Panic Attacks vs. Anxiety Attacks: What Is the Difference?

By Irmanie Hemphill, MD, FAAFP
Medically reviewed
August 2, 2021

Both panic attacks and anxiety attacks are periods of heightened fear, discomfort, or nervousness, usually accompanied by feeling shaky, sweaty, trembly, dizzy, and nauseous.

Many people use the terms interchangeably to describe these experiences.

However, according to the manual that mental health professionals use to diagnose mental health conditions, called the DSM-5, panic attacks are the only clinically recognized term.

While anxiety can make us feel many of the same ways, panic attack symptoms are more physically and psychologically intense and can come on suddenly, sometimes out of nowhere.

On the other hand, anxiety symptoms usually build gradually and occur as a response to a known trigger.

It’s important to understand what distinguishes a panic attack from an anxiety attack, as well as related conditions and treatments for both.

Symptoms

While panic attacks and anxiety have some of the same symptoms, they also have unique symptoms that differentiate the two.

In fact, you can have an anxiety attack and a panic attack at the same time.

The following symptoms are some of the most common physical and emotional signs of panic attacks and anxiety attacks: 

SymptomsPanic attackAnxiety attack
PhysicalSweatingXX
ShakingXX
DizzinessXX
LightheadednessXX
Fast heart rate or pounding heartXX
Difficulty breathingXX
Feeling like you’re chokingXX
NauseaXX
Abdominal crampingXX
Feeling chilled or hot flashesXX
Numbness or tingling in hands or feetXX
Difficulty falling asleep or insomnia X
Muscle tensionX
Emotional Feeling depersonalization or derealizationX
Feeling an urge to escapeX
Feeling like you might lose control or go crazyX
Fearing that you’ll dieX
IrritabilityX
Difficulty concentratingX
Racing thoughtsX
Uncontrollable worryingX
FearXX

According to the DSM-5, a panic attack is a “an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes,” and contains four or more of the symptoms above. 

Panic attacks can build quickly, and they usually reach their highest intensity in a matter of minutes. They usually last between 5-20 minutes. After a panic attack subsides, people often feel exhausted.

Many people go to the doctor or emergency room the first time they have a panic attack or for particularly strong ones, mistaking it for a heart attack or stroke.

The symptoms of anxiety attacks are physically and psychologically less intense than in panic attacks, and they often occur in response to a known stressor or phobia.

While an anxiety attack isn’t a term officially recognized by the DSM-5, it does describe a real experience people have of heightened feelings of anxiety.

When people refer to anxiety attacks, they are often describing an intensification of the symptoms above, or bouts of worrying that makes other activities difficult to focus on or enjoy.

Generally, during an anxiety attack, people do not experience a fear of losing control—or a fear of dying—as is common during a panic attack.

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Panic Attacks vs. Anxiety Attacks

While panic attacks and anxiety attacks share many of the same symptoms, such as a pounding heart, gastrointestinal upset, and fear, panic attack symptoms are typically more intense.

They tend to reach their peak intensity after about 10 minutes, while anxiety builds more slowly as an accumulation of anxious feelings over hours or even days or weeks.

Another difference is while panic attacks can occur in response to a known phobia or a scary experience, they also can happen unexpectedly, when one is calm or even at night when asleep.

Panic attacks that wake you up from your sleep are called nocturnal panic attacks.

Anxiety, on the other hand, usually has an identifiable cause, like a life change such as divorce, a lifestyle issue such as a stressful job or drinking too much caffeine, or a well-known stressor like public speaking.

Because anxiety attacks don’t have an official definition, they can refer to different experiences, like over thinking or worrying, or sweating and shortness of breath.

Panic attacks, however, must satisfy specific conditions as outlined in the DSM-5.

Causes

Both panic attacks and anxiety attacks can stem from factors like a stressful event, genetic predisposition, or substance use, including caffeine, alcohol, and illicit drugs.

But, given their inherent differences, they may have different causes. Other causes are more likely if you don’t have a family history of mental illness.

Panic attacks, by definition, come on suddenly, often in response to a trigger. For example, if you have a phobia of heights, you might have a panic attack on an airplane.

Triggers may also be related to past experiences: People who have been in car accidents, for example, might have a panic attack while driving. 

Some research suggests both of these responses could be tied to fight-or-flight response, which is activated when your body senses a threat and pumps stress hormones through your body. 

Anxiety attacks, on the other hand, generally happen as a result of chronic stress, and when a person has worrisome or negative thoughts about life circumstances or events.

Sometimes, anxiety attacks can occur as a side effect to medications such as stimulants used to treat ADHD, or steroids used to treat inflammation. 

Risk Factors

While panic attacks and anxiety attacks can occur on their own—especially in people with panic disorder or anxiety disorders in their families—certain medical conditions can make it more likely a person will experience them.

Some of these conditions include: 

  • Hyperthyroidism
  • Heart disease
  • Diabetes
  • Respiratory conditions like COPD or asthma
  • Drug abuse or withdrawal 
  • Chronic pain 
  • Lyme disease
  • Neurological disorders, such as Guillain-Barré syndrome
  • Alzheimer’s disease
  • Vitamin or mineral deficiencies 
  • Food allergies
  • Irritable bowel syndrome
  • Rare tumors that affect the nervous system and release fight-or-flight hormones

If you experience anxiety or panic attacks, it doesn’t mean you have an anxiety or panic disorder. Anyone can experience these attacks sometimes, especially during life transitions or times of stress.

