What Is the Difference Between a Panic Attack and an Anxiety Attack?
A panic attack is a sudden surge of intense fear that peaks within minutes. "Anxiety attack" is an everyday phrase for anxiety that climbs more slowly around a specific worry. On the panic attack vs. anxiety attack question, Cleveland Clinic draws the line at onset: stressors set off anxiety that may build gradually, while panic arrives suddenly and unexpectedly.
Only one of the two terms has a clinical definition. The DSM-5, the diagnostic manual of the American Psychiatric Association, defines a panic attack as an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, with four or more of 13 listed symptoms, according to the criteria reproduced in a 2016 Substance Abuse and Mental Health Services Administration report. Cleveland Clinic states that the current edition, the DSM-5-TR, "doesn't recognize or define an anxiety attack." This post explains what each term describes, when chest pain needs medical care, what helps during an attack, and how panic is treated.
This post is for educational purposes only and is not a substitute for individualized professional care.
What is a panic attack?
A panic attack is a short episode of intense fear or discomfort that starts abruptly and brings strong physical symptoms. The National Institute of Mental Health (NIMH) lists these physical symptoms:
Pounding or racing heart
Sweating
Chills
Trembling
Difficulty breathing
Weakness or dizziness
Tingly or numb hands
Chest pain
Stomach pain or nausea
The DSM-5 list also includes a feeling of choking, a sense of unreality or of being detached from yourself, fear of losing control, and fear of dying. Four or more symptoms together, peaking within minutes, fit the definition.
NIMH says a panic attack can last from a few minutes to an hour or sometimes longer. Cleveland Clinic puts the usual range at 5 to 20 minutes, with symptoms peaking within 10 minutes of the start.
An attack does not need a visible cause. The American Psychiatric Association explains that panic attacks "may be expected, such as a response to a feared object, or unexpected, apparently occurring for no reason."
For the physical side of anxiety more broadly, this guide to what anxiety feels like in the body covers the symptoms and how the nervous system sets them off.
What do people mean by an anxiety attack?
Because the DSM-5-TR does not define it, "anxiety attack" has no agreed symptom list and no time frame. The phrase gets used in two ways.
Some people use it for a panic attack. A clinician speaking on a 2021 Michigan Medicine podcast said anxiety attacks are not a clinical term and that the phrase gets used interchangeably with panic attacks.
Others use it for a stretch of high anxiety that rises ahead of a known stressor. That second meaning lines up with how the American Psychiatric Association separates two emotions. Fear, in its wording, is a response to an immediate threat, while anxiety is anticipation of a future concern. The association describes panic attacks as sudden episodes of intense fear.
A related question is whether the feeling is anxiety or ordinary stress. This post on telling anxiety apart from everyday stress covers the patterns that separate them.
Panic attack vs anxiety attack: how the two compare
Onset: Cleveland Clinic describes panic attacks as sudden and anxiety as something that may build gradually.
Peak: The DSM-5 definition of a panic attack requires a peak within minutes. No definition sets a peak for an anxiety attack.
Cause: Panic can be expected or unexpected, per the American Psychiatric Association. Cleveland Clinic ties anxiety to stressors.
Clinical status: A clinician can document a panic attack against the DSM-5 symptom list. "Anxiety attack" is a description, and two people who use it may mean different things.
The labels can overlap in the same person. StatPearls, a clinical reference hosted by the National Library of Medicine, notes that panic attacks are not limited to panic disorder and can occur alongside other anxiety and mood disorders. The American Psychiatric Association gives depression and PTSD as examples.
When you describe an episode to a doctor or therapist, the details carry more weight than the label: how fast it started, how long it lasted, what you felt in your body, and what was happening beforehand.
Does one panic attack mean you have panic disorder?
No. NIMH says not everyone who has a panic attack goes on to develop panic disorder.
Panic disorder, as NIMH defines it, involves recurrent and unexpected panic attacks along with ongoing worry or changes in behavior driven by fear of the next attack. The DSM-5 criteria call for at least one attack followed by 1 month or more of that persistent concern.
The numbers show the gap between the two. Cleveland Clinic reports that every year up to 11% of people in the United States experience a panic attack. NIMH estimates that 2.7% of U.S. adults had panic disorder in the past year and 4.7% have it at some point in their lives. Those NIMH figures come from the National Comorbidity Survey Replication, conducted from 2001 to 2003, so they are more than 20 years old.
A diagnosis takes an evaluation by a qualified professional. NIMH suggests starting with a health care provider such as a primary care doctor, psychiatrist, psychologist or clinical social worker.
