Difference Between Anxiety Attack and Panic Attack: What You Need to Know

Anxiety attacks and panic attacks are often used interchangeably, but they're actually different experiences with distinct characteristics. Understanding the differences between these two types of episodes can help you better recognize what you're experiencing and seek appropriate treatment.

While both involve intense feelings of fear or distress, they differ in their onset, duration, intensity, and whether they're recognized as official diagnoses in medical literature.

Key Takeaways

• Panic attacks are recognized in the DSM-5 as a specifier that can occur in the context of panic disorder or other mental health conditions. On the other hand, "anxiety attacks" is an informal term describing episodes of heightened anxiety that aren't officially defined in medical literature.

• Panic attacks typically occur suddenly without warning and peak within minutes, whereas anxiety attacks usually build gradually in response to specific stressors and can last for extended periods from minutes to days.

• Both conditions can significantly impact daily functioning and often benefit from similar treatments, including cognitive behavioral therapy and medication, though accurate diagnosis by a healthcare provider is essential for developing an effective treatment plan.

What is a Panic Attack?

A panic attack is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an abrupt surge of intense fear or discomfort that reaches a peak within minutes. A panic attack isn’t a standalone diagnosis in itself; it is a specifier that may accompany other diagnoses, such as a social anxiety disorder. For instance, a diagnosis might read “social anxiety disorder with panic attacks”.

The specifier provides descriptive information about a person’s symptoms and is used to guide treatment decisions. 

A panic disorder, on the other hand, is a diagnostic condition associated with recurrent panic attacks with no obvious trigger. 

To meet diagnostic criteria, a panic attack must include at least four of the following physical and psychological symptoms:

Physical symptoms:

• Heart palpitations, pounding heart, or accelerated heart rate

• Sweating

• Trembling or shaking

• Sensations of shortness of breath or smothering

• Feelings of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• Feeling dizzy, unsteady, lightheaded, or faint

• Chills or heat sensations

• Numbness or tingling sensations

Psychological symptoms:

• Derealization (feelings of unreality) or depersonalization (feeling detached from oneself)

• Fear of losing control or "going crazy"

• Fear of dying

Panic attacks are intense experiences that typically last between 520 minutes, though some people report attacks lasting up to an hour. The symptoms usually peak around 10 minutes and then gradually subside, though some residual anxiety symptoms may persist for up to an hour. Because the physical symptoms can be so severe, particularly chest pain and shortness of breath, many people experiencing their first panic attack seek emergency medical care, believing they're having a heart attack.

The DSM-5 recognizes two types of panic attacks:

Unexpected Panic Attacks

These occur without an obvious trigger or warning, seemingly "out of the blue." This unpredictability is a hallmark feature of panic disorder.

Expected Panic Attacks

These are triggered by specific situations or cues, such as someone with a phobia encountering their feared object or situation.

Research indicates that panic attacks are common, affecting approximately 11% of people in a single year. However, having panic attacks doesn't necessarily mean you have panic disorder; the attacks can occur alongside various mental health conditions.

What is Panic Disorder?

Panic disorder is diagnosed when someone experiences recurrent, unexpected panic attacks followed by at least one month of persistent worry about having additional attacks or concern about their consequences (such as fear of losing control or having a heart attack). People with panic disorder may also make significant behavioral changes to avoid situations where they fear attacks might occur.

Patients diagnosed with panic disorder may experience fear and anxiety in a physical manner, in addition to cognitive symptoms. 

Panic disorder affects approximately 2-3% of adults annually in the U.S., with a lifetime prevalence of up to 4-5% and typically begins in late adolescence or early adulthood. The condition affects women approximately twice as often as men. 

People diagnosed with panic disorder are at greater risk of developing other conditions, including other anxiety disorders, major depression, and substance use disorders.

What is an Anxiety Attack?

Unlike panic attacks, "anxiety attack" is not a formal diagnostic term in the DSM-5. Instead, it's a colloquial term people use to describe episodes of intense anxiety. While medical professionals don't diagnose "anxiety attacks," the term describes a real experience — periods when anxiety symptoms become particularly overwhelming. 

