What is the difference between an anxiety attack and a panic attack?

Distinguishing Anxiety Attacks from Panic Attacks

"Anxiety attack" is not a formal diagnostic term in psychiatric classification systems, while panic attack is a well-defined clinical syndrome characterized by an abrupt surge of intense fear reaching peak intensity within 10 minutes with specific physical and cognitive symptoms.

Key Clinical Distinction

Panic attacks are discrete, time-limited episodes with a rapid onset and predictable symptom cluster, whereas the term "anxiety attack" is colloquially used to describe periods of heightened anxiety that lack the specific diagnostic criteria required for panic attacks 1, 2.

Panic Attack: Formal Diagnostic Criteria

Panic attacks are characterized by a discrete period of intense fear or discomfort in which four or more of the following symptoms develop abruptly and reach a peak within 10 minutes 1, 2:

• Palpitations, pounding heart, or accelerated heart rate 1, 2
• Sweating 1, 2
• Trembling or shaking 1, 2
• Sensations of shortness of breath or smothering 1, 2
• Feeling of choking 1, 2
• Chest pain or discomfort 1, 2
• Nausea or abdominal distress 1, 2
• Feeling dizzy, unsteady, lightheaded, or faint 1, 2
• Derealization (feelings of unreality) or depersonalization (being detached from oneself) 1, 2
• Fear of losing control or "going crazy" 1, 2
• Fear of dying 1, 2
• Paresthesias (numbness or tingling sensations) 1, 2
• Chills or hot flushes 1, 2

"Anxiety Attack": Non-Specific Clinical Presentation

The term "anxiety attack" lacks formal diagnostic criteria and is used informally to describe episodes of heightened anxiety that may 3, 4:

• Build gradually rather than reaching peak intensity within 10 minutes 5
• Involve excessive, uncontrollable worry about everyday situations 3
• Present with fewer than four of the panic attack symptoms 1, 2
• Lack the abrupt onset characteristic of panic attacks 5
• Be triggered by identifiable stressors or worries 3, 4

Clinical Context and Diagnostic Implications

Panic Disorder vs. Other Anxiety Disorders

Panic disorder is diagnosed when recurrent unexpected panic attacks occur along with persistent concern about additional attacks, worry about their implications, or significant behavioral changes related to the attacks 1, 2. This differs fundamentally from other anxiety presentations 6, 7:

• Generalized Anxiety Disorder involves chronic, pervasive worry about multiple topics with physical symptoms but without discrete panic attacks as the defining feature 3
• Social Anxiety Disorder features anxiety triggered specifically by social evaluation situations, though panic-like symptoms may occur in these contexts 4
• Specific phobias involve anxiety reliably elicited by specific environmental stimuli 8

Cultural Variations in Presentation

The presentation of panic attacks varies across cultural contexts 9:

• European Americans commonly express heart-focused panic attacks 9
• Southeast Asian refugee populations more often express somatic-focused panic attacks related to beliefs about blocked wind or chi 9
• These cultural variations represent the same underlying panic phenomenon with different symptomatic expression 9

Critical Diagnostic Pitfalls to Avoid

Medical Conditions That Mimic Panic

Always rule out medical conditions before attributing symptoms solely to anxiety or panic 10:

• Hyperthyroidism can cause anxiety symptoms through excessive thyroid hormone 10
• Cardiac arrhythmias can initiate or mimic panic attacks with palpitations and chest discomfort 10
• Hypoglycemia can trigger panic-like symptoms due to blood sugar fluctuations 10
• Pheochromocytoma may present with episodic symptoms resembling panic attacks 8

Substance-Induced Presentations

Caffeine excess, stimulant medications, and illicit drug use can directly provoke panic-like symptoms 10. Alcohol and substance withdrawal can create rebound anxiety and panic 10.

Practical Clinical Approach

When Evaluating Acute Episodes

Focus on the temporal pattern: panic attacks reach peak intensity within 10 minutes with abrupt onset, while general anxiety episodes build more gradually 1, 2, 5. Document the specific number and type of symptoms present, as the four-symptom threshold is diagnostically significant 1, 2.

Assessment of Functional Impact

Both panic attacks and heightened anxiety episodes can cause significant distress, but panic disorder specifically involves 1, 7:

• Persistent fear of future panic attacks 1
• Concern about implications or consequences of attacks 1
• Significant behavioral changes to avoid situations where attacks might occur 1
• Potential development of agoraphobia in 30-50% of cases 9

Treatment Implications

The distinction matters because panic disorder has specific evidence-based treatments 6, 5:

• Benzodiazepines (alprazolam, clonazepam, diazepam) show strong efficacy for panic disorder with rapid symptom control 6, 5
• SSRIs (particularly paroxetine and fluoxetine) and SNRIs (venlafaxine) demonstrate effectiveness for panic disorder 5
• TCAs and MAOIs also show efficacy but with different tolerability profiles 5
• Cognitive-behavioral therapy with interoceptive exposure is specifically designed for panic disorder 9

In contrast, generalized anxiety without panic attacks may respond better to different treatment approaches focused on worry reduction rather than panic-specific interventions 3.