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Panic Attack vs. Anxiety Attack: Things to Know
Feelings of fear, dread or unease can be paralyzing. Identifying your symptoms — and knowing help is available — is key to recovery.
When you feel a sudden rush of nerves or high emotion, it’s likely that your body responds in turn. Sweating, shakiness or feelings of nausea, among other things, might occur.
Such discomfort, particularly if the sensations are new, could prompt a person to ask: Am I experiencing a panic attack? Or is it an anxiety attack?
It’s likely you’re experiencing either anxiety or a panic attack.
Anxiety is a condition defined as excessive, persisting worry over an imminent event such as death or illness, or even minor events such as being late for an appointment or other uncertain outcomes. Symptoms include fatigue, hypervigilance, restlessness and irritability — and are often chronic.
Panic attacks, on the other hand, are short bursts of intense fear often marked by increased heart rate, brief chest pain or shortness of breath. Typically lasting fewer than 30 minutes, they could occur once or repeatedly — sometimes without reason. These episodes can send patients to the emergency room, as they are sometimes mistaken for a heart attack.
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What is the difference between a panic attack and anxiety?
Anxiety is basically what we experience when we are worrying about some future event — anticipating a bad outcome that might happen. It’s often involved with muscle tension and a general feeling of uneasiness. And it usually comes on gradually.
A panic attack is different. It’s associated with a very abrupt onset of intense fear because of a sense of threat happening right now, the fight-or-flight response that we’re hardwired to have in order to deal with immediate danger. It sets off that alarm.
When might one or the other occur?
So if you’re walking down a dark alley, you are probably thinking that there could be potential danger; that anxiety of anticipation, the feeling in your stomach, the elevated heart rate. But if you’re walking down that alley and somebody jumps out with a knife, then you’re likely to have a panic attack — an overwhelming urge to escape a situation that is dangerous.
Panic attacks also can be triggered by subtler cues, like certain bodily sensations. A person could have a pain in the chest and interpret that as a heart attack. Or they feel lightheaded and think they’re having a stroke.
How do our bodies decide which reaction is appropriate?
Biologically, panic attacks are associated with the autonomic nervous system and the amygdala — places designed to detect threat and danger. And anxiety is associated with the prefrontal cortex, which has to do with planning and anticipating.
Could both conditions occur at once?
Yes. A person might be really anxious about going to a party. Sometimes, then, when they go into those situations, they’ll have a panic attack on top of the anxiety because they perceive the situation as potentially dangerous psychologically: Are they going to judge me?
Are certain individuals more susceptible? Which condition is more common?
People are hardwired to experience both anxiety and panic attacks. Some are more prone to worry and anxiety because they have a very sensitive nervous system. If they grow up with others who are worriers, they can learn to worry.
Clinically, we probably see more patients dealing with anxiety than panic attacks. That’s because anxiety is so much a part of people’s normal emotional lives. They can feel anxious in a lot of different situations.
How do you help affected patients?
With anxiety to the point where it’s part of a disorder — let’s say generalized anxiety disorder, mostly characterized by anxiety and worry about a whole bunch of different situations — we would treat it by teaching a patient about the role of worry in creating the symptoms and how to manage the worry. That sometimes involves challenging unrealistic thoughts or working to increase one’s ability to tolerate uncertainty, which is a big part of anxiety.
For the socially anxious, we usually come up with a hierarchy from the least- to most-scary types of situations and systemically get them to go out and test their fears of what might happen.
With panic attacks, we might show them a diagram and explain the fight-or-flight response; their mind or body is trying to help them. If you’ve had a panic attack that came out of the blue, you might become afraid of lightheadedness and avoid activities that spur adrenaline. So we might hyperventilate for a minute in a controlled way to get to the point where they’re not afraid of their own bodily sensation. We work on internal avoidance of those cues that become scary, and desensitize them.
It doesn’t mean a patient will never be anxious again, but there is good evidence that they can get over these conditions if they engage in treatment. A lot of it depends on how severe the disorder is.
