Panic Attack or Anxiety Attack?


You’ve heard of anxiety attacks. You’ve heard of panic attacks. Have you heard of the difference? I realized that a lot of people might be like me and even have one or both of these disorders and still not understand the difference. Don’t worry. You aren’t alone. It took me dating a therapist to have direct access to be comfortable enough to admit that I didn’t know the difference to ask. Initially, I googled it, and I found a lot about both, but it was hard to understand what was legit, and what was someone’s opinion, and no one seemed to want to touch the difference with a 10’ pole. If I hadn’t taken notes (not joking) when I asked Death, I still wouldn’t be able to tell you the difference. It took a couple conversations, and a lot of questions for me to fully grasp it. So, hopefully you’re smarter than me, and hopefully I can put this together in a comprehensible fashion. 


So, to get to end, we have to start at the beginning. 


What is anxiety? For those of you who want the quick answer: Excessive worry you can’t control, that affects you more days than not. If you’re the type that’s sick of the quick answer and want to dive deeper with me, please read on. Looking at reputable sources for information like the DSM-5, the definition of anxiety (Generalized Anxiety Disorder, GAD) isn’t as easy as a once sentence definition. Like most mental disorders, there are criteria you need to meet. 

  1. You worry a lot. Like A LOT. More days than most, and you can’t remember the last time you felt like you had a break from your worry. +10 pts

  2. You worry about a couple things in your life. It’s not just work, or just the kids, or just the partner, or just the PTA, or just the side hustle. It’s 2+ areas. 

  3. Bonus if you worry about everything! 

  4. You don’t feel like you can control your worry. 

  5. You’re restless. Even if you hide it well with a jiggly leg, or if you clean to distract yourself from it, admit it, you’re on edge. 

  6. You get gassed easily. You wear out. It feels like you need more breaks than you used to (back when you didn’t feel so anxious all the time). 

  7. It’s hard to focus. Sometimes you’re a squirrel going after the shiny, but sometimes it just goes blank. Which is weird for you. Well, you might have accepted it as normal by now. 

  8. You get bitchy. We all do it! Sometimes it really is PMS (guys get it, too admit it). Sometimes it’s because you’re amped up, anxious, and ready to claw some eyes out. 

  9. You don’t have some other mental disorder that better explains all of that and other symptoms you might also have. 

  10. Ok, listen up here, because if you said yes to all of those, but say no to this one, you are not diagnosable with GAD. Not to say you don’t get anxious sometimes, but please adjust your language if you find you’re not diagnosable to leave room for people who need the verbiage you use to make an impact when they use it. *Disclaimer over. ~Your anxiety affects your life in a significant way. You are impaired by your anxiety either socially, at work, or in other ways of your life. Essentially, your anxiety has to stop you from doing something that people without anxiety have no problem doing. 



Examples:

  1. You take so many days off work you have no sick leave in your bank and you’re facing write ups. 

  2. You fail tests as the result of high anxiety. 

  3. You don’t send the 2nd or 3rd texts because you’re worried you’re too much. 

  4. You refuse to go up to new people. You rather take the - sit at a distance, stare and hope they notice - approach. 

  5. You have conversations in your head 3 times before anything is said out loud all while standing in front of the person. 

  6. You avoid communicating with supervisors or teachers because you can’t stop thinking about alllllll the ways it could go wrong.

  7. You plan excessively because if you think of all the ways it could go wrong and prepare, it might not be so bad. 

  8. You write, and re-write texts just to delete them and leave the person on read because you’re not sure how you will be taken. 

