Almost everyone who calls me about panic uses the phrase “anxiety attack” at some point in the first five minutes. It is a completely reasonable thing to say. It is also the single most common place where people get confused about what is actually happening to them.
The confusion matters, because the two experiences respond to different things.
What is a panic attack, and what are the symptoms?
A panic attack is a defined clinical event, not a figure of speech. The criteria describe an abrupt surge of intense fear or discomfort that peaks within minutes, along with at least four symptoms from a list of thirteen.
Here are all thirteen. Most of them are physical:
- Pounding heart or racing pulse
- Sweating
- Trembling or shaking
- Shortness of breath
- A feeling of choking
- Chest pain or tightness
- Nausea or stomach distress
- Dizziness or feeling faint
- Chills or heat surges
- Numbness or tingling
- Feeling detached from yourself or from reality
- Fear of losing control
- Fear of dying
Two details in that definition do most of the work. It comes on abruptly, and it peaks. A panic attack is not a mood you sink into. It is a spike, and it usually crests and starts falling within about ten minutes, even though it can leave you shaky for hours afterward.
The other thing worth knowing: a panic attack can start from a completely calm state. People wake up out of a sound sleep with one. That is part of why they feel so much like a medical emergency. There is no obvious cause to point at.
What does an anxiety attack feel like?
“Anxiety attack” is not a diagnosis. You will not find it in the diagnostic manual, which is why two clinicians can use the phrase and mean slightly different things.
What people usually mean by it is real, though. They are describing anxiety that built up gradually, attached itself to something specific, and stayed. The work presentation. The medical test results. The conversation you have been dreading. It can last hours or days, it waxes and wanes, and it rarely has the sharp peak that defines a panic attack.
I never correct someone's vocabulary in a first session. What they call it matters far less than what actually happened.
How can you tell the difference between a panic attack and an anxiety attack?
Three questions usually sort it out.
- How fast did it arrive? Panic slams. Anxiety creeps.
- Did it peak and come down? Panic crests within minutes. Anxiety can hum along all afternoon.
- How loud was your body? Panic is overwhelmingly physical, to the point that people go to the emergency room. Anxiety is more often mental, with the body in the background.
Here is the picture I use with clients. A panic attack is a fire alarm going off in an empty hallway, deafening and sudden and over before you find the source. Anxiety is smoke slowly filling a room. You notice it, then you keep noticing it, and after a while you cannot remember what it was like to breathe clean air.
Both are miserable. They are not the same problem.
How long does a panic attack last?
A panic attack peaks within minutes, usually around ten, and the sharpest part is generally over well inside half an hour. That short arc is one of the clearest ways to tell panic from anxiety, which can sit on you for days.
The aftermath lasts longer than the attack. Many people feel wrung out, shaky, or braced for the next one well into the following day, which is why an attack that lasted twenty minutes can feel in memory like it lasted all afternoon.
Why does the difference change your treatment?
It matters because it changes what treatment aims at.
Panic runs on a misread of your own body. A 2018 review found that mistaking normal body sensations for signs of catastrophe is the thing that most sets panic apart from other kinds of anxiety. Your heart speeds up, and the thought is not “I stood up too fast,” it is “something is badly wrong.” So panic treatment goes after that misread directly, and has you practice the sensations on purpose until they stop meaning danger.
Anxiety that builds around a real stressor is a different job. There the work is usually about the worry itself, the problem underneath it, and what you have been putting off because of it.
Aim panic treatment at generalized worry and you will miss. Aim worry treatment at panic and the attacks keep coming.
Does one panic attack mean you have panic disorder?
No, and this is the part I most want people to hear.
In a national survey of more than 9,000 American adults, 22.7% had experienced panic attacks without ever developing panic disorder. Panic disorder itself was far less common, at 3.7% without agoraphobia. Close to one in four people have had the experience. Most of them never develop the condition.
A panic attack is an event. Panic disorder is a pattern: attacks that keep coming, plus a month or more of dreading the next one or rearranging your life to avoid it. The attack is not what makes it a disorder. What you do next is.
That is also where the opening is. Panic disorder develops through avoidance, which means the window between a first attack and a lasting problem is a window you can act in.
When should you see a doctor about panic attack symptoms?
Before you decide anything is psychological, rule out the physical. Chest pain, a racing heart, and shortness of breath all belong to panic and to several medical conditions, and no article can tell them apart for you.
If symptoms are new, severe, or different from what you have had before, get evaluated. People sometimes feel foolish going to the emergency room and finding out it was panic. It is not foolish. It is the correct order of operations, and a clean workup is useful information for treatment.
The short version
- A panic attack is a defined event: abrupt, peaking within minutes, with at least four physical symptoms.
- “Anxiety attack” is not a diagnosis, but it usually describes something real: anxiety that built slowly, attached to a specific worry, and stuck around.
- Speed and shape tell you which: panic spikes and crashes, anxiety builds and lingers.
- The difference changes the treatment. Panic work targets the misread of body sensations. Worry work targets the worry.
- One panic attack is not panic disorder. Close to a quarter of adults have had one without ever developing the condition.
- Get new or severe physical symptoms checked first. Always.
If you landed here after your first one, the useful thing to know is that what happens next is not fixed. A panic attack is frightening and it is survivable, and it does not have to become the thing your life organizes itself around. If it already has, that is treatable too. What actually works for panic covers the options, and panic disorder treatment is what that looks like here.
New, severe, or unfamiliar physical symptoms, especially chest pain, always deserve a medical check first. Panic and heart symptoms can look alike, and ruling out a medical cause is part of good care, not an overreaction.
Frequently asked questions
Can you have a panic attack and an anxiety attack at the same time?
Yes, and it is common. Long-running anxiety about something specific raises your baseline, and a panic attack can spike out of the top of it. People often describe a stressful week that ended in an attack. The two are separate events, not opposites, and plenty of people deal with both.
Can you have a panic attack without feeling anxious first?
Yes. Panic attacks can start from a completely calm state, including out of sleep. That is one of the things that makes them so frightening, because there is no obvious trigger to explain what your body just did.
Is an anxiety attack less serious than a panic attack?
Not necessarily. A panic attack is more intense in the moment, but prolonged anxiety can do more damage to your sleep, your work, and your relationships over time. Intensity and seriousness are different measures, and both are worth treating.
References
- Substance Abuse and Mental Health Services Administration. Diagnostic criteria for panic attack and panic disorder (reprinting DSM-5 criteria), in Substance Use Disorder Treatment for People With Co-Occurring Disorders, TIP 42, 2020. Read the criteria
- Kessler RC, Chiu WT, Jin R, Ruscio AM, Shear K, Walters EE. The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Archives of General Psychiatry, 2006;63:415–424. Read the study
- Ohst B, Tuschen-Caffier B. Catastrophic misinterpretation of bodily sensations in panic disorder, other anxiety disorders, and healthy subjects. PLOS One, 2018. Read the study