Panic Attacks and Panic Disorder
Symptoms, Treatment, and Self-Help Tips
If you’ve ever experienced a sudden surge of overwhelming anxiety and fear then you’re familiar with the feeling of having a panic attack. Your heart pounds, you can’t breathe, and you may even feel like you’re dying or going crazy. Left untreated, panic attacks can lead to panic disorder and other problems. They may even cause you to withdraw from normal activities. But panic attacks can be cured and the sooner you seek help, the better. With the right treatment and self-help, you can reduce or eliminate the symptoms of panic, regain your confidence, and take back control of your life
What is a panic attack?
A panic attack is an intense wave of fear characterized by its unexpectedness and debilitating, immobilizing intensity. Panic attacks often strike out of the blue, without any warning, and sometimes with no clear trigger. They may even occur when you're relaxed or asleep.
A panic attack may be a one-time occurrence, although many people experience repeat episodes. Recurrent panic attacks are often triggered by a specific situation, such as crossing a bridge or speaking in public—especially if that situation has caused a panic attack before. Usually, the panic-inducing situation is one in which you feel endangered and unable to escape, triggering the body’s fight-or-flight response.
You may experience one or more panic attacks, yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder, social phobia, or depression. Regardless of the cause, panic attacks are treatable. There are strategies you can use to cope with the symptoms as well as effective treatments.
Paula had her first panic attack six months ago. She was in her office preparing for an important work presentation when, suddenly, she felt an intense wave of fear. Then the room started spinning and she felt like she was going to throw up. Her whole body was shaking, she couldn’t catch her breath, and her heart was pounding out of her chest. She gripped her desk until the episode passed, but it left her deeply shaken.
Paula had her next panic attack three weeks later, and since then, they’ve been occurring with increasing frequency. She never knows when or where she’ll suffer an attack, but she’s afraid of having one in public. Consequently, she’s been staying home after work, rather than going out with friends. She also refuses to ride the elevator up to her 12th floor office out of fear of being trapped if she has a panic attack.
Panic attack signs and symptoms
The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. They rarely last more than an hour, with most ending within 20 to 30 minutes. Panic attacks can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or even sitting on the couch at home.
Panic attack symptoms include:
- Shortness of breath or hyperventilation
- Heart palpitations or racing heart
- Chest pain or discomfort
- Trembling or shaking
- Choking feeling
- Feeling unreal or detached from your surroundings
- Nausea or upset stomach
- Feeling dizzy, light-headed, or faint
- Numbness or tingling sensations
- Hot or cold flashes
- Fear of dying, losing control, or going crazy
Is it a heart attack or a panic attack?
Most of the symptoms of a panic attack are physical, and many times these symptoms are so severe that you may think you’re having a heart attack. In fact, many people suffering from panic attacks make repeated trips to the doctor or the emergency room in an attempt to get treatment for what they believe is a life-threatening medical problem. While it’s important to rule out possible medical causes of symptoms such as chest pain, elevated heart rate, or difficulty breathing, it’s often panic that is overlooked as a potential cause—not the other way around.
Signs and symptoms of panic disorder
While many people experience just one or two panic attacks without further episodes or complications—and there’s little reason to worry if that’s you—some people go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks.
You may be suffering from panic disorder if you:
- Experience frequent, unexpected panic attacks that aren’t tied to a specific situation
- Worry a lot about having another panic attack
- Are behaving differently because of the panic attacks, such as avoiding places where you’ve previously panicked
While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:
Anticipatory anxiety – Instead of feeling relaxed and like your normal self in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This “fear of fear” is present most of the time, and can be extremely disabling.
Phobias and Irrational Fears: Recognize, Treat, and Overcome Them
Phobic avoidance – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia.
Panic disorder with agoraphobia
Agoraphobia was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks and panic disorder. Although it can develop at any point, agoraphobia usually appears within a year of your first recurrent panic attacks.
If you’re agoraphobic, you’re afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You may also be afraid of having a panic attack where you wouldn’t be able to get help. Because of these fears, you start avoiding more and more situations.
For example, you may begin to avoid:
- Crowded places such as shopping malls or sports arenas.
- Cars, airplanes, subways, and other forms of travel.
- Social gatherings, restaurants, or other situations where it would be embarrassing to have a panic attack.
