Panic attack vs. anxiety attack: Distinguishing symptoms and how to tell the difference

• A panic attack and an anxiety attack are different conditions, though they share some similarities.
• Panic attacks occur when you have 4 or more of the 13 symptoms listed in the DSM-5, and they usually resolve themselves after 5 to 10 minutes.
• Anxiety attacks are not listed in the DSM-5, and while they may present some of the symptoms of a panic attack, they can range in duration and intensity.
• This article was medically reviewed by David A. Merrill, MD, PhD, psychiatrist and director of the Pacific Brain Health Center at Pacific Neuroscience Institute at Providence Saint John's Health Center.

Panic attacks and anxiety attacks are often used interchangeably, but they actually describe two different events.

A panic attack is an intense, debilitating surge of anxiety that may come on unexpectedly, and doesn't always have a clear trigger.

An anxiety attack, on the other hand, is an outburst of anxiety that's usually preceded by feelings of worry or stress — you'll likely be aware of what's triggering the anxiety attack.

It can be difficult to distinguish between panic and anxiety, as they share similar mental and physical symptoms, and you can use the same relaxation strategies to deal with an attack.

Here's what you need to know about the difference between a panic attack and an anxiety attack.

What is a panic attack?

A panic attack is a sudden onset of fear, often marked physically by a racing heart, chest tightness, or nausea. It's estimated that about 23% of Americans have had a panic attack in their lifetime.

If someone experiences multiple episodes, they may have panic disorder — a type of anxiety disorder that affects about 2% to 3% of Americans. It's characterized by recurring panic attacks, which develops into a fear of panic attacks that affect daily life.

Panic attack symptoms

There are 13 major symptoms of a panic attack, according to the DSM-5, or the manual that mental health professionals use to diagnose patients.

O'Rourke says that one must experience at least four of these symptoms in order for it to be clinically recognized as a panic attack:

• Increased heart rate
• Shortness of breath or the feeling that you can't breath
• Sweating
• Trembling or shaking
• Choking sensation
• Chest pain
• Nausea or other abdominal discomfort
• Lightheadedness, dizziness, or feeling faint
• Feeling suddenly cold or hot
• Going numb or tingly in certain parts of the body
• Feelings of detachment from yourself or reality
• A sense of doom, or fears that you will die
• Fear that you're losing control

What is an anxiety attack?

An anxiety attack is a mental surge of anxiety, says Anthony Puliafico, PhD, a clinical psychologist at Columbia University and director of the Columbia University's Clinic for Anxiety and Related Disorders.

Anxiety attacks are usually brought on by feelings of worry or stress, and while they can resemble panic attacks, they may not be as physically intense.

For example, an anxiety attack can occur when someone with generalized anxiety, a type of anxiety disorder, fears that the ceiling will fall on them at any moment — even though it's unlikely that it would.

Anxiety attack symptoms

According to Sarah O'Rourke, PhD, a clinical psychologist at Duke Health, anxiety attacks are not referenced in the DSM-5.

So, unlike with panic attacks, there's not one set of recognized symptoms. Instead, anxiety attacks are often described as a flare-up of generalized anxiety disorder.

Anxiety attacks may present similar symptoms as a panic attack, though they will likely not be as severe.

• Chest pains
• Chills
• Increased heart rate
• Lightheadedness
• Sweating
• Fear or sense of doom

How to deal with a panic attack or anxiety attack

A panic attack tends to peak after 10 minutes, Puliafico says, and it should resolve on its own. However, there are certain strategies you can employ in the middle of a panic attack to help remain calm and get through it.

Because anxiety attacks have similar symptoms as panic attacks, these relaxation techniques will likely be useful in both cases.

For example, O'Rourke recommends "square breathing," which is a way to visualize your breath and allow it to slow down.

1. Picture a square in your head. Starting at the bottom left corner of the square, and traveling up its left side, slowly take a deep breath while counting to four.
2. Then moving from the top left to the top right of the square, hold your breath for four seconds.
3. Take a deep breath for four counts while traveling down the right side of the square, and then hold your breath again for four counts as you move from the bottom right to the bottom left.
4. Repeat the breathing technique around the square until your heart rate slows down, and a slower breath doesn't feel forced. You should feel more relaxed.

This method of controlled breathing activates the parasympathetic nervous system.

During a panic attack, your fight or flight response is triggered. Your parasympathetic nervous system is what helps your body move out of that fight or flight response so that you may return to a relaxed state.

Other strategies to deal with panic or anxiety attacks include:

Ground yourself

O'Rourke also describes a grounding technique called "5-4-3-2-1" — which includes noticing these items in your surroundings:

• 5 things you can see
• 4 things you can touch
• 3 things you can hear
• 2 things you can smell
• 1 thing you can taste

It's used to reorient you in your physical environment, O'Rourke says. Not only will this exercise briefly distract you from the physical symptoms you're experiencing, but it can also stop you from dwelling on your anxious, racing thoughts.

Recognize what you're going through

Puliafico says that, often, one of the biggest concerns for someone having a panic attack is that something is seriously wrong with them.

"My first recommendation would be to recognize the symptoms for what they are. That 'I'm not in danger,'" Puliafico says.

O'Rourke says that positive thoughts can also help you get through this stressful moment.

If it's not your first panic attack, she offers the example, "I've coped with a panic attack before and I can cope with this one too."

Related articles from Health Reference:

• The 5 types of anxiety disorders and how to know if you have one
• How to deal with anxiety and improve your mental health
• Am I depressed? Take our quiz to gauge your symptoms and find the right treatment
• Exercise for depression: How regular physical activity can help mental health
• Learn about mindfulness and its benefits — and how to practice it with or without meditation