Anxiety Attack vs Panic Attack

Anxiety is a common feeling for many people and may be mild, moderate, or severe, with a severe and prolonged period of anxiety often being referred to as an anxiety attack. Panic is an extreme form of anxiety and can cause very intense and distressing symptoms. A period of extreme panic is called a panic attack.

What is a panic attack?

A panic attack is the sudden onset of extreme physiological symptoms and a feeling of extreme fear. Panic attacks can be very intense and distressing, particularly if they occur unexpectedly ^[1].

People who regularly experience unexpected panic attacks may be diagnosed with panic disorder, which is one of several anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, 5^th edition (DSM-5), although panic attacks may also occur in the context of other anxiety disorders and mental health conditions ^[2][3].

Panic attacks can occur suddenly and unexpectedly, for seemingly no clear reason, or may occur due to a trigger, fear, or phobia. For example, someone with agoraphobia may experience a panic attack upon leaving their house ^[4].

People with panic disorder or who regularly experience panic attacks may live in fear of a panic attack occurring, due to the distress that the symptoms can cause ^[1].

What is an anxiety attack?

Anxiety disorders typically cause ongoing and persistent symptoms, occasionally with periods of more severe or troubling symptoms, which many refer to as an anxiety attack. However, this is not a diagnosable condition or official term in the DSM-5 ^[3], so, anxiety attacks may differ from person to person, depending on how they define their own symptoms of anxiety.

Often, people experience an anxiety attack in the context of an anxiety disorder, due to the anticipation of a feared situation. For example, someone with social anxiety disorder may experience an anxiety attack in the days leading up to a big presentation at work. A presentation at work would be an event in which a socially anxious person expects to experience the fear of being judged or making a mistake ^[5].

Anxiety attacks can cause an avoidance of the anticipated fear. Avoidance can reduce the symptoms of anxiety if the situation is no longer going to occur, but this is likely to then reinforce the avoidant behaviors and fear associated with the situation ^[3][5].

Panic attack vs anxiety attack: Symptoms

Symptoms of a panic attack

The onset of symptoms of a panic attack often occurs very quickly, within a matter of minutes, and are very extreme. A panic attack may last a short time, between a few minutes and up to an hour, before subsiding ^[2].

The symptoms of a panic attack are often so distressing that people sometimes feel that they are experiencing a heart attack. People experiencing panic attacks might be afraid that they may die or be in serious danger, especially if they have not had prior experience of panic attacks. Because of this fear, people sometimes attend the emergency room or call 911 during a panic attack, which may even exacerbate their symptoms ^[4].

Common symptoms of a panic attack include ^[2][3]:

• A feeling of intense fear or dread
• A feeling of losing control or a sense of reality
• A fear of dying
• Racing or pounding heart
• Palpitations
• Breathing difficulties
• Chest pain
• Feeling weak, dizzy, or faint
• Numbness or tingling in hands or feet
• Hot flushes or chills
• Sweating
• Shaking
• Nausea

Symptoms of an anxiety attack

In comparison, symptoms of an anxiety attack tend to start more gradually and increase over time. Typically, the physical symptoms are not as severe as those of a panic attack, although they may include similar sensations that are mild or moderate in comparison ^[4][5].

However, symptoms of an anxiety attack can last much longer and are usually brought on by a trigger, so potentially can last for days prior to an upcoming situation that evokes fear ^[3].

Symptoms of an anxiety attack can include ^[3][5]:

• Insomnia, nightmares, or other sleep disturbances
• Constant worrying that is difficult to stop
• Feeling agitated and restless, being unable to sit still
• Feeling irritable
• Rigidity and tension in the muscles
• Feeling very tired and worn out
• Aching or upset stomach
• Inability to concentrate on work or hobbies

Panic attack vs anxiety attack: Causes

The cause of panic attacks and anxiety attacks is not clear and may differ from person to person, although there are several potential factors that can increase the risk of their occurrence.

Differences

Panic attacks can occur unexpectedly, with no clear cause, while anxiety attacks are typically related to a trigger. Panic attacks can even occur during sleep, causing the individual to wake suddenly with the onset of a panic attack. These are known as nocturnal panic attacks ^[6].

In other cases, a panic attack may occur due to a trigger, as might an anxiety attack. However, a panic attack will usually occur in a triggering situation, such as being faced with a fear or phobia, while an anxiety attack tends to be triggered by the anticipation of a fear or situation that causes anxiety, with prolonged symptoms prior to the actual situation ^[3][4].

