Anxiety disorders are some of the most common mental health conditions, and panic disorder is a specific type of anxiety disorder. Unexpected, sudden panic attacks characterize panic disorders. However, anxiety attacks are not described as an official symptom or disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the handbook most commonly used by U.S. mental healthcare professionals.
However, in contrast, the term anxiety attack is often used to describe an acute expression of someone's anxiety, brought about in anticipation of or in response to something that causes stress or worry.
This article will define panic and anxiety attacks and their causes, risk factors, and diagnostic criteria. It will also provide options for treatment and lifestyle changes to reduce and cope with symptoms.
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How Do I Know If I’m Having a Panic or Anxiety Attack?
Though they can feel similar, there are some key differences between panic and anxiety attacks. Panic attacks tend to come on quickly, often without warning, are very intense, and last only a few minutes. In contrast, anxiety attacks often occur in anticipation of something that causes extreme worry or is perceived as a danger, such as during an elevator ride.
Another difference is that panic attacks are accompanied by an intense physical reaction, such as chest tightening and difficulty breathing, and they sometimes cause a person to feel as though they are dying.
The main characteristic of panic attacks is that they come on suddenly and often unexpectedly. They involve an abrupt feeling of intense fear or discomfort that usually subsides within a few minutes. The symptoms experienced during a panic attack differ from person to person or from situation to situation.
- Palpitations, pounding heart, or accelerated heart rate
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- Chills or heat sensations
- Numbness or tingling
- Feelings of unreality or being detached from oneself
- Fear of losing control or "going crazy"
- Fear of dying
Causes and Risk Factors
There isn't a single cause of a panic disorder or panic attacks, and they are likely to be triggered by different things for different people. Some common risk factors include:
- Genetics or a family history of anxiety disorders
- Other mental health issues and diagnoses, such as mood disorders
- Substance use issues
- Major life stressors
- Certain medical conditions
Panic attacks are not uncommonly diagnosed in the emergency department of hospitals, as the physical symptoms, like a racing heart, chest pain, and dizziness, may prompt an assessment for possible emergency medical conditions. Though they can be scary, panic attacks are not life-threatening, and a healthcare provider can rule out medical conditions such as heart disease.
Once a physical cause for the symptoms has been ruled out, a mental healthcare provider can diagnose panic disorder and panic attacks. To diagnose a panic attack, there needs to be an abrupt surge of intense fear or discomfort that peaks within minutes, accompanied by at least four other physical and emotional symptoms.
For panic disorder, there must be recurrent attacks and a persistent concern about additional attacks or their consequences, resulting in related, maladaptive behavioral changes.
There are many types of anxiety disorders, such as generalized anxiety disorder (GAD), social anxiety disorder, and phobias. Anxiety disorders are typically characterized by excessive worry related to a specific situation, like being in small spaces or being generalized to many situations.
Sometimes, people will experience an onset of anxiety-related symptoms in response to, or in preparation for, a specific situation. Though an anxiety attack is not a diagnosable mental disorder, these acute symptoms may be characterized in that way.
When to Seek Support for Anxiety
Regardless of how anxiety presents, seeking mental health support is important for anyone who experiences anxiety that interferes with their daily life.
Each type of anxiety disorder causes different symptoms. The types of anxiety disorders outlined in the DSM-5 include:
- Generalized anxiety disorder (GAD)
- Panic disorder
- Agoraphobia (a fear of certain situations or places)
- Social phobia, also called social anxiety disorder
- Separation anxiety disorder
- Selective mutism (an anxiety disorder in which people, generally children, can't speak in certain social situations)
As an example, the symptoms of GAD include persistent and excessive anxiety and worry about numerous events or activities lasting greater than six months and accompanied by three or more of the following symptoms:
- Feeling keyed up or on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Muscle tension
- Difficulty falling or staying asleep
When a person experiences one or more of these anxiety-related symptoms, they might refer to it as an anxiety attack.
Causes and Risk Factors
A certain amount of anxiety is a normal part of life and is meant to keep us safe. Anxiety doesn't generally require treatment unless it interferes with a person's development or daily life.