- Physical exercise in case it triggers panic.
- Certain food or drinks that could provoke panic, such as alcohol, caffeine, sugar, or specific medications.
- Going anywhere without the company of someone who makes you feel safe. In more severe cases, you might only feel safe at home.
Causes of panic attacks and panic disorder
Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, or having a baby. Severe stress, such as the death of a loved one, divorce, or job loss can also trigger panic attacks.
Panic attacks can also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of panic, it’s important to see a doctor to rule out the following possibilities:
- Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn't close correctly
- Hyperthyroidism (overactive thyroid gland)
- Hypoglycemia (low blood sugar)
- Stimulant use (amphetamines, cocaine, caffeine)
- Medication withdrawal
Self-help tips for panic attacks
No matter how powerless or out of control you may feel about your panic attacks, it’s important to know that there are many things you can do to help yourself. The following self-help techniques can make a big difference to helping you overcome panic:
Learn about panic and anxiety. Simply knowing more about panic can go a long way towards relieving your distress. Read up on anxiety, panic disorder, and the fight-or-flight response experienced during a panic attack. You’ll learn that the sensations and feelings you have when you panic are normal and that you aren’t going crazy.
Avoid smoking, alcohol, and caffeine. These can all provoke panic attacks in people who are susceptible. If you need help to kick the cigarette habit, see How to Quit Smoking. Also, be careful with medications that contain stimulants, such as diet pills and non-drowsy cold medications.
Learn how to control your breathing. Hyperventilation brings on many sensations (such as lightheadedness and tightness of the chest) that occur during a panic attack. Deep breathing, on the other hand, can relieve the symptoms of panic. By learning to control your breathing, you can calm yourself down when you begin to feel anxious. And if you know how to control your breathing, you're also less likely to create the very sensations that you're afraid of.
Practice relaxation techniques. When practiced regularly, activities such as yoga, meditation, and progressive muscle relaxation strengthen the body’s relaxation response—the opposite of the stress response involved in anxiety and panic. And not only do these relaxation practices promote relaxation, but they also increase feelings of joy and equanimity.
Connect face-to-face with family and friends. Symptoms of anxiety can become worse when you feel isolated, so reach out to people who care about you on a regular basis. If you feel that you don’t have anyone to turn to, explore ways to meet new people and build supportive friendships.
Exercise regularly. Exercise is a natural anxiety reliever so try to get moving for at least 30 minutes on most days (three 10-minute sessions is just as good). Rhythmic aerobic exercise that requires moving both your arms and legs—like walking, running, swimming, or dancing—can be especially effective.
Get enough restful sleep. Insufficient or poor quality sleep can make anxiety worse, so try to get seven to nine hours of restful sleep a night. If sleeping well is a problem for you, these tips to getting a good night’s sleep can help.
Treatment for panic attacks and panic disorder
The most effective form of professional treatment for tackling panic attacks, panic disorder, and agoraphobia is therapy. Even a short course of treatment can help.
Cognitive behavioral therapy focuses on the thinking patterns and behaviors that are sustaining or triggering your panic attacks and helps you look at your fears in a more realistic light. For example, if you had a panic attack while driving, what is the worst thing that would really happen? While you might have to pull over to the side of the road, you are not likely to crash your car or have a heart attack. Once you learn that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying.
Exposure therapy for panic disorder allows you to experience the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. You may be asked to hyperventilate, shake your head from side to side, or hold your breath. These different exercises cause sensations similar to the symptoms of panic. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic.
Therapy for Anxiety Disorders: Your Options
Exposure therapy for panic disorder with agoraphobia includes exposure to the situations you fear and avoid is also included in treatment. As in exposure therapy for specific phobias, you face the feared situation until the panic begins to go away. Through this experience, you learn that the situation isn’t harmful and that you have control over your emotions.
Medication for panic attacks and panic disorder
Medication can be used to temporarily control or reduce some of the symptoms of panic disorder. However, it doesn't treat or resolve the problem. Medication can be useful in severe cases, but it should not be the only treatment pursued. Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder.
