Usually the terms panic attack and anxiety attack are used interchangeably in our culture. However, they actually refer to two very different but related things. To further complicate this matter, it’s not uncommon for mental health and medical professionals to also misunderstand this difference.
Why does this matter? Well, in terms of everyday conversations (e.g., talking with a friend about how you’re feeling), it probably doesn’t matter that much. However, in terms of understanding personal symptoms and options for anxiety counseling, it does matter quite a bit. People who understand the difference can more accurately describe their anxiety experiences and can better understand their options for treatment. Also, mental health professionals are better able tailor treatment to address the most important clinical issues at play.
So, what’s a panic attack?
Well panic attack is a clinically defined term. It’s found in the DSM-5 (the big boring book of mental health disorders) and is used for diagnosing panic disorder. The key point here is that panic attacks often feel unprovoked. They usually feel like they are coming “out of the blue” – a sudden rush of fear. They are accompanied by intense physical sensations, strong feelings of wanting to escape or get away from the situation where they occur, and a sense of impending doom (feeling as if something REALLY bad is going to happen).
It usually happens without a trigger and does not involve a growing, escalating feeling of anxiety. For example, if you are anxious about something going on in your life (unpaid bills, your children, worrying incessantly) which gradually becomes worse, and you then get to the point of severe anxiety, that isn’t a panic attack. The reason it isn’t a panic attack is because it does not have a sudden onset and doesn’t feel “out of the blue” (even if some of the symptoms are similar).
The following list are some of the physical sensations that often accompany panic attacks:
- Pounding or racing heart
- Chest pain or discomfort
- Shortness of breath or sensations of smothering
- Trembling or shaking
- Feeling of choking
- Dizziness, feeling unsteady, feeling faint
- Nausea or abdominal distress
- Hot flashes or chills
- Fear of dying (e.g., fear of having a heart attack)
- Fear of going crazy
- Fear of doing something uncontrolled
Studies have shown that panic attacks occur in a large portion of the population (between 10% and 33% of the population in a given year). However, having a panic attack does not equal having panic disorder. In fact, if you have periodic panic attacks but still manage to carry on with your life relatively unaffected, you don’t have a diagnosable condition.
Having panic disorder also requires that the rest of your life be disrupted by ongoing fear of having another panic attack. For instance, you might worry you’re going to die, lose control, go crazy, etc. You also might start avoiding places and situations where you have had panic attacks in the past or avoid going places where it would be difficult to get away if you did have a panic attack.
So, what’s an anxiety attack?
Well, an anxiety attack is related but different. Anxiety is a clinically defined term, though technically anxiety attack is not. The key point here is that anxiety is usually experienced as worry – ongoing, ruminative worry. When this worry gets to the point of being severe or debilitating, this could be referred to as an anxiety attack (or an attack of anxiety). However, the trigger here is known. Additionally, the anxiety grew over time. For example, you may be worried and overwhelmed by all of the things going on in your life. This worry might get to the point where you have an anxiety attack.
Attacks of anxiety might include some of these physiological sensations and cognitive experiences:
- Inability to stop worrying even if it doesn’t help you solve anything
- Worrying as an attempt to get rid of anxiety (trying to worry yourself out of your worry)
- Restlessness or feeling keyed up
- Muscle tension
- Difficulty concentrating
- Irritability or edginess
- Difficulties with sleep
- Increased startle response
- Increased heart rate
- Shortness of breath
The key here is that the anxiety doesn’t feel “out of the blue”, instead it’s in reaction to things in the person’s life that they are worrying about. People with this type of anxiety might have what we know as Generalized Anxiety Disorder, it may be in reaction to a previous trauma, or it may be part of a different anxiety disorder. The specific diagnosis/label is way less important than understanding the difference in symptoms, because it changes how treatment is done.
So, why does this difference matter?
Well, for starters, it’s always nice to have accurate information about what you deal with. While simply knowing this doesn’t take the anxiety or panic away, there might be some comfort in having a good understanding of your symptoms. You will also be more prepared to describe your experiences and discuss treatment options with your mental health provider.
Next, understanding this distinction is important because it changes the way that therapy is done. A cognitive behavioral therapist who understands this difference and understands evidence-based anxiety treatment can tailor his or her approach to your unique needs.
For example, the thing that is unique to panic disorder (and, in fact, maintains it and makes it worse over time) is that it involves intense fear of further panic attacks. Therefore, a therapist using evidence-based treatments will work with clients on dealing with and overcoming this specific fear. This may involve what we call interoceptive exposure (gradually exposing ourselves to the bodily sensations that are experienced during panic attack), among other things. When done correctly, this can drastically improve a client’s experience of their symptoms.
Likewise, a behavioral therapist using evidence-based treatment for intense attacks of anxiety and worry will be able to tailor treatment to the unique needs of their client. This therapist would be more likely to work directly with the client’s thoughts and feelings of what is going on in their life that they are worrying about.
These difference are very important, and unfortunately not always understood completely. Remember that evidence-based treatment of anxiety is one of the most effective forms of treatment that we have for anything. If you suffer from anxiety or panic, please remember that there are effective treatments available and that you deserve to live a life not ruled by your symptoms.