panic attacks the same thing? Not quite.
“Panic attack” is a formal medical term for a specific mental-health phenomenon.
The term “panic attack” appears in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). That’s the official manual that mental health professionals use to identify and diagnose mental illness or related events.
“Anxiety attack,” on the other hand, is not a formal medical term. It does not appear in the DSM, and it has no defined criteria. But anyone who is feeling anxious all of a sudden may describe that experience as an “attack.”
Here’s how to tell them apart.
What is a panic attack?
The DSM classifies panic attacks as a specific type of anxiety (SAMSA, 2016).
The thing that distinguishes a panic attack from other types of anxiety is its intensity and speed. Panic attacks tend to come on quickly, and they often include body symptoms like trembling, breathing problems, or lightheadedness (Andrews, 2018).
According to its formal DSM definition, a panic attack is “[a]n abrupt surge of intense fear or intense discomfort that reaches a peak within minutes.”
During that period of intense fear or discomfort, the symptoms of a panic attack include (SAMSA, 2016):
- Heart palpitations, a pounding heart, or an accelerated heart rate
- Trembling or shaking
- Shortness of breath
- Sensation of choking
- Chest pain or discomfort
- Nausea or an upset stomach
- Feeling dizzy, unsteady, lightheaded, or faint
- Derealization (feelings of unreality) or depersonalization (feeling detached from oneself)
- Fear of losing control or “going crazy”
- Fear of dying
- Sensations of numbness or tingling
- Chills or hot flashes
If panic attacks are not related to specific fears or situations, happen often, or are followed by at least 30 days of worry about another panic attack, you might have a panic disorder. Not every person who has a panic attack will develop panic disorder. A panic attack can strike out of the blue as a one-off event and never come back (Torpy, 2011).
High functioning anxiety: signs and what to do about it
What is an anxiety attack?
Everyone deals with anxiety from time to time.
While “anxiety attack” has no formal definition, you could call any period of anxiety that does not meet the panic-attack criteria an “attack.”
According to the DSM, the symptoms of anxiety include (SAMSA, 2016):
- Fear of uncertainty or the unknown
- Restlessness or feeling keyed up or on edge
- Being easily fatigued
- Problems concentrating
- Muscle tension
- Sleep problems (difficulty falling or staying asleep, or unsatisfying sleep)
We all experience anxiety now and then. But for some, it can be so common or debilitating that it meets the definition of a disorder.
For example, if your anxiety is “difficult to control” and occurs “more days than not for at least six months, about a number of events or activities (such as work or school performance),” you may meet the criteria for generalized anxiety disorder.
If your anxiety is a reaction to specific situations or triggers—such as spending time around other people—you may be dealing with a specific anxiety disorder, such as “social anxiety disorder” (SAMSA, 2016).
How are panic attacks and anxiety attacks different?
If you’re trying to differentiate between panic attack and anxiety attack symptoms, think about how your body feels.
Again, panic attacks often cause noticeable physical symptoms such as trembling, an upset stomach, dizziness, or breathing problems (SAMSA, 2016). Many people describe them as feeling like a heart attack or some other life-threatening medical event (Andrews, 2018).
Anxiety attacks or other forms of anxiety may cause muscle tension or “keyed up” feelings. But they don’t usually cause the kinds of intense physical symptoms that doctors associate with panic attacks (SAMSA, 2016).
Physical symptoms aside, panic attacks tend to be extremely distressing. If you’re experiencing “overwhelming” fear or terror, that’s more typical of a panic attack than other forms of anxiety (Grillon, 2018).
How are panic attacks and anxiety attacks similar?
Again, both are forms of anxiety. And people with anxiety disorders are at high risk for panic attacks. In many ways, a panic attack is just a very extreme type of anxiety attack.
It may be helpful to think of the relationship as similar to the link between a heart attack and heart disease. Heart disease has its own set of symptoms and criteria. And people who have it are at increased risk for a heart attack. But heart disease and heart attacks are not the same thing (NHLBI, n.d.).
In a nutshell, a panic attack is a specific, super-intense type of anxiety attack.
What causes a panic attack?
Some people experience panic attacks when they’re exposed to a specific situation or trigger.
