By HAYDEN FINCH, PhD
I often hear the terms “panic attack” and “anxiety attack” being used interchangeably, and until a few weeks ago, this never really bothered me. In my head, they mean different things, but I know what people mean when they talk about either a panic attack or an anxiety attack, so making the distinction didn’t seem to matter. And then one of my clients, who has panic attacks, described to me how invalidated he feels when others, who have anxiety, claim to understand first-hand what he is experiencing. Suddenly the importance became clear to me.
For sure, both panic and anxiety are debilitating and deserving of treatment. But claiming to know what one is like when you have the other is not only incorrect, it can be insensitive. That’s not to suggest panic is worse than anxiety or vice versa — both can be equally problematic in their own way. So in the interest of making sure we don’t accidentally invalidate each other, let’s learn to distinguish between anxiety and panic.
“And then one of my clients, who has panic attacks, described to me how invalidated he feels when others, who have anxiety, claim to understand first-hand what he is experiencing. Suddenly the importance became clear to me.”
Let’s start with the basics. The DSM-5, which is the diagnostic manual psychologists and psychiatrists use (for better or for worse…), defines very specifically what a panic attack is. It does not define an anxiety attack, and in that sense, an anxiety attack isn’t really a thing. By the DSM’s definition, a panic attack is an abrupt surge of intense fear or intense discomfort that peaks within 10 minutes and then subsides. The symptoms include at least four of the following:
- 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. light-headed, or faint
- Chills or heat sensations
- Numbness or tingling sensations
- Feelings of unreality or feelings of being detached from oneself
- Fear of losing control or “going crazy”
- Fear of dying
Anxiety attacks are usually triggered by something stressful or threatening. So, consider a person with a fear of elevators being shoved into an elevator. Or a person with social phobia entering a job interview. Or someone with generalized anxiety whose daughter is not home at her curfew. By contrast, panic attacks CAN be triggered by something in the environment (like those examples) but more often come out of the blue. Like you’re just lying in bed, minding your own business, trying to go to sleep and BAM! Panic attack. The physical symptoms ramp up immediately, whereas in an anxiety attack they build more gradually (though sometimes it feels very, very quick).
Whereas anxiety can be mild, moderate, or severe, panic attacks are very severe and disruptive. The person having a panic attack is seized with terror, fear, and apprehension. They suddenly feel extremely intense fear, and sometimes panic attacks are mistaken for a heart attack and people seek emergency services because they believe they are having a true medical emergency. Most people having an anxiety attack know they are freaking out because they’re worried about something identifiable, and the symptoms tend to be somewhat less intense than those seen in a panic attack.
With panic attacks, the attack is so terrifying that people often begin worrying about having future attacks. With anxiety, because most people know what caused the attack, they don’t typically worry about another attack (though they might worry about having anxiety in general). Anxiety symptoms usually tend to be persistent and long-lasting, but with panic the symptoms themselves don’t linger, it’s just the worry about the symptoms coming back that lingers.
There are also some distinguishing symptoms. Anxiety is more likely to come with sleep problems, fatigue, muscle tension, irritability, restlessness, and worry than panic. And panic is more likely to come with feeling disconnected from yourself (like watching your life as though it’s a movie) and your surroundings and a fear of dying than anxiety.
Check out this YouTube video by Marlena Stell, owner of the cosmetics company Makeup Geek, who describes a panic attack.
Whether you have anxiety, panic attacks, or both, you should know treatment is available. The treatment for Panic Disorder (where you have had at least one panic attack and then are consumed with worrying about future attacks) is somewhat different than the treatment for other anxiety conditions, so it’s important to notice your symptoms and describe them as completely as you can to your psychologist. Also, some medical conditions can cause symptoms that are very similar to those listed above, so it’s a good idea to get checked out by a physician just to make sure you’re not dealing with a medical condition that hasn’t been treated. Assuming it’s anxiety or panic and not a medical condition, step one is to find yourself a good psychologist. There are pharmacological approaches that can also be considered, but (especially for panic), it’s usually advised to have a psychologist on your team as well who can teach you more long-term coping options.
Hayden C. Finch, PhD,
is a practicing psychologist
in Des Moines, Iowa.
