Anxiety Attacks vs Panic Attacks: Key Differences Explained by a Neurologist

Anxiety and panic are terms often used interchangeably by the general public, but they refer to distinct psychological and physiological experiences. While both anxiety attacks and panic attacks involve intense discomfort and a sense of fear, they differ in various aspects, including their symptoms, duration, triggers, and how they affect individuals in the long term. Understanding these differences is essential for patients and healthcare providers alike, particularly neurologists, psychiatrists, and general practitioners who frequently encounter these disorders.

In this comprehensive guide, we will explore anxiety attacks and panic attacks, delve into their similarities and differences, discuss the physiological and neurological mechanisms behind them, and provide useful information on diagnosis and treatment. This article aims to clear the confusion between these two conditions while offering a resourceful insight into the nuances that separate them.

What Are Anxiety Attacks?

Anxiety attacks are not formally recognized as a medical term by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is often used by mental health professionals. However, the phrase "anxiety attack" has entered the common lexicon to describe a heightened state of anxiety that can come on gradually or acutely.

Anxiety is characterized by a state of worry or fear that is often vague and future-oriented. While it may not always have an identifiable trigger, it usually stems from prolonged stress, overthinking, or anticipation of a particular event. People experiencing an anxiety attack may describe feelings of dread or uneasiness, accompanied by physical symptoms like:

• Increased heart rate
• Sweating
• Shortness of breath
• Dizziness
• Muscle tension
• Difficulty concentrating
• Stomach disturbances such as nausea or diarrhea

These symptoms tend to build up over time and are less sudden and overwhelming than the symptoms of a panic attack. Anxiety attacks usually subside once the stressor is removed or when the person is able to manage the situation more effectively. Importantly, the individual is often aware of the source of their anxiety, even if the response seems disproportionate to the situation.

What Are Panic Attacks?

In contrast, panic attacks are sudden and intense surges of fear or discomfort, and unlike anxiety attacks, they are officially recognized by DSM-5. Panic attacks typically appear without warning, can happen at any time, and often reach their peak intensity within minutes. These episodes are characterized by four or more of the following symptoms:

• Palpitations or accelerated heart rate
• Trembling or shaking
• Sensations of shortness of breath or smothering
• chest pain or discomfort
• Choking sensations
• Nausea or abdominal distress
• Feeling dizzy, lightheaded, or faint
• Chills or hot flashes
• Sweating
• Feelings of unreality (derealization) or being detached from oneself (depersonalization)
• Fear of losing control or “going crazy”
• Fear of dying
• Numbness or tingling sensations (paresthesias)

A key hallmark of panic attacks is their intense, overwhelming nature, which can lead to a profound sense of impending doom. People who experience panic attacks often feel that they are in immediate physical danger, even though no real threat exists. After a panic attack subsides, individuals may continue to worry about the possibility of another attack, a phenomenon referred to as anticipatory anxiety.

Key Differences Between Anxiety Attacks and Panic Attacks

1. Onset

• Anxiety Attacks: Anxiety attacks tend to build gradually over time, often in response to an ongoing stressor. For example, a person who has a presentation the next day may feel increasingly anxious as the time draws nearer.
• Panic Attacks: Panic attacks, on the other hand, are sudden and usually unexpected. They can occur at any time, even during sleep (a condition known as nocturnal panic attacks), without any clear stressor. They peak quickly, usually within 10 minutes.

2. Duration

• Anxiety Attacks: Anxiety attacks can last for extended periods, ranging from minutes to hours or even days in extreme cases. Since the intensity is generally lower than that of panic attacks, it may be easier to manage over time.
• Panic Attacks: Panic attacks tend to be short-lived, typically lasting about 5-30 minutes, although the after-effects can last longer. However, due to the extreme nature of the symptoms, they can feel much longer to the person experiencing them.

3. Symptoms

• Anxiety Attacks: Symptoms of anxiety attacks are often related to a general state of worry. There is a slow build-up of symptoms such as irritability, restlessness, and difficulty concentrating, with milder physical symptoms like muscle tension, headaches, or stomach issues.
• Panic Attacks: Panic attacks involve more severe physical symptoms that mimic those of a heart attack or other life-threatening medical conditions. The sense of terror is acute, and people often report feeling completely overwhelmed by fear or a sensation that they are dying.