For example, people who experience anxiety around spiders or in public places may have a panic attack when confronted with these sources of worry (Taylor, 2006).
On the other hand, some panic attacks seem to come from thin air. They have no source and don’t seem wrapped up in a specific fear or worry (NIMH, 2017).
Some other factors are associated with an elevated risk for a panic attack. These include (Taylor, 2006):
- A traumatic event
- Heavy caffeine consumption
- Use or withdrawals from drugs or alcohol
Do anxiety disorders lead to panic attacks?
The short answer is yes. Panic attacks are common among people with anxiety disorders. In fact, panic attacks are one of the most common symptoms of anxiety disorders or other psychiatric conditions. However, some people who have an anxiety disorder never experience a panic attack (Grillon, 2018).
According to the DSM, panic attacks are a feature of agoraphobia, social anxiety disorder, generalized anxiety disorder, and other anxiety-related disorders (SAMSA, 2016).
It’s also true that panic attacks can lead to a specific type of anxiety disorder, known as panic disorder. The DSM defines panic disorder as recurrent or unexpected panic attacks, followed by a month or more of either “persistent concern” or unhelpful changes to your life that are designed to help you avoid panic attacks (SAMSA, 2016).
How to control anxiety or panic attacks
Whether you’re dealing with a surge of anxiety or a full-blown panic attack, several treatment options can help.
One of the best and simplest involves calm and measured breathing. Breathe in for 4 seconds, hold your breath for 2 seconds, and then breathe out slowly for 6 seconds. Repeat this for one or two minutes. This technique can help calm both acute anxiety and panic attacks (Andrews, 2018).
If you’re trying to prevent sudden and intense anxiety attacks, there are a number of effective therapies—from drugs and counseling to lifestyle changes.
Some evidence-backed anxiety remedies include (Andrews, 2018):
- Cognitive-behavioral therapy, a form of psychotherapy that helps change your thoughts in ways that reduce anxiety
- Selective serotonin reuptake inhibitor (SSRI), a kind of antidepressant drug that is thought to help control the brain’s levels of the “happy hormone” serotonin
- Relaxation techniques
There are many others. But these are among the best-studied and most effective (Andrews, 2018).
To sum all this up, the differences between panic attacks and anxiety attacks can be a bit subtle. Some of their symptoms overlap, and they are tightly bound. But they are distinct mental-health issues. And fortunately, both are treatable.
- Andrews, G., Bell, C., Boyce, P., Gale, C., Lampe, L., Marwat, O., Rapee, R., & Wilkins, G. (2018). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Australian & New Zealand Journal of Psychiatry, 52(12), 1109–1172. doi: 10.1177/0004867418799453. Retrieved from https://journals.sagepub.com/doi/pdf/10.1177/0004867418799453
- Grillon, C., O’Connell, K., Lieberman, L., Alvarez, G., Geraci, M., Pine, D. S., & Ernst, M. (2017). Distinct responses to predictable and unpredictable threat in anxiety pathologies: effect of panic attack. Biological psychiatry. Cognitive neuroscience and neuroimaging, 2(7), 575–581. doi: 10.1016/j.bpsc.2016.08.005. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5665581/
- National Institutes of Mental Health (NIMH). (2017.) Mental Health Information: Panic Disorder. National Institutes of Mental Health (US). Retrieved from https://www.nimh.nih.gov/health/statistics/panic-disorder
- National Heart, Lung, and Blood Institute (NHLBI). (N.d.) Heart Attack. National Heart, Lung, and Blood Institute (US). Retrieved from https://www.nhlbi.nih.gov/health/heart-attack
- Substance Abuse and Mental Health Services Administration (SAMSA). (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t10/
- Taylor C. B. (2006). Panic disorder. BMJ (Clinical research ed.), 332(7547), 951–955. doi: 10.1136/bmj.332.7547.951. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1444835/
- Torpy, J. M., Burke, A. E., & Golub, R. M. (2011). JAMA patient page. Panic disorder. JAMA, 305(12), 1256. doi:10.1001/jama.305.12.1256. Retrieved from: https://jamanetwork.com/journals/jama/fullarticle/646264
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.