Similarities

There are many risk factors that can contribute to the occurrence of panic attacks and anxiety attacks.

These risk factors may include ^[1][4][5][7]:

• Genetics: Many people who experience panic attacks or anxiety attacks have a family member with an anxiety disorder, indicating that a family history of these types of conditions greatly increases the risk.
• Biology: Research suggests that people who experience panic attacks or anxiety disorders may have an imbalance of certain neurotransmitters and chemicals, such as GABA and serotonin, as well as an increase in activity in certain areas of the brain, such as the amygdala, indicating that these abnormalities can contribute to these conditions.
• Traumatic event: Traumatic events in childhood and/or adulthood have been shown to increase the risk of anxiety disorders and panic attacks.
• Stress: Anxiety and panic attacks can occur as a result of life stressors, such as moving houses, relationship problems, and work-related stress.
• Prior attacks: Many people who experience anxiety and panic attacks fear the onset or reoccurrence of these symptoms, which can potentially cause an attack. Also, the onset of a symptom, such as racing heart or stomachache, could cause a fear of an attack occurrence, even if this symptom is due to another cause.
• Other mental health conditions: Many people who experience anxiety or panic attacks also have another mental health condition, such as obsessive-compulsive disorder (OCD) or depression, indicating that coexisting conditions may cause or exacerbate one another.
• Substances: Use or withdrawal of substances such as caffeine, alcohol, cigarettes, and illicit drugs can all contribute to the development of panic attacks and anxiety symptoms.
• Medications: Similarly, there are several types of prescribed medications that may also contribute to these symptoms or worsen prior anxiety disorders.

Treatment for panic attacks and anxiety attacks

Panic attacks and anxiety attacks are typically treated with the same medications and therapies, although this may vary slightly depending on the condition in which the attack occurs.

Medication

Medications used in the treatment of panic attacks and anxiety disorders can include ^[1][2][5][8]:

• Antidepressants: Various types of antidepressants, but particularly selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, citalopram, and sertraline, are used in the treatment of various anxiety disorders and are typically effective at reducing symptoms of anxiety and associated emotional responses.
• Antihistamines: Hydroxyzine is an antihistamine that is approved for the treatment of anxiety disorders. It can help to improve mood and reduce anxiety symptoms, as well as producing a sedating effect that can help with sleep.
• Benzodiazepines: Benzodiazepines, such as lorazepam, diazepam, and clonazepam, are often used in the short-term treatment of anxiety, as they are very fast-acting so provide an almost instant relief of distressing and extreme symptoms, particularly those of a panic attack. However, they should not be used as a long-term treatment because of their risks and potential for abuse and addiction.
• Beta-blockers: Beta-blockers, such as propranolol, are a type of heart medication which have been found to be effective at reducing certain symptoms of anxiety, such as racing heart and trembling, so can be prescribed off-label for anxiety and panic attacks.

Therapy

Various types of therapy can be useful in managing anxiety and panic attacks, including ^[1][4][8]:

• CBT: Cognitive behavioral therapy can help to reduce the severity or occurrence of these symptoms by teaching ways to tolerate distress, changing negative thoughts and behaviors, and providing a better understanding of the condition in which anxiety and panic attacks occur.
• Exposure therapy: Exposure therapy is generally effective at treating anxiety and trauma-related conditions, by providing a gradual exposure to a feared situation or symptom, helping to desensitize and increase tolerance, reducing distressing emotional and physical responses.

Self-help

Symptoms of anxiety and panic attacks can potentially be reduced or managed by ^[1][2][7][9]:

• Relaxation activities: Breathing exercises, mindfulness, yoga, or meditation can help in managing symptoms of anxiety, as well as helping to reduce extreme symptoms during a panic attack.
• Reducing or avoiding caffeine and alcohol: It is advisable to avoid substances that can worsen or create these symptoms, such as caffeine, alcohol, and cigarettes.
• Having a healthy lifestyle: Eating a healthy diet, engaging in regular exercise, and maintaining a regular sleep cycle can all help to improve physical and mental wellbeing, thereby reducing the occurrence of attacks.
• Learning triggers: Keeping a diary or recording information around the occurrence of anxiety and panic attacks can help in recognizing triggers, which can be useful in managing and preventing the onset of distressing symptoms, as well as helping to prevent avoidant behaviors.