However, if you’re experiencing anxiety to the point that you can’t focus on anything else, or have recurrent panic attacks that cause you to worry about having another one, consider talking to your health care provider to see what support is available to you.

Anxiety and panic disorders are linked to a few other mental health conditions, including:

Diagnosis

If you think you may be having panic attacks, your doctor will likely conduct a full physical exam and blood tests to rule out other conditions, like a heart or thyroid problem.

The same is true for anxiety attacks: Your doctor will likely want to make sure you’re not experiencing an underlying medical condition such as diabetes or thyroid disease. 

If your physician suspects panic disorder, he or she might treat you. In some cases, clinicians refer patients with panic attacks or anxiety to a mental health professional like a psychiatrist or psychologist for evaluation and treatment.

Treatment Options for Anxiety and Panic Attacks

Thankfully, both anxiety and panic attacks respond well to treatment.

Psychotherapy, or talk therapy, especially cognitive behavioral therapy (CBT), can reduce the intensity and frequency of panic attacks, as well as help you cope with them better when they do happen.

CBT can also help people overcome the fear of having another panic attack, in addition to helping people deal with more generalized anxiety and what people perceive to be anxiety attacks.

Social support, including encouragement from loved ones or support groups, can also help people manage both generalized anxiety disorder and panic attacks.

Medication for anxiety and panic attacks

Panic attack treatment sometimes comes in the form of medication. Medications commonly prescribed for anxiety and panic disorder include selective serotonin reuptake inhibitors (SSRIs), which increase available serotonin in the brain, helping to regulate mood.

The effective SSRIs for panic attacks include escitalopram (Lexapro), fluoxetine (Prozac), and sertraline (Zoloft).

A similar type of panic attack medication prescribed for anxiety are serotonin and norepinephrine reuptake inhibitors (SNRIs), like venlafaxine (Effexor XR), duloxetine (Cymbalta), and desvenlafaxine (Pristiq), which work by increasing available serotonin and norepinephrine in the brain.

SSRIs and SNRIs are taken daily at a steady dose, to lessen generalized anxiety and decrease panic attacks.

Some people benefit from medication taken only as needed during periods of high stress.

Hydroxyzine (Atarax) is a medication approved to treat anxiety, and it is not habit-forming. Some people require benzodiazepines, which are sedatives, to help them during periods of panic.

Benzodiazepines work by calming the central nervous system to ease feelings of anxiety and panic. Common benzodiazepines prescribed for anxiety and panic are alprazolam (Xanax), clonazepam (Klonopin), and lorazepam (Ativan).

Benzodiazepines are safest when they are taken only as needed in anticipation of or in response to a severe stressor.

Home remedies for panic attacks and anxiety attacks

In addition to therapy and medication, the following lifestyle modifications can help create a calmer, more peaceful state in the mind and body:

  • Getting enough sleep
  • Exercising regularly
  • Limiting caffeine intake
  • Eating a healthy diet 
  • Practicing relaxation techniques (yoga, meditation, breathwork)
  • Finding a creative outlet (writing, dancing)
  • Engaging with social support systems
  • Avoiding tobacco and illicit drugs, and limiting alcohol use

What do do during a panic or anxiety attack

Both panic attacks and anxiety attacks can feel overwhelming, but fortunately, you can manage the symptoms on your own and with the support of trusted loved ones, such as friends, family members or a therapist. 

When a panic attack or anxiety attack happens, try to find a calm place where you can focus on calming yourself down. If you have medication for treating an acute panic attack, take the amount recommended by your doctor.

Deep breathing from the diaphragm has been shown to restore calm in the body, which can help with both anxiety and panic.

Mindfulness, or focusing on the present moment –– whether you inhale a calming smell or hold a comforting object –– can accomplish the same thing. 

Panic attacks often occur unexpectedly, so you may not be around trusted people when it happens. If you find yourself feeling panicked or anxious, try reaching out to someone familiar who can offer a comforting presence.

It can also help to remind yourself that the feeling, as scary as it is, will pass, and that you’re not experiencing something dangerous. 

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When to Seek Help

If anxiety or panic attacks are getting in the way of your daily life, see a health care provider to see what kinds of treatments will help you back to feeling your best.

If you’re experiencing what you think are anxiety and panic attacks, get a full physical examination with bloodwork to make sure other physiological conditions, like heart or thyroid problems, or vitamin and mineral deficiencies, aren’t causing your symptoms.

How K Health Can Help

Anxiety and depression are among the most under-reported and under-treated diseases in America. Nearly 20% of adults in the US suffer from mental health illness and fewer than half receive treatment. Our mission is to increase access to treatment for those suffering in silence.

You can start controlling your anxiety and depression and get access to the treatment you need with K Health. Starting at $12/month get prescriptions for mental health medications plus unlimited doctor visits through the K Health app. Start your free assessment to see if you’re eligible.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Irmanie Hemphill, MD, FAAFP

Dr. Hemphill is an award winning primary care physician with an MD from Florida State University College of Medicine. She completed her residency at Halifax Medical Center.

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