Causes of excessive anxiety might include:
- Family history of anxiety
- Chronic illness
- Specific experiences, like a relationship ending or the death of a loved one
- Financial difficulty
- Certain personality traits
Prevalence of Anxiety Disorders
Anxiety disorders are among the most prevalent chronic illnesses around the world significantly impacting people's lives. Among anxiety disorders, specific phobias are the most common.
Anxiety disorders each require different criteria for a formal diagnosis. However, although anxiety attacks are not outlined in the DSM-5, a mental healthcare professional might describe symptoms as an anxiety attack when they occur in anticipation of or response to a perceived threat.
What to Do During an Anxiety or Panic Attack
When acute anxiety or panic attack symptoms begin, several things can be done in the moment to help. These include:
- Grounding exercises: Do something to keep yourself grounded in the present moment and your current environment to avoid being overcome by worry or fear. Try looking around and naming everything you see of a certain color.
- Relaxation: Deep breathing or other relaxation exercises will help slow your heart rate and calm your breathing. Try drawing an invisible box in the air with your finger, and every time you make a new line, alternate between breathing in, holding your breath, and breathing out.
- Distraction: Try something to take your mind off the symptoms. Getting exercise or picturing a calming place, like the beach or nature, can serve as a temporary distraction.
Medication, psychotherapy, or a combination of both is recommended for anxiety and panic attacks.
For severe symptoms, your healthcare provider may prescribe medication. The most common and effective family of drugs for anxiety and panic disorders are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
- Cymbalta (duloxetine)
- Effexor XR (venlafaxine)
Research shows that psychotherapy is as effective as medication in reducing anxiety and panic disorder symptoms, including panic attacks. Though the type of therapeutic intervention and treatment plan will vary depending on the individual, the most common and effective approaches used to treat anxiety and panic disorder symptoms include:
- Cognitive behavioral therapy (CBT): This approach examines and challenges a person's maladaptive thoughts and behaviors.
- Mindfulness-based approaches: This approach teaches a person to become aware of the connection between thoughts, feelings, and the body and to stay in the present moment.
- Acceptance and commitment therapy (ACT): This approach encourages techniques to change how you relate to your physical sensations and anxiety itself.
- Panic-focused psychodynamic psychotherapy (PFPP): This approach explores maladaptive defense mechanisms and conflicts in relation to uncomfortable emotions that contribute to anxiety and panic.
Though these are the most common approaches, others may also be helpful. Work with a mental healthcare provider to determine the most effective modality for you.
Certain activities, behaviors, or environmental factors may contribute to worsening anxiety or bringing on panic attacks. Identifying the things that trigger symptoms can help bring some relief. Common contributors to anxiety and/or panic disorder symptoms include:
- Lack of sleep
- Not enough physical activity
There also may be specific scenarios that bring on anxiety or panic attacks. Keeping a journal that tracks situations and symptoms can shed light on themes and patterns.
Anxiety and panic attacks are hard to cope with alone. Research shows that having a strong social network contributes to resilience and helps protect against anxiety and panic disorder symptoms.
Panic and anxiety attacks cause symptoms that can bring about significant discomfort. Panic attacks tend to come on very quickly, often without warning, are very intense, and last only a few minutes. Anxiety attacks usually come on in response to, or anticipation of, something that causes worry or stress.
The specific symptoms of panic or anxiety attacks may vary from person to person. Genetics, family history, environmental factors, and physical or other mental illnesses can cause anxiety and panic attacks.
During an anxiety or panic attack, relaxation exercises, grounding techniques, and distraction can help ease symptoms. Long-term treatment might include medication, psychotherapy, or a combination of both. Certain lifestyle changes, like reducing caffeine and alcohol and increasing physical activity and sleep, can also help.
Frequently Asked Questions
Which is worse, panic attacks or anxiety attacks?
For many people, panic attacks are more intense than anxiety attacks because they come on without warning, include more physical symptoms, and may not have a clear trigger. While panic and anxiety attacks can be highly distressing, neither are life-threatening.
What does a panic attack feel like?
Panic attacks often include a combination of physical symptoms like shaking, sweating, dizziness, and chest pain, along with emotional symptoms like feelings of doom, dread, or a fear of dying.
How long do anxiety and panic attacks last?
Panic attacks usually come on abruptly and commonly last a few minutes. Anxiety attacks tend to last longer and generally occur in response to, or anticipation of, something that is experienced as a possible danger or worry.