What is the difference between Generalized Anxiety Disorder (GAD) and panic disorder?

Distinguishing GAD from Panic Disorder

Generalized Anxiety Disorder is characterized by persistent, excessive worry about multiple life circumstances lasting at least 6 months, while panic disorder is defined by recurrent, unexpected panic attacks—discrete episodes of intense fear peaking within 10 minutes. 1, 2

Core Diagnostic Features

Generalized Anxiety Disorder (GAD)

• Chronic, pervasive worry about numerous everyday situations or activities that the person finds difficult to control 1
• Symptoms must occur on most days for at least 6 months and significantly affect daily functioning 3, 4
• Presents with at least 6 of 18 symptoms across three domains: motor tension (trembling, muscle tension, restlessness), autonomic hyperactivity (palpitations, sweating, GI distress), and vigilance/scanning (feeling on edge, difficulty concentrating, sleep disturbance, irritability) 2
• The anxiety is not episodic but rather represents a chronic apprehensive mental state 4, 5

Panic Disorder (PD)

• Recurrent unexpected panic attacks—abrupt surges of intense fear reaching peak intensity within 10 minutes 2, 3
• Each attack involves at least 4 of 13 specific symptoms: palpitations, sweating, trembling, shortness of breath, choking sensation, chest pain, nausea, dizziness, derealization/depersonalization, fear of losing control, fear of dying, paresthesias, or chills/hot flushes 2
• The attacks are discrete episodes rather than continuous anxiety 4
• May occur with or without agoraphobia 2

Key Distinguishing Characteristics

The fundamental difference lies in chronicity versus episodic nature: GAD manifests as chronic, nonremitting anxiety, while panic disorder involves abrupt, episodic attacks with the involvement of at least 4 autonomic, cardiopulmonary, or neurologic symptoms 4.

Temporal Pattern

• GAD: Continuous worry and tension that waxes and wanes but persists throughout the day 1, 4
• Panic Disorder: Sudden onset attacks with symptom-free intervals between episodes, though anticipatory anxiety about future attacks may develop 2, 4

Symptom Focus

• GAD: Worry centers on multiple life domains (work, health, finances, relationships) without identifiable emotional stressors required 1, 4
• Panic Disorder: Fear focuses on the panic attacks themselves and their consequences (fear of dying, losing control, or having another attack) 2

Autonomic Symptoms

• GAD: Autonomic symptoms are present but less intense and more chronic 2
• Panic Disorder: Intense autonomic surge during attacks with at least 4 specific physical symptoms occurring simultaneously 2, 3

Assessment Tools

For GAD: Use the GAD-7 scale with scores of 0-4 (minimal), 5-9 (mild), 10-14 (moderate), and 15-21 (severe); the GAD-2 can serve as an ultra-brief screener with cutoff ≥3 requiring further assessment 1.

For Panic Disorder: The Panic Disorder Severity Scale (PDSS) is a 7-item tool with excellent sensitivity and specificity 3.

Common Diagnostic Pitfalls

• Failing to differentiate from medical conditions: Both disorders require ruling out hyperthyroidism, hyperparathyroidism, cardiac arrhythmias, and substance-induced causes before confirming diagnosis 6, 3
• Misattributing somatic symptoms: GAD patients frequently present with headache, noncardiac chest pain, fatigue, or GI complaints that have no physiologic foundation, leading to inappropriate resource utilization 4
• Overlooking comorbidity: Both disorders commonly co-occur with major depressive disorder and other anxiety disorders, requiring comprehensive assessment 7, 1
• Confusing adjustment disorder with GAD: GAD can manifest without identifiable emotional stressors, unlike adjustment disorder 4

Treatment Implications

Both disorders respond to SSRIs/SNRIs combined with cognitive behavioral therapy, but the specific CBT techniques differ: 8, 1

• GAD treatment emphasizes cognitive restructuring of chronic worry patterns and relaxation techniques 1
• Panic disorder treatment requires interoceptive exposure (deliberately inducing physical sensations), in vivo exposure to feared situations, and breathing retraining 6

Benzodiazepines provide short-term relief but are ill-advised for long-term GAD treatment due to cognitive impairment, abuse potential, and withdrawal effects; they should not be used as sole first-line treatment for panic disorder 6, 4. Treatment should continue for at least 9-12 months after recovery to prevent relapse in panic disorder 6, and 12 months before tapering in GAD 9.