How to tell the difference between an anxiety attack and a panic attack

I am no stranger to anxiety. I don’t remember a time in my life that I wasn’t visited by the familiar intrusive thoughts of worry and “what-ifs.” While I may have experienced some physical symptoms like increased heart rate with my anxiety episodes, it was always the worry that let me know anxiety was the culprit. 

When one night I had sudden hot flashes, a racing heartbeat, mild chest pain, and sweating, I thought I must be having a heart attack. I hadn’t felt anxious—at least not until I thought I was dying—so I didn’t consider the possibility this was anxiety-related. It went away after about half an hour, and I realized I was okay. When it happened again a few weeks later, I talked to my doctor and learned I was having panic attacks.

Anxiety attacks and panic attacks are often used interchangeably—but there are some key differences between the two.

“’Anxiety attack’ is a layman’s term for a feeling of heightened anxiety that generally builds over time due to excessive worry,” says Shana Olmstead, MA, LMHC, a psychotherapist in Kirkland, Washington. “A panic attack can feel more like it comes out of the blue, and can be due to underlying anxiety or stress but not necessarily happen at the time of the stressful situation.”

What are the symptoms of an anxiety attack vs. a panic attack?

Symptom	Anxiety attack	Panic attack
Excessive worry	Yes	Sometimes
Difficulty concentrating	Yes	Less likely
Irritability	Yes	Less likely
Restlessness	Yes	Less likely
Fatigue	Yes	Less likely
Muscle tension	Yes	Less likely
Disturbed sleep	Yes	Less likely
Increased startle response	Yes	Less likely
Increased heart rate/heart palpitations/pounding heart	Yes	Yes
Dizziness	Yes	Yes
Sensations of shortness of breath/difficulty breathing	Yes	Yes
Feelings of unreality	Less likely	Yes
Feeling detached from oneself	Less likely	Yes
Fear of losing control or going crazy	Less likely	Yes
Fear of dying	Less likely	Yes
Excessive sweating	Less likely	Yes
Trembling or shaking	Less likely	Yes
Feeling of choking	Less likely	Yes
Chest pain	Less likely	Yes
Nausea or abdominal discomfort	Less likely	Yes
Feeling lightheaded, unsteady, or faint	Less likely	Yes
Numbness of tingling sensations	Less likely	Yes
Chills	Less likely	Yes
Hot flashes	Less likely	Yes

How to tell the difference between an anxiety attack and a panic attack

“An anxiety attack is generally caused by the escalating intensity of worry in response to a real or perceived internal or external stressor,” says Sharon D. Thomas, MS, LCMHC, a licensed clinical mental health counselor at MindPath Care Centers in Raleigh, North Carolina. “This worry builds and the excessiveness of the stress becomes overwhelming, which can feel like an attack.”

“Panic attacks are similarly influenced by an internal/external stressor,” says Thomas, “but instead of the escalating or building response from the stressor of an anxiety attack, the fear responses are abrupt, intense, and highly disruptive to the individual’s capacity to function in response to the fear.”

Anxiety attacks:

• Are not a recognized condition, but rather a layman’s term for the feelings of increased anxiety. (They are often a symptom of a recognized anxiety disorder.)
• Are in response to a stressor (real or perceived).
• Come on slowly and build with excessive worry.
• Can feel overwhelming.
• Is more thought-focused, but can have some physical symptoms.

Panic attacks:

• Are recognized as a diagnosable condition, usually as part of a panic disorder.
• Come on suddenly and have symptoms that peak within minutes of the start of the attack.
• Are intense.
• Can be due to underlying anxiety, but don’t necessarily occur during a time of anxiety or stress.
• Occur in episodes, which may or may not happen again.
• Can occur on their own or as part of a different anxiety disorder such as social anxiety, generalized anxiety, or a specific phobia.
• Have at least four of the symptoms of panic attacks occurring within one episode.
• Typically last between 20 to 30 minutes, and rarely more than an hour.

What to do during an attack

The goal during both anxiety attacks and panic attacks is to calm down. There are immediate steps that can be taken to help with both types of attacks.