4. Triggers

• Anxiety Attacks: These attacks are usually connected to an identifiable source of worry. Common triggers include deadlines, social situations, or health concerns. The worry might feel excessive, but it is connected to a real-life event or situation.
• Panic Attacks: Panic attacks often occur without any clear trigger and can strike without warning. The lack of an obvious cause can make panic attacks feel more disorienting and frightening, particularly if they occur in seemingly safe environments like home.

5. Neurological Mechanisms

• Anxiety Attacks: Anxiety attacks are driven by the body's stress response, particularly through the hypothalamic-pituitary-adrenal (HPA) axis, which releases cortisol, the body’s primary stress hormone. This response primes the body to deal with prolonged stress.
• Panic Attacks: Panic attacks involve the sudden activation of the body's "fight or flight" response, likely through the autonomic nervous system. There may be a dysregulation of brain regions like the amygdala (responsible for fear responses), hippocampus (involved in memory), and the prefrontal cortex (which helps with decision-making and planning).

6. Psychological Effects

• Anxiety Attacks: Anxiety attacks often have a lingering effect on a person’s day-to-day life, contributing to long-term stress, sleep disturbances, and mood changes. Since anxiety builds gradually, it can lead to chronic conditions like generalized anxiety disorder (GAD) or social anxiety disorder.
• Panic Attacks: Panic attacks may lead to panic disorder if they recur frequently, but they are also associated with other conditions like agoraphobia, where individuals develop a fear of being in situations where escape might be difficult. People who experience frequent panic attacks often develop a deep-seated fear of the attacks themselves, leading to avoidance behaviors.

Diagnosing Anxiety and Panic Disorders

Both anxiety and panic attacks are linked to anxiety disorders but require different approaches to diagnosis. Clinicians, including neurologists and psychiatrists, use patient history, physical exams, and psychological evaluations to differentiate between the two.

• For anxiety-related disorders, doctors may look for chronic patterns of worry and symptoms lasting more than six months, particularly when the anxiety interferes with daily life. Generalized anxiety disorder (GAD), social anxiety disorder (SAD), and specific phobias are some of the most commonly diagnosed conditions linked with anxiety attacks.
• Panic disorders, on the other hand, are characterized by recurrent, unexpected panic attacks and a persistent fear of future episodes. Panic disorder may be accompanied by agoraphobia, a condition in which individuals avoid places or situations where they fear a panic attack might occur.

Treatment and Management

1. Cognitive Behavioral Therapy (CBT)

CBT is one of the most effective treatments for both anxiety and panic disorders. This form of therapy helps patients recognize distorted thinking patterns and replace them with more rational thoughts. By addressing the root causes of anxiety or panic, CBT empowers individuals to cope with their symptoms more effectively.

2. Medications

• For Anxiety Attacks: Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are often prescribed to manage chronic anxiety. Benzodiazepines may also be used for short-term relief in acute cases, but they are not a long-term solution due to the risk of dependence.
• For Panic Attacks: SSRIs, SNRIs, and benzodiazepines are also commonly prescribed for panic attacks. In more resistant cases, beta-blockers (which reduce physical symptoms like rapid heart rate) or antiepileptic drugs like pregabalin may be used.

3. Lifestyle Changes

Both anxiety and panic attacks can be alleviated through lifestyle adjustments, including:

• Exercise: Regular physical activity helps to lower cortisol levels and reduce stress.
• Mindfulness and Meditation: These practices can teach individuals how to stay grounded during moments of high anxiety or panic.
• Breathing Exercises: Techniques like diaphragmatic breathing can help manage symptoms of both anxiety and panic, particularly hyperventilation and dizziness.

4. Self-Care and Support Groups

Anxiety and panic disorders can make people feel isolated. Joining a support group or participating in forums where others share similar experiences can offer a sense of community and reduce the fear of stigmatization.

Neurologists’ Role in Managing Anxiety and Panic Disorders

As a neurologist, recognizing the subtle but crucial differences between anxiety attacks and panic attacks can be invaluable. The overlap of physical symptoms such as chest pain, dizziness, and shortness of breath can often lead patients to seek neurological consultation, especially when ruling out conditions like epilepsy, migraines, or other neurovascular disorders. Neurologists can assist in the differential diagnosis process by conducting a thorough neurological examination and referring patients to mental health professionals for long-term management when necessary.

Moreover, understanding the neurobiology of anxiety and panic disorders—such as the dysregulation of the amygdala and the autonomic nervous system—helps guide neurologists in explaining these conditions to patients. This, in turn, may reduce the stigma surrounding mental health and encourage patients to seek treatment.