Is It a Panic Attack or Anxiety?
A therapist explains how to distinguish between the two
I was eight years old when the wrecking ball of doom came a-swinging. One minute I was riding my Huffy Sweet Thunder down the road, speed lifting my pigtails, adrenaline twisting the handlebars as I launched off the curb, bravado daring me to let go, as if to say, “Hell ya, I’m omnipotent.” And the next moment, invincibility took a digger. I landed with a face full of dirt and a mouthful of blood, heart on fire, trembling like a newborn in the cold, drenched as if I had just gone swimming. I can still feel my T-shirt clinging to my back.
I was in the world, but not of it. My mind was screaming, “run away…run away!” But my body was frozen. What exactly I was running from I wasn’t sure. All I knew was that some reality had just blindsided me, awakening a terror within.
After five or so minutes in Dante’s inferno, the terror gave way, and some sense of “normal” returned. I pushed myself up from the dirt, de-clung my shirt, took a deep breath, and tried to steady myself enough to ride. I was wobbly for a while — not only while peddling my bike, but also inside; my thoughts, feelings, and mood all were “off.”
Whether it was from fear, shame, confusion, or some combination thereof, I kept the whole disconcerting episode a secret for years to come, as well as a few other episodes in kind that followed.
The difference between a panic attack and anxiety
The distress I experienced that day on my bike was a classic panic attack.
Panic attacks are short bursts of intense fear often accompanied by physical symptoms, such as a racing heart, chest pain or shortness of breath, dizziness, or nausea, and mental symptoms; for instance, feeling like you’re losing control or going crazy, or are detached from yourself or your surroundings, or having a sudden fear that you will die. Typically, panic attacks last fewer than 30 minutes and can occur once or repeatedly, sometimes without reason. Panic attacks often send people to the ER because they can be easily mistaken for a heart attack.
Panic attacks often send people to the ER because they can be easily mistaken for a heart attack.
Anxiety, on the other hand, is essentially what happens when we worry about some future event — the stressful anticipation of a bad outcome or perceived threat. While anxiety can also cause our hearts to race, breath to quicken, and dizziness to take hold, it also can trigger muscle tension, our startle reflex, difficulty concentrating, irritability, fatigue, disturbed sleep, and a general sense of restlessness and uneasiness.
Whereas panic attacks come on suddenly but leave relatively quickly, anxiety usually comes on gradually, becoming more pronounced over minutes or hours. Anxiety may also persist for days, weeks, even months and its intensity can vary in degrees.
How our bodies decide which response is appropriate
Both panic and anxiety are meant to help us survive. They serve as a built-in alarm system designed to protect us from danger. This alarm system is called the autonomic nervous system, and it is on constant alert. Panic attacks are associated with the amygdala, an area of the brain that is the core driver of fear. Anxiety is primarily associated with the prefrontal cortex, which has to do with planning and anticipation.
What’s important to know here is that with panic, the body codes it as an immediate, right-here-right-now threat. With anxiety it’s more, “You’re not in trouble yet, but trouble is coming, so you better ready your defenses.” (Whether this is an accurate assessment is another story. Anxiety often sends us out of our calm, rational “window of tolerance.”) It’s also worth noting that both conditions can occur at once. Say, a person is really anxious for weeks about an upcoming event. And when they arrive at the festivities, a wave of panic crashes over them, sending them into fight/flight/freeze.
Why we get panic attacks or have anxiety
People are hardwired for both panic attacks and anxiety, but there are some who are more likely to experience them; for instance, those who:
- Have an anxious personality.
- Have another mental health condition, such as depression or bipolar disorder.
- Have family members with anxiety, panic disorders, or history of trauma.
- Are more prone to worry because they grew up with worriers who taught them to do the same.
- Are living with a chronic medical condition or life-threatening illness.
- Have issues with alcohol or drug abuse.
- Have ongoing stress in their personal or professional lives, such as family conflict, relationship problems, or financial hardship.
- Have experienced a stressful life event, such as the death of a loved one or a divorce, or loss of a meaningful relationship.
- Have experienced past trauma.
- Have witnessed a traumatic event, either as a child or as an adult.
Studies show that females are more likely than males to have both panic attacks and anxiety. Also, people who experience anxiety have a greater risk of experiencing panic attacks. This said, just because you have anxiety doesn’t mean you will experience a panic attack.
People are hardwired for both panic attacks and anxiety, but there are some who are more likely to experience them.
What to do if you have a panic attack or experience anxiety
- “Admit, Acknowledge, and Accept” that what you’re feeling is real. This means that while the distressing experience may feel awful, it’s not actually dangerous; and that it will pass — especially if you stop fighting it — and in time, you will be alright. In short, don’t deny the premise or clobber yourself with shame. Panic and anxiety are natural responses. You’re only weak if you don’t face the reality of them head-on.
- Try grounding techniques, so that you stay firmly planted in the present, not lost in the dizzying past or fearful future.
- Practice titration. In somatic psychology, the word “titrate” is used to describe how much emotional “flow” we let into our system’s internal reservoir. To titrate our experience is to keep ourselves in an intentional place of choice and safety by opening and closing the tap on our emotions. It’s a process by which we slow down our internal response — emotional, cognitive, and physiological — so that we can more effectively process incoming information and get back into our rational mind.
- See a professional if either condition starts to affect your ability to function normally in life. Really, there are specialists who can help. You get no points for being a “survivor,” “victim,” or “martyr.”
When I lay in the dirt all those years ago, shaking like the proverbial leaf, not knowing which way was up, alone and confused, desperate to run away from me-myself-and-I — and yet held hostage by that “I,” it was truly a moment of suckitude in the third degree. But as I’ve learned, as a therapist, clinical ethicist, and pastoral counselor, I was not alone. Every year, upward of 10% of Americans experience a panic attack. Approximately 2% to 3% of them develop panic disorder. Anxiety is no different; it’s one of the most common mental health challenges, affecting over 19% of U.S. adults each year.
Some of us have diabetes or a heart condition. Others have vertigo, learning disabilities, claustrophobia, migraines, irritable bowl, inflamed gums, and so on. Honestly, it all stinks. But thankfully, there are real-world, real-time solutions that can help us overcome them.
So, do check them out.