When does chest pain need medical care?
Chest pain appears on the panic attack symptom list and on the heart attack warning list. Do not try to work out which one it is on your own.
The American Heart Association's warning signs of a heart attack include:
Discomfort in the center of the chest that lasts more than a few minutes, or goes away and comes back. It can feel like pressure, squeezing, fullness or pain.
Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath, with or without chest discomfort.
A cold sweat, nausea, or lightheadedness.
The American Heart Association says to call 911 for these signs. Chest pain or trouble breathing that is new or severe means call 911, even if you have had panic attacks before.
For symptoms that have passed, a medical visit is still worthwhile. Mayo Clinic advises getting evaluated by a primary care provider when you are unsure what is causing panic-like symptoms. StatPearls notes that medications, substance use, and medical conditions such as hyperthyroidism can produce similar episodes, which is why clinicians rule those out.
What helps during a panic attack?
Cleveland Clinic recommends four things to do while an attack is underway:
Slow your breathing. Breathe in through your nose as slowly, deeply and gently as you can, then out slowly through your mouth.
Name what is happening. Acknowledge that this is a panic attack and remind yourself that it is temporary and will pass.
Release muscle tension. Relax one muscle group at a time.
Come back to the present. Use mindfulness to focus on where you are right now.
In a separate article, Cleveland Clinic adds distraction through the senses, such as washing your face or petting the dog, and keeping track of when attacks happen so patterns become visible.
These are coping skills. They may ease an attack, and they do not replace treatment for panic that keeps coming back.
How is panic disorder treated?
NIMH describes cognitive behavioral therapy (CBT) as teaching different ways of thinking, behaving and reacting to the feelings that come during or before a panic attack. Exposure therapy, a CBT method, focuses on confronting the fears and beliefs tied to panic symptoms. One form, interoceptive exposure, involves exposure to the bodily sensations associated with panic attacks.
For a fuller picture of what sessions involve, see how therapy helps with anxiety, which covers CBT and what to expect.
Medication is another option NIMH describes, and that decision belongs with a doctor or other prescriber.
FAQ
Is an anxiety attack a real diagnosis?
No. The DSM-5-TR does not define it, according to Cleveland Clinic.
Are panic attacks dangerous?
Cleveland Clinic describes panic attacks as scary but not dangerous. Mayo Clinic adds that they are hard to manage alone and may get worse without treatment. Because the symptoms can resemble a heart attack, new or severe chest pain or trouble breathing still calls for 911.
Who is more likely to develop panic disorder?
NIMH data show past-year panic disorder was higher among women (3.8%) than men (1.6%) in the 2001 to 2003 national survey. NIMH also notes that the disorder often begins in the late teens or early adulthood.
Why would a panic attack happen with no danger present?
NIMH reports that some researchers think panic attacks work like false alarms, with the body's survival instincts firing too often, too strongly, or both.
How frequent are panic attacks?
NIMH says attacks can occur several times a day or as rarely as a few times a year.
What medications are prescribed for panic disorder?
NIMH lists SSRI and SNRI antidepressants, which may take several weeks to start working, beta-blockers for physical symptoms such as a rapid heart rate, and benzodiazepines. It cautions that some people build up a tolerance to benzodiazepines or become dependent on them. A prescriber can weigh these options with you.
If you need support right now
If you are in crisis or having thoughts of suicide, help is available 24 hours a day, 7 days a week.
988 Suicide and Crisis Lifeline: call or text 988, or chat at 988lifeline.org
Butler County Crisis Services: call 1-800-292-3866, or text 63288
Crisis Text Line: text HOME to 741741
Emergency: call 911
Bright Circle Counseling is an outpatient practice and does not provide emergency or crisis services.
Help for panic and anxiety in Cranberry Township
Bright Circle Counseling works with adults ages 18 and older, and panic attacks are among the concerns named on its anxiety treatment page. That approach combines CBT, mindfulness, and somatic awareness, and includes psychoeducation, identifying triggers, and gradual, supported exposure to feared situations. Nichole Barrett, LPC, NCC, CCTP, also offers cognitive behavioral therapy as its own service.
Sessions are held in person in Cranberry Township or by telehealth for adults throughout Pennsylvania. A free 15 minute consultation for new clients is available.
Visit Bright Circle Counseling or call 724-201-9593 today. Contact us for more information.
Written by Nichole Barrett, LPC, NCC, CCTP, founder of Bright Circle Counseling in Cranberry Township, PA.
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