Anxiety attack vs panic attack: how to tell the two apart

A panic attack is a sudden rush of intense fear that peaks within minutes and comes with strong physical symptoms, such as a pounding heart, breathlessness, shaking or feeling faint, often seemingly out of nowhere. “Anxiety attack” isn’t a medical term: people usually use it for a build-up of worry and tension that grows over hours or days, often around something stressful, and feels less explosive but can last much longer. In both cases, the most useful thing to do in the moment is to slow your breathing, let the feelings rise and fall without fighting them, and remind yourself they will pass.

What exactly is a panic attack?

A panic attack is a sudden surge of intense fear or discomfort that reaches its peak within minutes. The manual most clinicians use, the DSM-5, describes it by its symptoms, and an attack involves at least four of these:

• A pounding or racing heart
• Sweating
• Trembling or shaking
• Feeling short of breath or smothered
• A choking feeling
• Chest pain or discomfort
• Nausea or stomach upset
• Feeling dizzy, light-headed or faint
• Chills or hot flushes
• Numbness or tingling, often in the hands, feet or lips
• Feeling unreal, or detached from yourself
• Fear of losing control or “going crazy”
• Fear of dying

Panic attacks can come out of the blue, even when you’re relaxed or asleep, or they can be set off by a situation you fear, like a crowded train or a flight. They usually ease within about half an hour, though they can leave you shaky and drained for much longer.

Having one panic attack doesn’t mean something is wrong with you. Many people have one or two at some point in their lives, often during a stressful period, and never have another.

What do people mean by an anxiety attack?

When people say they had an anxiety attack, they usually mean a period when worry and tension built up until it felt overwhelming. It isn’t a diagnosis, so it doesn’t have a fixed definition, and different people use it for different things.

Often, it looks like this: something stressful is coming, or has happened, and over hours or days you feel more and more on edge. Your thoughts race through what could go wrong. Your muscles are tight, your stomach is unsettled, you can’t concentrate or sleep, and you might feel tearful or irritable. It rarely hits a sudden peak the way panic does, but it can hang around for much longer.

Some people also call a panic attack an anxiety attack, which is part of why the two get confused. And a slow build-up of anxiety can tip into a panic attack, so you can have both in the same day.

How do the two compare side by side?

The clearest differences are in how fast they start, how intense they get and how long they last. This table is a rough guide, since everyone’s experience is a bit different.

What does a panic attack feel like?

Many people describe a panic attack as the most frightening physical experience they’ve had. It often starts with a single sensation, such as a skipped heartbeat, a wave of dizziness or a tight chest, and within moments the body is in full alarm.

A common thought during a first attack is “I’m having a heart attack” or “I’m going to faint”, and plenty of people end up in an emergency department. That’s a reasonable thing to do if you don’t know what’s happening. Doctors would always rather check.

What keeps a panic attack going is a loop between body and mind. A physical sensation is noticed, it’s read as a sign of danger, that fear releases more adrenaline, the symptoms get stronger, and the stronger symptoms seem to confirm the danger. Understanding that loop is the first step to breaking it.

Why does your body react so strongly?

Your body reacts strongly because a panic attack is the fight-or-flight response going off at the wrong moment. That response evolved to help you survive real danger: adrenaline speeds up your heart and breathing, sends blood to your muscles and sharpens your attention.

When there’s no tiger to run from, those same changes feel alarming. Fast, shallow breathing lowers the carbon dioxide in your blood, which can cause tingling, light-headedness and a feeling that you can’t get enough air, even though you’re taking in plenty. Blood moving away from the stomach can bring nausea. The sense of unreality is the brain narrowing its focus.

None of this is harmful in itself. The body can’t keep up that level of alarm for long, which is why panic peaks and then fades, even if you do nothing at all.

What should you do during a panic attack?

During a panic attack, the aim is not to stop it by force but to let it pass with as little extra fear as possible. Fighting the feelings tends to add more adrenaline. Riding them out teaches your body that they aren’t dangerous.

