How to tell the difference between anxiety and panic, and why it’s important

I knew I had anxiety by the time I was 13, when I experienced my first panic attack, but it wasn’t until years later that I learned that “anxiety” doesn’t actually mean much at all. An anxiety disorder is a medical condition, but there are multiple types of anxiety disorders, each defined by different characteristics, symptoms and treatment options.

The fact that I was walking around saying I had “anxiety” before I had an official diagnosis troubles me now, because I didn’t know that not all forms of anxiety come with the vomiting, trembling, sweating, crying, heart palpitations and fear of dying that accompany my panic attacks. Panic attacks don’t look the same for everyone who has them, and not every type of anxiety disorder includes panic attacks at all. Implying that my experience was the definition of “anxiety” was misleading; plenty of people have anxiety disorders that don’t manifest like mine. 

When I talked about my symptoms with a doctor in high school, I was only diagnosed with generalized anxiety disorder. My panic disorder went unidentified and unaddressed until I was 19 because I didn’t know how to differentiate my general worrying from my panic attacks.

It’s important to know the differences so that you can talk to your doctor about your experiences and symptoms if you choose to seek treatment—and so that next time someone says they have “anxiety” because they got worked up before a test, you know to take that with a grain of salt.

What is an anxiety disorder?

An “anxiety disorder” isn’t just one illness. The term actually refers to a category of psychiatric conditions including generalized anxiety disorder, panic disorder, phobias, social anxiety disorder, selective mutism, obsessive compulsive disorder and more, according to the Anxiety and Depression Association of America. The organization also reports that anxiety disorders are the most common and pervasive mental disorders in the United States.

The most common type of anxiety disorder is generalized anxiety disorder which affects 6.8 million adults. GAD is characterized by excessive worry about a number of factors such as health, work, relationships and everyday life. It’s normal to experience a certain level of anxiety at some points in your life, but a GAD diagnosis may fit if you also feel restless, irritable, fatigued, distracted or dissociated; if you can’t seem to control your worried mind whether or not you understand that some of your fears may be unwarranted; or if you develop physical symptoms such as muscle tension, back pain, headaches or gastrointestinal problems.

For GAD, a selective serotonin reuptake inhibitor is often the first line of defense. Psychiatric medication is normally coupled with a form of talk therapy. Cognitive behavioral therapy can be extremely effective. A study in 2018 called CBT “the current gold standard of psychotherapy” due to being the most practiced, most studied and most effective type of therapy. When administering CBT, a counselor will help you identify your feelings in certain situations and get to the root of why you feel them, so you can start to recognize and then reduce the thought pathways that get you there in daily life.

What is panic disorder?

Panic disorder is a type of anxiety disorder that can develop in individuals who experience panic attacks. People with panic disorder have recurrent, unexpected panic attacks and develop the condition by agonizing over their experience of panic attacks. They worry about when panic might strike next and will actively change their behavior and routines to avoid situations they associate with the attacks, according to the National Institute of Mental Health

The tricky thing about PD is that the attacks can seem random and beyond the patient’s control. They can strike when you’re otherwise calm or even happy. That’s part of why it’s so important to understand PD from GAD: while both respond well to the combo of CBT and SSRIs, the goals and details of your therapy will be different based on which one you have. CBT for folks with GAD will seek to unpack your daily worries and will not likely focus on panic attacks (unless you suffer from both conditions concurrently). If you have PD, you’ll first have to uncover how your negative and anxious thoughts bring on your panic attacks. You’ll learn to understand that they aren’t random after all and work to restore your sense of control over your body and mind.

But what is a panic attack? Is it different from an anxiety attack?

Well, medically, no. So-called “anxiety attacks” aren’t recognized in the Diagnostic and Statistical Manual of Mental Disorders, the guide from which psychiatrists and psychologists determine diagnoses and recommend treatment options.

The DSM does recognize panic attacks, though. They are intense episodes of fear or doom that come on suddenly, last at highest intensity for less than 30 minutes, and are associated with a range of factors. Among other symptoms, panic attacks can include a sense of detachment from the world and your body (known as derealization and depersonalization), feeling like you are dying or dead, feeling like your throat is closing up, feeling lightheaded, brief chest pain or tightness and shortness of breath. Panic attacks sometimes occur back to back.

Alternatively, when people say that they’ve had an “anxiety attack,” they’re referring to more emotional aspects, like apprehension, distress or restlessness when anticipating a typically nerve-wracking situation, according to Healthline. These feelings pass once the event ends. While strong feelings of nervousness are certainly uncomfortable and distracting, they’re not panic attacks, and they don’t necessarily mean that you have an anxiety disorder.

The difference between anxiety disorders and anticipatory nervousness can seem insignificant in the moment; any amount of anxiety is uncomfortable. However, when it comes to seeking treatment, it’s important to understand what you’re truly experiencing to ensure you get the most appropriate care.