Dr. Sanam Hafeez, clinical psychologist, and faculty member at Columbia University, states that:
Anxiety attacks usually occur in reaction to a specific stressor, and are associated with feelings of worry, fear and apprehension. Panic attacks, on the other hand, tend to arise out of the blue and involve feelings of terror, fear and dread.
Sometimes panic attacks and anxiety attacks can be used interchangeably; although they present differently from each other and often feel different, both could involve intense emotions.
Panic Attack vs Anxiety Attack
It may be difficult to know whether you’re experiencing anxiety or a panic attack. Keep in mind the following:
SYMPTOMSANXIETY ATTACKPANIC ATTACKExcessive apprehension and worry✓Persistent irritability✓Restlessness and inability to relax, or feeling wound up or on edge✓Difficulty concentrating or mind going blank✓Sleep disturbance✓Easily fatigued✓Palpitations, pounding heart, or accelerated heart rate✓✓Feeling dizzy, unsteady, light-headed, or faint✓✓Sweating✓✓Nausea or abdominal distress (churning in the stomach)✓✓Fear of losing control or “going crazy”✓Fear of dying✓Feel like you are having a heart attack or on the verge of dying✓Sense of impending doom or danger✓Derealization (feelings of unreality) or depersonalization (being detached from oneself)✓
Panic Attacks
What does a panic attack feel like?
Panic attackscome on suddenly and involve significantly intense and oftenoverwhelming fear and discomfort.
Panic attacks can feel severe and have multiple physical symptoms, such as lightheadedness, difficulty breathing, and sometimes chest pain.
However, everyone has a different sensitivity, and the presentation of their physical symptoms will vary.
The main characteristic differentiating panic from anxiety is feeling an impending sense of doom, dread, terror, and worry that something terrible will happen.
Andrew Huberman, Neuroscientist at Stanford University School of Medicine
During a panic attack, a person may begin sweating and trembling, their heart starts pounding (and may feel like it will break out of their chest), they may have trouble breathing, and they start tofeel extremely dizzy, fearful, and nauseous.
The physical symptom can feel painful or sharp for some people and they may believe they are experiencing a heart attack due to rapid heart rate and chest pain, withsome people genuinely believing they are going to die.
It is not uncommon that following a panic attack, people may feel stressed and worried about the occurrence of additional panic attacks or the consequence of losing control.
How long do they last?
A panic attack can start suddenly; symptoms tend to reach their peak after about 10 minutes. After around 30 minutes, the symptoms tend to settle, although the effects may last longer. Usually, panic attacks can last between a few minutes and an hour.
What causes them?
Unexpected panic attacks could occur without any obvious cause, sometimes happening when previously feeling calm.
However, with more learning and awareness, people can point out the trigger of their panic attacks. For example, they may realize whenever they go to the supermarket, they feel panic.
Whilst the causes of panic attacks are not always known, there are some possible factors, such as brain chemistry, genetics, and hormones, which may play a role in someone being more likely to develop panic attacks.
Similarly, those who have more of an anxious or neurotic type of personality may be more likely to expect a panic attack. Another factor is if a family member, such as a parent or sibling, has an anxiety disorder.
What are some possible triggers for panic attacks?
Stressful job
Social situations
Exposure to a phobia
Reminders of traumatic experiences or memories
Worries associated with a chronic illness
Drug or alcohol withdrawal
Overconsumption of caffeine
Financial pressure
Relationship problems
Changing life situations, such as moving house or getting a new job
Can panic attacks occur at any time of day?
Panic attacks can occur very suddenly without any noticeable cause. Because of this, they can occur at any time of the day, including when at work or school, when driving a car, or even in themiddle of the night when fast asleep.
Anxiety Attacks
What do they feel like?
Anxiety attacks usually present as strong feelings of worry, fear, or distress that may build up gradually. This can also develop into emotional symptoms such as being restless, irritable, and feeling wound up or on edge. A person might experience physical symptoms such as muscle tension and difficulty sleeping.
The symptoms of anxiety can often build up and continue for a long period, days or even months at a time.
Anxiety does not tend to peak in the same way that panic does. A person is more likely to stay consistently anxious until the fearful situation is over or until symptoms fade away on their own.
Anxiety is usually related to the anticipation of a stressor, event, or experience, significantly the feeling that something bad will happen.