1. Name it. Tell yourself: “This is a panic attack. It feels awful, but it isn’t dangerous, and it will pass.”
2. Slow your breathing, especially the out-breath. Breathe in gently through your nose for a count of about four, and out through your mouth for longer, about six. Don’t try to take big gulps of air.
3. Stay where you are if it’s safe. Leaving can bring brief relief, but it can also teach your mind that the place was the problem.
4. Let the sensations be there. Notice them with curiosity rather than trying to push them away: “My heart is beating fast. My hands are tingling.”
5. Ground yourself. Look around and name a few things you can see, hear and touch. Press your feet into the floor.
6. Wait. Panic peaks and falls. Watching the clock can help, because you’ll see it ease.

Practising slow breathing when you’re calm makes it far easier to use when you’re not. The breathing exercises guide you through a calming pattern on screen, and our piece on 4-7-8 breathing explains why longer out-breaths settle the body and when another pattern might suit you better.

What to do afterwards

Be gentle with yourself. Have some water, rest if you can, and if you feel able, tell someone what happened. Try not to plan your life around avoiding another one. Avoidance is one of the main ways occasional panic grows into something bigger.

What helps when anxiety builds slowly?

When anxiety builds over hours or days, the most helpful things are the ones that release tension and stop worry from looping. Breathing still helps, but it’s usually only part of it.

• Move your body. A brisk walk, a run or some stretching uses up some of the stress energy.
• Separate what you can do from what you can’t. Write down the worry, then any small step you can take. Do the step, or put it in the diary.
• Cut back on caffeine and alcohol. Both can make tension worse, and alcohol tends to raise anxiety the next day.
• Talk to someone. Saying the worry out loud often shrinks it.
• Protect your sleep. Tiredness makes everything feel more threatening.

If the worry tends to go round and round, our piece on breaking an overthinking loop has practical ways to interrupt it.

When do panic attacks become panic disorder?

Panic attacks become panic disorder when they keep happening unexpectedly and you spend a month or more worrying about having another one, or change how you live to avoid them. It’s the fear of the next attack, and the life that shrinks around it, that marks the difference.

That might look like avoiding exercise because a raised heart rate feels too much like panic, not going to shops or on public transport, always sitting near an exit, or needing someone with you when you go out. When avoidance becomes widespread, it can develop into agoraphobia, a fear of being in places where escape or help feels hard to reach.

The good news is that panic disorder is one of the most treatable anxiety problems. Cognitive behavioural therapy, which helps you understand the panic loop and gradually face the sensations and situations you’ve been avoiding, is well established. A doctor can talk you through treatment options.

Is it anxiety, or could it be stress?

Sometimes what feels like an anxiety attack is really an intense stress reaction: your body responding to too much pressure, too little rest or a difficult event. Stress usually eases when the pressure does. Anxiety tends to carry on, or find new things to worry about, even when life is calmer.

The two overlap a lot, and both can bring on panic. Our piece on telling stress from anxiety looks at the differences in more detail.

Should you take an anxiety test after an attack?

An anxiety test can be a useful next step, especially if attacks or long stretches of worry have been happening for a few weeks. It won’t tell you what kind of attack you had, but it shows how much anxiety has been part of your life lately.

The anxiety test on Sprout uses the GAD-7, a seven-question questionnaire that asks how often signs of worry and tension have bothered you over the last two weeks. It was designed to screen for generalised anxiety disorder, and later research by the team that created it found it also flags other common anxiety problems, panic disorder among them, reasonably well. A higher score isn’t a diagnosis, but it’s a good reason to talk to a doctor. Our piece on GAD-7 score ranges explains what each result means.

The short version

A panic attack is fast, intense and physical, and passes within minutes. What most people call an anxiety attack is slower, more about worry and tension, and lasts longer. Both are frightening and both are common, and neither means you’re in danger, though new chest pain always deserves a medical check.

If attacks are becoming more frequent, or worry about them is starting to shape your days, it’s worth getting support sooner rather than later. A good place to begin is the two-minute worry check, and then a conversation with your doctor, taking your result along.