Panic Attacks vs. Anxiety Attacks: What Is the Difference?

By Chesney Fowler, MD
Medically reviewed
March 24, 2020

Both panic attacks and anxiety attacks are periods of heightened fear, discomfort, or nervousness, usually accompanied by feeling shaky, sweaty, trembly, dizzy, and nauseous. Many people use the terms interchangeably to describe these experiences. However, according to the manual that mental health professionals use to diagnose mental health conditions, called the DSM-5, panic attacks are the only clinically recognized term.

While anxiety can make us feel many of the same ways, panic attack symptoms are more physically and psychologically intense and can come on suddenly, sometimes out of nowhere.

On the other hand, anxiety symptoms usually build gradually and occur as a response to a known trigger. It’s important to understand what distinguishes a panic attack from an anxiety attack, as well as related conditions and treatments for both.

What Is a Panic Attack?

According to the DSM-5, a panic attack is a “an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes,” and contains four or more of the following symptoms:

  • Sweating
  • Shaking
  • Dizziness or lightheadedness
  • Fast or pounding heartbeat
  • Feeling like you can’t catch your breath or can’t breathe
  • Feeling like you’re choking
  • Nausea
  • Abdominal cramping
  • Feeling chilled or hot
  • Numbness or tingling in hands and feet
  • Feeling like you need to escape
  • Feeling depersonalization or derealization
  • Fearing that you could go crazy or lose control
  • Fearing that you’ll die

Panic attacks can build quickly and reach their highest intensity in a matter of minutes. They usually last between 5-20 minutes. After a panic attack subsides, people often feel exhausted.

Many people go to the doctor or emergency room the first time they have a panic attack or for particularly strong ones, mistaking it for a heart attack or stroke.

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What Is an Anxiety Attack?

Anxiety attacks are distinct from panic attacks in that the symptoms are physically and psychologically less intense, and often occur in response to a known stressor or phobia, rather than out of the blue.

While an anxiety attack isn’t a term officially recognized by the DSM-5, it does describe a real experience people have of heightened feelings of anxiety.

Symptoms of anxiety can include:

  • Muscular tension
  • Increased heart rate
  • Shortness of breath
  • Restlessness
  • Irritability
  • Difficulty concentrating
  • Uncontrollable worrying
  • Insomnia or difficulty falling asleep

When people refer to anxiety attacks, they are often describing an intensification of the symptoms above, or bouts of worrying that makes other activities difficult to focus on or enjoy.

Generally during an anxiety attack, people do not experience fears of death or losing control as they do during a panic attack.

Panic Attacks vs. Anxiety Attacks

While panic attacks and anxiety attacks share many of the same symptoms, such as a pounding heart, gastrointestinal upset, and fear, panic attack symptoms are typically more intense. They tend to reach their peak intensity after about 10 minutes, while anxiety builds more slowly as an accumulation of anxious feelings over hours or even days or weeks.

Another difference is while panic attacks can occur in response to a known phobia or a scary experience, they also can happen unexpectedly, when one is calm or even at night when asleep. Panic attacks that wake you up from your sleep are called nocturnal panic attacks.

Anxiety, on the other hand, usually has an identifiable cause, like a life change such as divorce, a lifestyle issue such as a stressful job or drinking too much caffeine, or a well-known stressor like public speaking.

Because anxiety attacks don’t have an official definition, they can refer to different experiences, like over thinking or worrying, or sweating and shortness of breath. Panic attacks, however, must satisfy specific conditions as outlined in the DSM-5.

Treatment Options for Anxiety and Panic Attacks

Thankfully, both anxiety and panic attacks respond well to treatment. Psychotherapy, or talk therapy, especially cognitive behavioral therapy (CBT), can reduce the intensity and frequency of panic attacks, as well as help you cope with them better when they do happen. CBT can also help people overcome the fear of having another panic attack, in addition to helping people deal with more generalized anxiety and what people perceive to be anxiety attacks.

Panic attack treatment sometimes comes in the form of medication. Medications commonly prescribed for anxiety and panic disorder include selective serotonin reuptake inhibitors (SSRIs), which increase available serotonin in the brain, helping to regulate mood.

The effective SSRIs for panic attacks include escitalopram (Lexapro), fluoxetine (Prozac), and sertraline (Zoloft). A similar type of panic attack medication prescribed for anxiety are serotonin and norepinephrine reuptake inhibitors (SNRIs), like venlafaxine (Effexor XR), duloxetine (Cymbalta), and desvenlafaxine (Pristiq), which work by increasing available serotonin and norepinephrine in the brain. SSRIs and SNRIs are taken daily at a steady dose, to lessen generalized anxiety and decrease panic attacks.

Some people benefit from medication taken only as needed during periods of high stress. Hydroxyzine (Atarax) is a medication approved to treat anxiety, and it is not habit-forming. Some people require benzodiazepines, which are sedatives, to help them during periods of panic.

Benzodiazepines work by calming the central nervous system to ease feelings of anxiety and panic. Common benzodiazepines prescribed for anxiety and panic are alprazolam (Xanax), clonazepam (Klonopin), and lorazepam (Ativan). Benzodiazepines are safest when they are taken only as needed in anticipation of or in response to a severe stressor.

In addition to therapy and medication, the following lifestyle modifications can help create a calmer, more peaceful state:

  • Getting enough sleep
  • Exercising regularly
  • Limiting caffeine intake
  • Eating a healthy diet
  • Practicing relaxation techniques (yoga, meditation, breathwork)
  • Finding a creative outlet (writing, dancing)
  • Engaging with social support systems

If you do find yourself experiencing anxiety or panic, you can try to regain your calm by reminding yourself that you are experiencing anxiety and not something dangerous, and tell yourself that it is a time-limited discomfort that will pass. Going somewhere quiet where you can breathe slowly—in through your nose and out through your mouth—might also help, as can calling a trusted person in your life to share what you are experiencing and ask for support.

If you experience anxiety or panic attacks, it doesn’t mean that you have an anxiety or panic disorder. Anyone can experience these attacks sometimes, especially during times of stress or life transitions.

However, if you’re experiencing anxiety to the point that you can’t focus on anything else, or have recurrent panic attacks that cause you to worry about having another one, you might want to make a visit with your health care provider to see what support is available to you.

Anxiety and panic disorders are linked to a few other mental health conditions, like:

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When to Seek Help

If anxiety or panic attacks are getting in the way of your daily life, see a health care provider to see what kinds of treatments will help you back to feeling your best. If you’re experiencing what you think are anxiety and panic attacks, get a full physical examination with bloodwork to make sure other physiological conditions, like heart or thyroid problems, or vitamin and mineral deficiencies, aren’t causing your symptoms.

How K Health Can Help

Anxiety and depression are among the most under-reported and under-treated diseases in America. Nearly 20% of adults in the US suffer from mental health illness and fewer than half receive treatment. Our mission is to increase access to treatment for those suffering in silence.

You can start controlling your anxiety and depression and get access to the treatment you need with K Health. Starting at $19/month get prescriptions for mental health medications plus unlimited doctor visits through the K Health app. Start your free assessment to see if you’re eligible.

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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Chesney Fowler, MD

Dr. Fowler is an emergency medicine physician and received her MD from George Washington University. She completed her residency in emergency medicine at Christiana Care Health System. In addition to her work at K Health, Dr. Fowler is a practicing emergency medicine physician in Washington, DC.

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