There are, however, other anxiety disorders recognized in the DSM-5, which often feature anxiety surges, such as generalized anxiety disorder, social anxiety disorder, etc.

Anxiety attacks typically involve:

Emotional Symptoms

• Excessive worry or fear

• Feeling restless, wound up, or on edge

• Sense of apprehension or dread

• Difficulty concentrating

• Irritability

• Feeling overwhelmed

Physical Symptoms

• Muscle tension

• Rapid heartbeat

• Difficulty sleeping

• Fatigue

• Headaches

• Stomach problems

• Shortness of breath

The key difference between anxiety attacks and panic attacks is that while anxiety attacks may include physical symptoms like muscle tension or mild shortness of breath (that may overlap with panic attack symptoms), they are typically less severe than the intense somatic symptoms of a panic attack. 

Anxiety attacks usually build gradually and are typically triggered by specific stressors such as work pressures, relationship conflicts, financial concerns, or ongoing life challenges. They can last for extended periods, from minutes to hours or even days, with varying intensity levels throughout.

Differences Between Panic Attacks and Anxiety Attacks

Understanding the distinctions between these experiences can help you communicate more effectively with healthcare providers:

Onset and Duration

Panic attacks: Come on suddenly and unexpectedly, reaching peak intensity within minutes. They typically last 5 to 20 minutes, though the effects may linger longer.

Anxiety attacks: Usually develop gradually over minutes to hours in response to stressors, though chronic anxiety may persist longer.

Intensity

Panic attacks: Extremely intense with severe physical symptoms that often mimic serious medical emergencies. The intensity can be overwhelming and frightening.

Anxiety attacks: Can range from mild to moderate or severe. While distressing, the symptoms are generally less intense than panic attacks and don't typically reach the same peak level of terror.

Triggers

Panic attacks: May occur without any obvious trigger, especially in panic disorder. Even when triggered by specific situations (expected panic attacks), the intensity of the response seems disproportionate.

Anxiety attacks: Usually have identifiable triggers — specific worries, stressors, or situations that provoke the anxious response.

Diagnostic Recognition

Panic attacks: Officially recognized as a “specifier” in the DSM-5 with specific diagnostic criteria. They can be diagnosed as a standalone feature (not a mental health condition) or as part of panic disorder or other conditions.

Anxiety attacks: Not formally recognized in the DSM-5 as a distinct condition. The symptoms are instead typically associated with various anxiety disorders.

Primary Symptoms

Panic attacks: Must include at least four specific symptoms from the DSM-5 list, often with prominent fear of dying or losing control. Feelings of derealization or depersonalization are common.

Anxiety attacks: Primarily involve excessive worry and tension, with physical symptoms that tend to be less severe and more related to muscle tension and sleep disturbances.

How Common Are These Experiences?

Both panic attacks and ongoing anxiety are prevalent in the general population. Research indicates that more than one in five U.S. adults experience some form of mental illness each year, with anxiety disorders being among the most common.

Anxiety disorders affect approximately 40 million adults in the United States. While not everyone with an anxiety disorder experiences panic attacks, people with anxiety disorders are at increased risk for them. Studies show that panic attacks can occur across various mental health conditions, including anxiety disorders, mood disorders, and even psychotic disorders.

Causes and Risk Factors

Both panic attacks and heightened anxiety can develop due to various factors:

Genetic factors: Having a family history of anxiety disorders or panic disorder increases your risk. Research suggests you have a 40% increased risk of developing panic disorder if a first-degree relative has the condition.

Brain chemistry: Dysfunction in the amygdala (the part of the brain that processes fear) and chemical imbalances in neurotransmitters like serotonin, GABA, and stress hormones like cortisol may play significant roles.

Chronic stress: Prolonged stress from work, family responsibilities, financial concerns, or other life pressures can contribute to both panic and anxiety symptoms.

Traumatic experiences: Past trauma, especially adverse events before age 18, increases the likelihood of developing panic disorders and anxiety disorders later in life.

