You Asked: What’s the difference between anxiety and a panic attack?

We all become anxious or nervous from time to time–when studying for a big test, for instance, or when going through financial hardship. For some people, overwhelming thoughts and behaviors become so frequent and forceful that they begin to overtake their lives.

How do you tell if your everyday anxiety has crossed the line or maybe even developed into a panic disorder?

Kathleen Roblyer, a psychiatric-mental health nurse practitioner (PMHNP) and clinical assistant professor at the Texas A&M Health Science Center College of Nursing, specializes in treating patients with anxiety and mood disorders. She said, “Anxiety is a common experience. When the presentation of anxiety meets certain criteria, such as in generalized anxiety disorder (GAD), it becomes a disorder. Panic attacks can occur alone or as a symptom of a panic disorder and are diagnosed when someone displays four or more specific symptoms.”

Anxiety is a protective mechanism related to fight or flight, and small amounts of anxiety in your life are expected and normal. If there is not a recurring threat, your brain archives the response to fear and doesn’t store it as a trigger. Anxiety disorders, such as GAD, can develop when people experience exaggerated worry and tension even when there is no reason for apparent concern. There are a number of different types of anxiety disorders.

“Anxiety becomes unhealthy when it progresses from occasional worries to a state of worry that changes your thinking and everyday behaviors. If anxiety is disrupting your life, you need to seek help from a health care provider,” Roblyer said.

GAD affects 6.8 million adults in the United States in any given year. Women are more likely to suffer from an anxiety disorder but it will impact both men and women, according to the Anxiety and Depression Association of America.

GAD often occurs gradually and the risk for the disorder is highest between childhood and middle age. Although the exact cause of GAD is unknown, research has shown biological factors, family background and life experiences–particularly stressful ones–play a significant role.

Panic attacks may occur abruptly from a calm state but are often brought on because of a stressor or trigger that creates more anxiety. Panic attacks are short, very severe, and then resolved, usually within minutes. Anxiety may be a period of elevated worry that can last minutes, hours or even days.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines a panic attack as the abrupt onset of intense fear or discomfort that reaches a peak within minutes and includes at least four of the following symptoms:

• Palpitations, pounding heart or accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, light-headed or faint
• Chills or heat sensations
• Paresthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (being detached from oneself)
• Fear of losing control or “going crazy”
• Fear of dying

“A panic attack is a specific event that occurs with defined characteristics and involves feelings of intense fear, danger or doom,” Roblyer said. “Anxiety is a more general term, related to stress and worry.”

According to Roblyer, people in her practice who suffer from panic attacks have often experienced a traumatic event in their past, and a mental or physical trigger may cause the onset of the attack. “It’s extremely important for a person to begin talking to a counselor to begin processing after significant traumatic events. Since it is possible to treat anxiety and panic disorders with talk therapy rather than with medication, it is best not to delay treatment. As the condition becomes more severe, it may require medication,” she said.

Roblyer emphasized that people who utilize illicit drugs like marijuana, methamphetamines, and cocaine can actually make their anxiety or panic disorders worse. “We see people use drugs like cannabis (marijuana) to try and relax or calm their fears, but in doing so, they actually exacerbate the anxiety. When the drugs wear off, the anxiety may become more severe.” Excessive caffeine can also contribute to higher levels of anxiety.

Roblyer said any person who experiences severe symptoms of anxiety or panic should contact their health care provider for an assessment. “People don’t need to try to differentiate between the two,” she said. “If you are experiencing distress that interferes with your daily life then you should seek help.”