Medications used may include:
Antidepressants. It takes several weeks before they begin to work, so you have to take them continuously, not just during a panic attack.
Benzodiazepines. These are anti-anxiety drugs that act very quickly (usually within 30 minutes to an hour). Taking them during a panic attack provides rapid relief of symptoms. However, benzodiazepines are highly addictive and have serious withdrawal symptoms, so they should be used with caution.
How to help someone having a panic attack
Seeing a friend or loved one suffering a panic attack can be frightening. Their breathing may become abnormally fast and shallow, they could become dizzy or light-headed, tremble, sweat, feel nauseous, or think they’re having a heart attack. No matter how irrational you think their panicked response to a situation is, it’s important to remember that the danger seems very real to your loved one. Simply telling them to calm down or minimizing their fear won’t help. But by helping your loved one ride out a panic attack, you can help them feel less fearful of any future attacks.
Stay calm yourself. Being calm, understanding, and non-judgmental will help your loved one’s panic subside quicker.
Focus your loved one on their breathing. Find a quiet place for your friend to sit and then guide them to take slow, deep breaths for a few minutes.
Do something physical. Together, raise and lower your arms or stamp your feet. It can help to burn off some of your loved one’s stress.
Get your friend out of their own head by asking them to name five things around them or talking soothingly about a shared interest.
Encourage your loved one to seek help. Once the panic attack is over, your loved one may feel embarrassed about having an attack in front of you. Reassure them and encourage them to seek help for their anxiety.
Resources and references
Panic Disorder: When Fear Overwhelms – Provides an overview of panic disorder, including the symptoms, causes, and treatment. Includes information on how to manage a panic attack. (National Institute of Mental Health)
Answers to Your Questions About Panic Disorder – Covers the signs and symptoms of panic attacks, the causes of panic disorder, and the effective treatments. (American Psychological Association)
Screening for Panic Disorder – Online test helps determine if you’re experiencing the signs and symptoms of panic disorder. (Anxiety Disorders Association of America)
9 Surprising Depression Symptoms
Watch out for these sneaky signs and learn how to get the help you need.
Most of us would recognize classic signs, with its heavy veil of sadness and hopelessness. But what if you just started getting stomachaches or were suddenly very snappy? Could you be suffering from depression without knowing it? (Here are 5 strange and surprising triggers of the mental condition.)
"Depression doesn’t always look like debilitating sadness," says Richard Kravitz, MD, MSPH, a professor of internal medicine at University of California, Davis. "Patients are reluctant to consider depression as a cause of their symptoms—in part because they may equate it with weakness, but also in part because they simply don’t associate their symptoms with depression."
MORE: 7 Simple Changes To Your Home That Fight Depression
Accurately identifying the problem is key, he adds, because the sooner you get treatment, the easier it will be to return your happy, healthy self. Here are 9 surprising signs of the disease you don’t want to miss.
You're in pain.
Mental illness and pain share some of the same biological pathways and neurotransmitters. About 75% of people who suffer from the blues also deal with recurring or chronic pain, research shows. In a Canadian study published in the journal Pain, people with depression were four times more likely to have intense or disabling neck and low back pain than those without. "When you're in a negative state, you're apt to tune into your body more carefully, and therefore feel any discomforts more acutely," Kravitz explains. (Try these 9 yoga poses guaranteed to boost your mood.) You might also notice other signs like stomachaches and headaches, or just experience greater sensitivity to pain in general. A 2008 study in the Archives of General Psychiatry found that when unhappy people anticipate pain, their brain activity indicates more emotion and less coping, so they're less able to handle the hurt.
Your pants feel snug.
Where did that extra roll come from? Maybe from all the late-night ice cream, you've been inhaling? Or from the frozen dinners you've been eating because you don't feel like shopping or cooking? Although comfort food can raise levels of the mood-boosting brain chemical serotonin, over time emotional eating can lead to weight gain and feelings of guilt and shame, plus it does nothing to treat the underlying cause. A new study in the journal Obesity confirms that high levels of stress and depression make it tough to drop pounds and stick to effective weight-loss strategies. On the flip side, some people may lose weight, as depression zaps appetite.