  9. You never talk to that person again because you’re ashamed you left them on read for so long. 

  10. Someone, somewhere has said “You’re overthinking” to you at some point. 

  11. Your symptoms can’t be ruled out as a side effect, whether that be for medication, or substance use/abuse. 


“I’m having a panic attack.” How many times have you heard people say this? Probably more frequently than you’ve been around people experiencing panic attacks. Here’s my thing, it's actually pretty invalidating to people who experience true panic attacks for someone to say they are experiencing a panic attack when they are really just experiencing high anxiety. Actual panic attacks require someone to experience an abrupt, rapid surge of intense fear or discomfort and 4 of the following bodily sensations: 

  • Palpitations,

  • pounding or racing heart,

  • sweating, trembling, 

  • shortness of breath or feeling smothered, 

  • feeling choked, 

  • chest pain, 

  • nausea or abdominal discomfort, 

  • feeling dizzy or lightheaded, 

  • fear of dying

  • numbness or tingling, 

  • and chills or heat sensations.  

The other part of this all, is that these symptoms need to peak within minutes. Meaning you need to experience at least four symptoms on the list above simultaneously with intense fear or discomfort for it to truly be considered a panic attack. 


Another aspect of this oh so lovely disorder is that it needs to cause significant impairment or distress in one of your life domains (e.g., work, relationships, etc). If it doesn’t do that, again, can’t call it a technical panic attack. A simple check in is if you had insight the first time you had the experience, it more than likely wasn’t a panic attack. 


Often, people truly think something is physically wrong with them numerous times before they finally realize (or are told by a medical professional) they’re panic attacks. 


Examples of panic attacks: 

  • Going to the ER thinking you are having a heart attack due to chest pain, palpitations, difficulty breathing, etc. 

  • Thinking you are going into anaphylactic shock and your airway is closing even if you haven’t been exposed to an allergen recently. 

  • Feeling like you lost control of your breath, even though you use it as a coping technique. 

  • Your world closes in on you, and you don’t always know why. It feels like the walls are too close, and something is around your throat. 

  • Your lips and fingers get tingly. It feels like you just drank something minty, but you can’t taste it, all you can taste is fear.


Due to the severity of response in your nervous system, true panic attacks can’t last longer than 20 minutes. That’s not to say everything is hunky-dory after that 20 minutes. It's just to say that a person’s body can’t maintain that level of arousal for longer than that. The panic attack can end, and a person can still feel anxiety (as well as exhaustion from the attack itself). Also, due to how our nervous system works, you can’t have back to back panic attacks. Our nervous system needs time to reset before another panic attack can be triggered. 


So, now we’ve covered the basis. We know what anxiety is, what it isn’t. What panic attacks are and what they aren’t. What is the difference between an anxiety attack and a panic attack? Why are there two terms for seemingly the same thing? This is the part that I couldn’t seem to find online by myself. I mean it gets pretty confusing when Medical News Today puts out an article on “How to recognize an anxiety attack.” I can’t lie, it’s taking everything I have not to correct that title, but I needed you to see the gravity of what we are working with. See for yourself. 


WebMd does a good job of confusing, but effectively using those darn ‘ole LSI keywords by mashing Panic Attacks and Anxiety Disorder together in an article here in a search for “definition of anxiety attack”. They don’t explain the difference, they just gloss over the fact that people have used anxiety and panic interchangeably and assume that’s enough for you. It’ wasn’t enough for me, personally. 


“Anxiety Attacks” are not recognized by the DSM-5 (remember, that’s the big book of rules for assessment of mental disorders). The DSM-5 does however, define anxiety as a feature of a number of common psychiatric disorders. Panic attacks are also recognized by the DSM-5. Essentially, anxiety attacks are a buzzword to mean less than panic attacks but more than general anxiety. The main difference being; you don’t think you’re going to die. Shit is crazy, but you’re not worried about tunnels and bright lights. I personally call this “high anxiety”. 


Healthline did a decent job of explaining differences in a clinical way here if you’re the type who likes less story and more graph (no hard feelings, I get it). 


Stay tuned for a post about Coping Techniques to use with a variety of mental disorders. 


Also see:

Depression Quiz

The Worry Tree - Villain Esteem Style

Minfulness Meditation Bullshit

How to Adapt

How Exercise Effects Depression (and anxiety)

How to Shop for a Therapist

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