Triggers for anxiety attacks can depend on the types of anxieties the person has. Someone with a fear of social situations may experience anxiety attacks when having to do a presentation in front of their class or when attending parties with many people.
However, sometimes people may also struggle to identify the stressor of their anxiety. For example, some people can constantly feel anxious without realizing the link to their excessive worries of self-criticism.
People who cannot pinpoint the trigger of their anxiety can experiencefree-floating anxiety,often experiencing persistent worry when there appears to be no reason for days, weeks, or months on end.
Can anxiety lead to panic?
Some people with anxiety may progress to panic attacks. If a person with panic or anxiety disorder suspects a panic attack may happen, they could experience a rush of anxiety in anticipation of a panic attack.
This can result in all the same symptoms of anxiety attacks which may, in turn, trigger the panic attacks itself.
For example, those who are worried or fearful about enclosed spaces may experience a panic attack when in an elevator.
Certain anxiety conditions can be a cause of anxiety and subsequent panic attacks, and each condition has its own specific causes and associated symptoms:
Generalized anxiety disorder– the presence of excessive anxiety and worry about a variety of topics, events, and situations.
Social anxiety disorder– a condition associated with the irrational fear and anxiety of being watched, judged, or embarrassing oneself.
Specific phobias – this features the irrational fear of an object, place, or situation, e.g., fear of spiders (arachnophobia), or open spaces (agoraphobia).
Separation anxiety disorder– the excessive fear of being separated from the primary caregiver.
When Should You Seek Treatment or Support?
It is important to note that anxiety and panic attacks do not largely affect an individual’s daily life for a period of time, as these emotions are normal for a human being to some extent.
It’s worth looking for help if panic attacks or anxiety attacks impact your ability to function normally (e.g., do your job and everyday activities).
Suppose you have started to avoid certain places or situations that cause you distress, such as socializing with certain people or avoiding areas where you have previously experienced anxiety or panic attack. In that case, this is also a sign to seek help.
In the short term, avoiding anxious or fearful situations can make a person feel safe, but this is a problem in the long term as avoidance can keep people anxious.
Diagnosis
To diagnose panic disorder or an anxiety disorder, a discussion with a doctor or mental health professionals, such as psychologists or psychiatrists, is usually the first step to evaluating symptoms.
During this evaluation, the doctor will usually take the individual’s medical history, complete a physical exam, and may undertake other tests to rule out any medical illness that may be contributing to the symptoms.
Questions may be asked about the symptoms being experienced, including their intensity, durations, and the impact they may have on the individual’s normal daily functioning. This will help aid a diagnosis, usually based on the criteria found in the DSM-V.
The DSM-V classifies panic attacks into two clear categories: expected and unexpected. Whilst expected panic attacks are associated with a specific fear, unexpected panic attacks have no apparent trigger.
Since anxiety attacks are not a formal diagnosis within the DSM-V, instead individuals experiencing these attacks may be diagnosed with a type of anxiety condition such as generalized anxiety or social anxiety disorder, depending on the types of symptoms.
Treatment and Management
People may find that some techniques work better for them than others, whilst some may try a combination of treatments to improve well-being.
Psychotherapy
Psychotherapies are beneficial to better understanding symptoms and developing methods of managing them.Cognitive behavioral therapy(CBT) is a popular psychotherapy recommended for those with panic or other anxiety disorders.
CBT helps individuals identify the thoughts that contribute to fear or anxiety and learn to challenge them, replacing them with realistic and helpful ones.
Exposure therapyis another type of psychotherapy that is mostly recommended for those with specific phobias. This therapy involves gradually exposing the individual to the feared object or situation whilst practicing relaxation techniques.
The vicious cycle of anxiety
Over time, the source of the fear should become less frightening for the individual, and there should be fewer anxiety attacks as a result.
How to reverse the cycle of anxiety
Medication
The primary reason for taking medication is to help in reducing symptoms. Medication may only be required for a short period of time to control the symptoms whilst utilizing other strategies.
Antidepressantssuch as selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for anxiety disorders as they act on the neurotransmitter serotonin – a chemical associated with mood and feelings of happiness. Examples of SSRIs are Zoloft (Sertraline) and Lexapro (Escitalopram).