MORE: 7 Unusual New Treatments For Your Depression
You have a short fuse.
If the slightest mishap sends you into a rage, or grouchy is your new normal, you may be in a blue funk. In a 2013 study published in the journal JAMA Psychiatry, 54% of people with depression reported feeling hostile, grumpy, argumentative, foul-tempered, or angry. "Once you’re on the negative side of the house, you're more accessible to the rooms where other negative moods hang out—irritability, frustration, and anger," says Simon Rego, PsyD, associate professor of clinical psychiatry and behavioral sciences at Albert Einstein College of Medicine and director of psychology training at Montefiore Medical Center. "You're not directly there, but it's a short walk."
MORE: Just One Workout A Week Can Improve Your Mood
You feel nothing.
Feeling blah? Neutral? Numb? "Most of us have motivations that get us out of bed in the morning, whether it's work, exercise, socializing, or making breakfast," says Rego. "But for people who are depressed, those pulls dry up." And things that once brought tears or smiles now barely register. This kind of zombie behavior is a hallmark sign of mental illness, and it can make you seem cold, distant or aloof, pushing away the people who would otherwise give you love and support.
Your evening cocktail is now three.
If you're having several glasses of alcohol every night, it's probably more than a rough day at work. (Are you overdoing it? Check out these 6 sneaky signs you drink too much.) Nearly one-third of people with depression also have an alcohol problem, research shows. And though one drink can take the edge off, a second or third can amplify negative emotions—anger, aggressiveness, anxiety, and greater sadness. It's important to note: You don't have to be an alcoholic to be abusing alcohol. The healthy limit, according to the U.S. Department of Health and Human Services, is one drink per day for women, and two drinks per day for men.
This is your body on alcohol:
...or gambling or shopping. Basically doing anything in excess, especially online can be a sign of depression. Several studies confirm that people who go online compulsively and have more virtual social interactions than real ones may be depressed. They may feel deprived of real human companionship and/or may be using the online world to escape from their thoughts and feelings. While Internet addiction and depression are separate diagnoses, they often overlap. "The quest for a short-term boost is a common coping mechanism," says Rego.
Your head is in the clouds.
Daydreaming a lot lately? About becoming a movie star, falling madly in love, how your friend's kid is smarter than yours, or the boss has it in for you? Psychologists from Harvard University have shown that we're happiest when our minds are firmly rooted in the present moment, and when our minds wander, it can make us wistful, anxious, and unhappy. (Here's how to become more mindful—no matter how crazy your life is.) While daydreaming can help find creative solutions to problems, more often than not it's linked to signs of a low mood.
You can't make up your mind.
We make upwards of 70 conscious decisions every day, Columbia University research shows, and most of them are no-brainers. Snooze or wake up? Get dressed or stay in pajamas? Eat oatmeal or eggs? (Find out what happened when one Prevention editor ate oatmeal every morning for a month.) Read or watch TV? "When we’re depressed, those cognitive processes take a big hit," says Rego. "Little things we normally don't think twice about suddenly become weighty decisions."
You've stopped combing your hair.
Even if your grooming routine was modest to begin with, it may disappear when you're depressed. In a 2014 survey of more than 10,000 people, 61% who had poor oral health reported suffering depression. And the more dental issues they had, the more severe the problem was. "It's a spectrum," says Rego. "Neglecting your physical wellbeing and appearance is only problematic when it crosses over into distress or dysfunction." Ultimately, not caring what you look like on the outside is a strong sign of problems happening on the inside.
Panic Stations: Coping with Panic Attacks – Self-help series of workbooks offers strategies, exercises, and activities that teach you how to manage panic attacks. (Centre for Clinical Interventions)
Mastering Panic – Offers step-by-step, self-help tips for overcoming panic attacks and panic disorder. The tips are based on cognitive behavioral therapy. (Agoraphobia and Panic Disorder Foundation)
Self-Help for Panic Attacks – Use the left-hand menu on this website to navigate through a wealth of self-help tips for coping with and reducing panic attacks. (Anxieties.com)
Overcoming Agoraphobia – Describes helpful cognitive techniques for overcoming agoraphobia and what to do if you have a panic attack.