Medical conditions: Certain health conditions, including thyroid disorders, heart arrhythmias, asthma, and chronic pain, can trigger or worsen anxiety and panic symptoms.

Substance use: Caffeine, alcohol, certain medications, and recreational drugs can trigger panic attacks or worsen anxiety symptoms.

Treatment Options

Despite their differences, panic attacks and anxiety attacks often respond to similar treatment approaches. The most effective treatments typically combine therapeutic interventions with lifestyle changes and, when appropriate, medication.

Psychotherapy

Cognitive-behavioral therapy (CBT) is considered the gold standard treatment for both panic disorder and anxiety disorders. CBT helps you identify and change thought patterns that contribute to anxiety and panic. For panic disorder specifically, a technique called interoceptive exposure, where you deliberately induce physical sensations associated with panic attacks in a safe environment, has shown particular effectiveness in reducing fear of these sensations.

Other beneficial therapeutic approaches include:

Exposure therapy: Gradually facing feared situations in a controlled way to reduce anxiety responses over time.

Dialectical behavior therapy (DBT): Teaching skills for managing intense emotions and tolerating distress.

Acceptance and commitment therapy (ACT): Learning to accept anxiety rather than fighting it, while committing to values-based action.

For people diagnosed with panic disorder, the techniques used in pyschotherapy (e.g.: breathing training) can have a positive impact on any associated comborbities that exist. For instance, slow-breathing techniques can benefit patients who also have asthma or hypertension.

Medication

When symptoms are severe or significantly impact daily functioning, medication may be recommended:

SSRIs and SNRIs: Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are first-line medications for anxiety and panic disorders. Common examples include sertraline, escitalopram, and venlafaxine.

Benzodiazepines: While these medications can provide rapid relief, they're not recommended for long-term use due to risks of dependence and side effects. They may be prescribed for short-term use in specific situations.

Beta-blockers: Sometimes prescribed to manage physical symptoms of anxiety, particularly in performance situations. However, they do not address underlying psychological anxiety. 

Note: SSRIs and SNRIs are first-line medications; specific dosing should be guided by a qualified healthcare provider.

Lifestyle Approaches

Research supports various lifestyle interventions that can complement professional treatment:

Regular exercise: Physical activity has been shown to reduce anxiety symptoms, though more research is needed on optimal exercise types and amounts.

Relaxation techniques: Deep breathing exercises, progressive muscle relaxation, and guided imagery can help manage symptoms during anxious periods.

Mindfulness and meditation: These practices can improve anxiety symptoms and help you develop a different relationship with anxious thoughts.

Sleep hygiene: Prioritizing consistent, adequate sleep can significantly impact anxiety levels.

Limiting stimulants: Reducing caffeine and avoiding other stimulants can help decrease the frequency and intensity of panic and anxiety symptoms.

When to Seek Professional Help

Whether you're experiencing panic attacks or intense anxiety, professional evaluation is important if:

• Symptoms persist for several weeks or occur frequently

• You avoid places, activities, or situations due to fear of having panic or anxiety symptoms

• Physical symptoms are severe or concerning

• Your quality of life, work, relationships, or daily functioning is affected

• You experience thoughts of self-harm or suicide

• You're using alcohol or drugs to cope with symptoms

A healthcare provider can conduct a thorough evaluation to rule out medical conditions that can mimic anxiety or panic (such as thyroid disorders, heart problems, or respiratory conditions) and provide an accurate diagnosis. Early intervention can prevent symptoms from worsening and improve long-term outcomes.

Getting Started with Blossom Health

If panic attacks or anxiety are interfering with your life, Blossom Health can connect you with board-certified psychiatrists who specialize in anxiety and panic disorders. Our virtual platform makes accessing quality mental health care convenient, with appointments typically available within days.

Your Blossom Health provider will conduct a comprehensive evaluation to accurately diagnose your condition and develop a personalized treatment plan that may include therapy referrals, medication management, and practical coping strategies. All appointments are covered by in-network insurance, making professional care accessible and affordable.

Medical Disclaimer

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. If you are experiencing a mental health crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988.

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