1. Try self-calming by deep breathing in for a count of four, and breathing out for a count of six. Then repeat. This helps slow your breathing and heart rate down and creates an overall feeling of calm.
2. Practice mindfulness with the 5-4-3-2-1 exercise. Observe five things you can see, four things you can hear, three things you can touch, two things you can smell, and one thing you can taste. Pick up or touch objects and notice their features: Are they soft or hard? What color are they? Are they heavy or light?
3. Practice progressive muscle relaxation. Starting with the feet, tense each muscle in the body for 30 seconds and release, one at a time.
4. Self-talk. Remind yourself you are safe and this will pass.
5. Seek out help by talking with a friend, a medical professional, or anyone else who is calming in the moment.

Treatment for anxiety and recurring panic attacks depends on the underlying cause for them. It’s important to see a medical practitioner for a proper diagnosis. Treatment for anxiety and panic disorders can include:

1. Lifestyle changes. Practicing relaxation exercises such as yoga, exercising regularly, getting enough sleep, and avoiding stimulants like smoking and caffeine can help with overall feelings of anxiety.
2. Cognitive behavioral therapy (CBT). Focusing on thinking and behavioral patterns.
3. Exposure therapy. Repeatedly experiencing the panic sensations in a controlled setting such that they induce less fear over time. With phobia-induced anxiety or panic, this may include being exposed to the phobia trigger.
4. Medications. Anxiety and panic disorders can be treated with medications that are taken regularly, such as antidepressants like Prozac, Zoloft, Paxil, Lexapro, or Celexa. Panic attacks can be treated with fast-acting anxiety medications like benzodiazepines such as Xanax or Ativan. Benzodiazepines can be habit-forming, and their use should be carefully monitored by a healthcare provider. Antidepressants can affect different people in different ways—follow your healthcare provider’s directions.

Are anxiety and panic attacks dangerous?

While anxiety and panic attacks feel very distressing, they are not dangerous on their own.

That said, the first time someone experiences these symptoms, they should go to the ER to rule out something more serious like a heart attack or blood clot.

People who have recurring anxiety or panic attacks usually begin to recognize the sensations and are able to distinguish them from something more serious.

Anxiety and panic attacks rarely last longer than an hour, and usually less than half an hour. If the symptoms are lasting longer than usual, are more intense, feel different than they usually do, don’t respond to efforts to calm down, have symptoms that are not consistent with a panic attack (such as pain radiating into the jaw or down either arm), or there is a question it could be something other than a anxiety or a panic attack, go to the ER.

While anxiety and panic attacks themselves are not dangerous, they can be a symptom of more serious underlying conditions. It’s important to see a healthcare provider to test for physical conditions, and to find the specific cause of the attacks.

Causes and risk factors for panic disorders

Anxiety and panic attacks can both be caused by anxiety disorders, but panic attacks can have causes that are not related to mental health, including:

• 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

There are a few factors that increase your risk of having panic disorders. They include:

• Being female. Women are twice as likely to experience panic disorders than men.
• Genetics. Panic disorders can run in families.
• Age. Panic disorders usually begin between the teen years and age forty.
• A trigger. A stressful event such as job loss, trauma, or abuse (past or present)—or even happy events such as marriage or the birth of a child—can increase the chances of panic attacks.
• Mental health conditions. Panic attacks can be a symptom of several mental health conditions such as agoraphobia, depression, or anxiety disorders.
• Substance use disorder. Alcohol and drug use, as well as smoking, can create physical sensations like lightheadedness or fast heartbeat that can lead to feelings of anxiety.

Now that I know what my panic attacks feel like, I am able to talk myself through them. By recognizing what is happening, I can tell myself that these sudden hot flashes mean I am probably about to have a panic attack, and I can prepare myself. With the help of a regular medication routine, tools to help myself calm down, and an understanding of what is happening to me, my panic attacks have become much more manageable and my overall anxiety has lowered.

Panic attacks and anxiety are frightening and disruptive—but with help and treatment, it can get better.