What’s the Difference Between an Anxiety Attack and a Panic Attack?
You probably use the terms panic attack and anxiety attack interchangeably, like when venting about a big work deadline or reenacting your Taylor Swift ticket saga. But the truth is, you aren’t using either term correctly. Anxiety attacks aren’t a real clinical thing—there’s no such diagnosis in the DSM-5, or Diagnostic and Statistical Manual of Mental Disorders (more on that below). And panic attacks are fast, furious episodes of full-body terror—not a catchall phrase for feeling super-stressed. Here’s how to recognize the signs of a panic attack, understand what is happening in your body, and bring yourself back down.
What it is: A panic attack is defined as four or more of the 13 physical and cognitive (thought-related) symptoms listed below, and it comes on spontaneously or in relation to a stressful event, like giving a speech. “The symptoms typically hit more or less all at once and peak within 10 minutes,” says Ellen Hendriksen, PhD, a clinical psychologist at Boston University’s Center for Anxiety and Related Disorders and the author of How to Be Yourself. “It’s sudden, intense, and very physical.” Along with the most common—heart palpitations, sweating, trembling, and feeling like you can’t breathe—you might experience fear of losing control (“like I’m going to take off all my clothes and run screaming through the street”) or a fear that you’re going crazy, or worse, that you’re dying. Symptoms like derealization cause people to believe things are unreal (“The world is just a movie”), while depersonalization is a detachment from the self (“This is not really my hand”). This surge of symptoms is very difficult to manage alone, which is why people having a panic attack often rush to the hospital. One common concern: “Am I having a heart attack?”
Heart palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded, or faint
Derealization or depersonalization
Fear of losing control or “going crazy”
Fear of dying
Paresthesia (numbness or tingling)
Chills or heat sensations
What it isn’t: While panic attacks have a clinical definition, heightened anxiety— the intense, uncomfortable feeling we often call an anxiety attack—can take many forms. “Some people manifest it physically, meaning they somaticize; some people manifest it as worry; and some people channel it into action, like when my husband is anxious, he cleans the house,” says Hendriksen. One differentiator between heightened anxiety and a panic attack, says Jeanette M. Bennett, PhD, an experimental health psychologist and researcher at the University of North Carolina, Charlotte, is your level of control. If someone is hyper-anxious and their heart is racing and their breathing rate is up but they can get up from their desk, go for a walk, and feel better, then what they are likely experiencing is heightened anxiety.
What to do in the moment: If you’ve never had a panic attack before and suddenly feel chest pain, shortness of breath, or upper body discomfort, go to the emergency room to confirm that what you’re feeling isn’t a heart attack. If you’ve had them before, use these tips from Hendriksen to de-escalate an episode:
1. Talk yourself down. Remind yourself, This is a panic attack, and that you’ve been through this before. Really drive home the messaging that while this is uncomfortable, it’s not dangerous.
2. Breathe very slowly. Imagine blowing a bubble through a bubble wand—if you blow too hard, it will pop. “Your body systems are a package deal. By slowing your breathing, you can also slow the others,” says Hendriksen.
3. Do a mini cold plunge. Hold your breath for 30 seconds while pressing a frozen compress to your eyes. Even better, submerge your face in a sink full of ice water. “This triggers the dive reflex by mimicking a fall into a cold body of water and shuts down non-survival-related functions, including strong emotion,” says Hendriksen.
How to manage in the long run: If you limit your life due to panic attacks (e.g., you stop going to the gym or driving), it’s time to get treatment. “You need a two-pronged approach,” says Bennett, who adds that because of their intensity, using drugs such as benzodiazepines or SSRIs provides relief (either at the onset of an attack or regularly), depending on the patient’s experience. “But that’s only a Band-Aid,” she says. While pharmacology manages the physical or biological aspect, cognitive therapy is the most effective at altering the way the mind reacts.
One form of cognitive behavioral therapy that’s very successful is interoceptive exposure therapy, where a clinician exposes the patient to whatever physical sensation starts the cascade, like a racing heart. (In that case, they might ask the person to do high knee raises to get their heart going, then confront that fear.) “If they can do that and get used to it, when it does happen out of the blue, ideally, they’ll think, Oh, this old thing, and move through it,” says Hendriksen. The upshot: Panic attacks are a treatable condition, not a life sentence.
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