Anti-anxiety medications may also be prescribed, including benzodiazepines. Examples of anti-anxiety medications are Xanax (Alprazolam) and Valium (Diazepam). However, benzodiazepines have a high risk of dependence (could be addictive) and should be used with careful monitoring in the short term.
Alternatively, beta blockers can also help with physical symptoms such as heart racing and are not at risk of dependence like benzodiazepines.
Lifestyle
As well as medication and psychotherapy, many lifestyle changes can be made to help manage panic and anxiety attacks. Firstly, it is helpful to understand the signs and triggers of what is causing the panic or anxiety.
Although panic attacks can often seem unexpected, this may be due to a lack of awareness, and “unexpected” could be a subjective term. Thus individuals are encouraged to build awareness in general.
If the source of the triggers is identified, it could be possible to reduce and manage this source. For instance, if overworking at a job is the cause of attacks, adjustments could be made with the employer to ensure the individual is not over-exerting themselves, or the individual can decline to work an extra load if they are significantly affected.
It may also be useful to have a good support network to help the individual talk through their struggles. Confiding in close friends or family members could offload some of the anxiety the person is feeling. Likewise, joining support groups for panic or anxiety can help individuals feel less isolated and learn helpful tips to manage their attacks.
Relaxation exercises have also been found to be beneficial for those with panic and anxiety disorders. This can include trying out yoga, meditating, mindfulness, and deep breathing.
During or immediately after a panic or anxiety attack, it may be useful to complete relaxation exercises to help manage or recover from the intense feelings quicker.
Also, visualization is another technique that can be used during an attack where individuals imagine they are in an environment that is relaxing or safe for them, with the aim of calming their anxious or panicked symptoms.
Finally, other lifestyle techniques such as diet and exercise, have proven to be useful for managing feelings of anxiety and improving mental health in general. Getting adequate sleep and limiting alcohol, drugs and caffeine intake can also be beneficial for those experiencing panic and anxiety attacks.
Do you need mental health support?USAContact the National Suicide Prevention Lifeline for support and assistance from a trained counselor. If you or a loved one are in immediate danger: https://suicidepreventionlifeline.org/1-800-273-8255UKContact the Samaritans for support and assistance from a trained counselor: https://www.samaritans.org/; emailjo@samaritans.org.Available 24 hours a day, 365 days a year (this number is FREE to call):116-123Rethink Mental Illness: rethink.org0300 5000 927
Do you need mental health support?
USA
Contact the National Suicide Prevention Lifeline for support and assistance from a trained counselor. If you or a loved one are in immediate danger: https://suicidepreventionlifeline.org/
1-800-273-8255
UK
Contact the Samaritans for support and assistance from a trained counselor: https://www.samaritans.org/; emailjo@samaritans.org.
Available 24 hours a day, 365 days a year (this number is FREE to call):
116-123
Rethink Mental Illness: rethink.org
0300 5000 927
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th edition. American Psychiatric Association; 2013.
Craske, M.G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N. & Baker, A. (2008).Optimizing inhibitory learning during exposure therapy.Behaviour Research and Therapy, 46, 5–27.
Foa, E. B., Kozak, M.J. (1986). Emotional processing of fear: Exposure of corrective information.Psychological Bulletin, 99, 20–35
Gregory KD, Chelmow D, Nelson HD, et al. Screening for anxiety in adolescent and adult women: A recommendation from the Women’s Preventive Services Initiative. Ann Intern Med. 2020. doi:10.7326/M20-0580
National Institutes of Mental Health.Panic disorder: When fear overwhelms.
National Institute of Mental Health.Anxiety disorders.
Wagner, A. P. (2002).What to do when your child has obsessive-compulsive disorder: Strategies and solutions. Rochester, NY: Lighthouse Press.
Wagner, A. P. (2003). Cognitive-behavioral therapy for children and adolescents with obsessive-compulsive disorder.Brief Treatment and Crisis Intervention, 3(2), 291-306.
Florence Yeung
BSc (Hons), Psychology, MSc, Clinical Mental Health Sciences
Florence Yeung is a certified Psychological Wellbeing Practitioner with three years of clinical experience in NHS primary mental health care. She is presently pursuing a ClinPsyD Doctorate in Clinical Psychology at the Hertfordshire Partnership University NHS Foundation Trust (HPFT). In her capacity as a trainee clinical psychologist, she engages in specialist placements, collaborating with diverse borough clinical groups and therapeutic orientations.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
