How to differentiate between an anxiety attack and a panic attack, counsellors weigh in

You’re stressed and can't deal with pressure or tight deadlines. You tend to spiral if you’re not in control of a situation and often other things happening around you decide what’s going to happen next. When any of this happens, you’re either about to have an anxiety attack or a panic attack. Though the two terms are often used interchangeably, they are very different in nature and their symptoms. And it’s important to know what you’re feeling, especially in a stressful situation. 

Thus, leading counsellors tell us the difference between an anxiety attack and a panic attack, and the reason why it is important to be able to tell one from the other. Some of the common symptoms for both include fast heartbeats, shortness of breath and feeling sweaty, nauseous, dizzy or any discomfort in the chest. 

The confusion is valid

Even mental health professionals sometimes mix up the two. This is primarily because the Diagnostic and Statistical Manual of Mental Disorders (DSM), the mental health bible, doesn't list them separately with different diagnoses. Instead, they’re part of a criteria that describe various anxiety-related disorders. They are isolated incidents that are then used as criteria for a full-blown disorder. The DSM definition of a panic attack is: ‘The sudden onset of intense fear or discomfort, which reaches its peak within minutes (including physical and cognitive symptoms) and these panic attacks are a key component of panic disorder.’ On the other hand, an anxiety attack is termed as a formal diagnosis and there is no definition. The manual focuses on the diagnosis of various anxiety disorders. The DSM recognises a panic attack as an individual entity, while an anxiety attack is the symptom of a problem. And this is a problem mental health practitioners face. 

The basic differences  

Trigger and build-up: Anxiety attacks are typically identified by triggers related to specific stressors and situations. They involve a gradual build-up. When you understand the trigger, you are able to understand the cause of the build-up. On the other hand, a panic attack can occur with or without an obvious trigger and it can be triggered by unrelated and external factors. The trigger here is ambiguous and a panic attack is characterised by a sudden and intense surge of panic. 

Symptoms: In an anxiety attack, the physical symptoms are accompanied by cognitive symptoms—excessively worrying about the situation, fear, and the focus is on the stressor or trigger. You’re thinking about it and your mind spirals. While in a panic attack, there are more severe overwhelming physical symptoms—palpitations, chest and hand pain, and a racing of the heart. The cognitive symptoms here are the fear of dying and going crazy, and that’s where the focus is. 

Duration and intensity of the attack: The duration of a panic attack is short whereas an anxiety attack occurs over a longer period of time and subsides as the stressor is addressed. A panic attack will peak within a few minutes and is characterised by extreme intensity. 

Treatment: Managing anxiety attacks involves addressing the underlying stressor or using relaxation techniques or coping strategies. Treating a panic attack requires one to visit a psychiatrist and psychologist, where you’re given medicine as well as therapy. 

Examples of a panic attack

You can have a panic attack at any time as it happens unexpectedly and gets done in a few minutes. This happens when you’re losing control of the situation, or there is a fear of life. An example: You panic when you realise you lost the house keys but will calm down as soon as you find it. You will also panic when a car comes in front of you on the road. Your heart will start pounding, and you feel dizzy or get a headache due to these intense symptoms. But it does go away once the problem goes away. 

What an anxiety attack looks and feels like 

Anxiety lingers and is prolonged. It builds over a period of time. When you experience a stressor every single day, the anxiety builds up. There is a constant source of anxiety that you cannot do anything about. It’s not life-threatening, but you feel a loss of control over the outcome which is why it seems like a threat. 

For instance, if your boss gives you an assignment with an unrealistic deadline, you’re more likely to get an anxiety attack. You will most probably get a panic attack when you realise you completely forgot the deadline and your boss asks you to submit the assignment. For a very long time, your boss has been telling you about a project that will come on your plate, and you’re now dreading the situation and being anxious about it, and how you’ll complete it. Your anxiety is mild, but you feel restless. Your neck and shoulders are tense, you’re irritable and have trouble going to sleep. These are some of the key symptoms of being anxious. 

You need to know about what’s a panic disorder

The panic goes away as soon as the stressor goes away. Your anxiety, on the other hand, can be managed as well. But it's important to know about panic disorder, that is a combination of a lot of things. A panic disorder occurs when panic attacks occur a lot. It’s an umbrella term where all the anxiety factors come into play. A panic attack is an isolated incident, whereas its recurrence is a disorder.  

It could be because of a traumatic episode in your life, a stressful situation, or an imbalance in your neurotransmitters, genetics, or temperament. 

Inputs by Sherene Aftab, founder of Serene Hour Counselling & Career Advice Consultancy, and Mehezabin Dordi, clinical psychologist, Sir H N Reliance Foundation Hospital, Mumbai