Panic attack vs. anxiety attack: Distinguishing symptoms and how to tell the difference

Symptoms of a panic attack include racing heart, chest tightness, and nausea. DjelicS / Getty Images
A panic attack and an anxiety attack are different conditions, although they share some similarities.
Panic attacks happen when you have 4 or more of the 13 symptoms listed in DSM-5, which usually resolve on their own after 5 to 10 minutes.
Anxiety attacks are not listed in the DSM-5, and while they can exhibit some of the symptoms of a panic attack, they can vary in duration and intensity.
This article has been medically reviewed by David A. Merrill, MD, PhD, psychiatrist and director of the Pacific Brain Health Center at the Pacific Neuroscience Institute at Providence Saint John's Health Center.
This story is part of the Insider's Guide to Anxiety.
Panic attacks and anxiety attacks are often used interchangeably but actually describe two different events.
A panic attack is an intense, debilitating wave of anxiety that can occur unexpectedly and does not always have a clear trigger.
An anxiety attack, on the other hand, is an outbreak of fear that is usually preceded by feelings of worry or stress. You will likely know what triggers the anxiety attack.
It can be difficult to distinguish between panic and anxiety because they have similar mental and physical symptoms, and you can use the same relaxation strategies to deal with an attack.
Here's what you need to know about the difference between a panic attack and an anxiety attack.
What is a Panic Attack?
A panic attack is a sudden onset of anxiety, often physically characterized by a racing heart, chest tightness, or nausea. It is estimated that approximately 23% of Americans have had a panic attack in their lifetime.
If someone has multiple episodes, they may have panic disorder - a type of anxiety disorder that affects around 2 to 3% of Americans. It is characterized by recurring panic attacks that develop into a fear of panic attacks that affect daily life.
Panic attack symptoms
According to DSM-5, or the manual that mental health professionals use to diagnose patients, there are 13 main symptoms of a panic attack.
O'Rourke says that at least four of these symptoms must appear in order for it to be clinically recognized as a panic attack:
Increased pulse
Shortness of breath or feeling like you cannot breathe
Trembling or trembling
Chest pain
Nausea or other abdominal discomfort
Light-headedness, dizziness, or fainting
Suddenly feel cold or hot
Becoming numb or tingly in certain parts of the body
Feelings of detachment from yourself or from reality
A sense of doom or fear that you will die
Fear that you will lose control
What is an anxiety attack?
An anxiety attack is a mental wave of anxiety, says Dr. Anthony Puliafico, clinical psychologist at Columbia University and director of the Clinic for Anxiety and Related Disorders at Columbia University.
Anxiety attacks are usually caused by worry or stress, and while they may resemble panic attacks, they may not be as physically intense.
For example, an anxiety attack can occur when someone with generalized anxiety, a type of anxiety disorder, fears that the upper limit will fall on them at any time - even if it is unlikely.
Anxiety attack symptoms
According to Sarah O'Rourke, PhD, a clinical psychologist at Duke Health, anxiety attacks are not mentioned in the DSM-5.
So unlike panic attacks, there isn't a single set of recognized symptoms. Instead, anxiety attacks are often described as the flare-up of a generalized anxiety disorder.
Anxiety attacks can have symptoms similar to a panic attack, although they are likely not as severe.
Chest pain
Increased pulse
Fear or sense of doom
How to deal with a panic attack or an anxiety attack
A panic attack peaks in 10 minutes, Puliafico says, and should resolve on its own. However, there are certain strategies you can use in the middle of a panic attack to help you stay calm and get through it.
Because anxiety attacks have symptoms similar to panic attacks, these relaxation techniques are likely to be useful in both cases.
For example, O'Rourke recommends "quadratic breathing," which you can use to visualize and slow your breathing.
Imagine a square in your head. Start in the lower left corner of the square and go up the left side. Take a slow deep breath as you count to four.
Then move from the top left to the top right of the square and hold your breath for four seconds.
Take four deep breaths as you move down the right side of the square, then again hold your breath four times as you move from bottom right to bottom left.
Repeat the breathing technique around the square until your heart rate slows and a slower breath doesn't feel forced. You should feel more relaxed.
This method of controlled breathing activates the parasympathetic nervous system.
Your fight or flight response is triggered during a panic attack. Your parasympathetic nervous system helps your body get out of this fight or flight response so you can return to a relaxed state.
Other strategies for managing panic or anxiety attacks include:
Ground yourself
O'Rourke also describes a grounding technique called "5-4-3-2-1" - which involves noticing these objects around you:
5 things you can see
4 things you can touch
3 things you can hear
2 things you can smell
1 thing you can taste
It's used to reorient you in your physical environment, says O'Rourke. Not only does this exercise briefly distract you from the physical symptoms, but it can also keep you from preoccupying yourself with your fearful, racing thoughts.
Know what you are going through
Puliafico says that one of the biggest worries for someone who has a panic attack is often that something is seriously wrong with them.
"My first recommendation would be to recognize the symptoms for what they are. I'm in no danger," says Puliafico.
O'Rourke says positive thoughts can also help you get through this stressful moment.
If it's not your first panic attack, she provides the example: "I have dealt with a panic attack before and can deal with it too."
Related Articles from Health Reference:
The 5 types of anxiety disorders and how to know if you have one
How to deal with anxiety and improve your mental health
Am I Depressed? Take our quiz to measure your symptoms and find the right treatment
Exercise For Depression: How Regular Physical Activity Can Help Mental Health
Learn more about mindfulness and its benefits - and how you can practice it with or without meditation
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