Imagine experiencing an all-encompassing surge of fear combined with chest tightness, shortness of breath, or a slew of other frightening symptoms. How would you label this episode?
If you would call this an anxiety attack, you’re not alone. But, according to experts, that’s not the most accurate description for this kind of terrifying occurrence. If you spoke to a mental health professional, they would likely tell you that this constellation of symptoms signals a panic attack.
“In my experience, a patient will say, ‘I had an anxiety attack,’ but what they mean is that they had a panic attack,” Neda Gould, Ph.D., a clinical psychologist and associate director of the Johns Hopkins Bayview Anxiety Disorders Clinic, tells SELF. “‘Anxiety attack’ is more of a layperson's term.”
To that point, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which professionals rely on to identify various mental health conditions, only outlines panic attacks, not “anxiety attacks.”
The DSM-5 defines a panic attack as the rapid onset of intense fear plus at least four additional anxiety-provoking physical or psychological symptoms.
Those other symptoms include:
- Heart palpitations, a pounding heart, or an accelerated heart rate. “It can feel like your heart is going to jump out of your chest,” Mona Potter, M.D., medical director at the McLean Anxiety Mastery Program in Boston, Massachusetts, tells SELF.
- Trembling or shaking
- Feeling short of breath or smothered
- Feeling as though you’re choking
- Chest pain or discomfort
- Nausea or abdominal distress. “You can feel sick to your stomach: It can tighten, have sharp pains, or feel like butterflies,” says Dr. Potter.
- Feeling dizzy, unsteady, light-headed, or faint. “You might experience tunnel vision, like the world is closing in,” says Dr. Potter.
- Experiencing chills or, alternately, stifling heat
- Numbness or tingling sensations
- Derealization (feeling like reality is confusing or no longer exists) or depersonalization (feeling detached from your thoughts, feelings, and body). “You know you're there, but don't feel like you are truly present, and you don’t feel like yourself,” says Dr. Potter.
- Fear of losing control or that you’re “going crazy”
- Fear of dying. “Often times, a panic attack will land someone in the ER because it feels like they are having a heart attack or asthma attack that requires immediate attention,” says Dr. Potter.
Although panic attacks can feel neverending, they will eventually hit a peak and dissipate, Dr. Potter says. Episodes typically crest within 10 minutes, but the length can vary.
Some—but not all—people who experience panic attacks do so in the context of an anxiety condition called panic disorder.
About 4.7 percent of U.S. adults experience panic disorder at some time in their lives, according to the National Institute of Mental Health (NIMH). The number of people who experience panic attacks is higher because of a key distinction: “Not all people who have panic attacks get to a point of panic disorder,” Dr. Potter says.
Panic disorder means you have repeated panic attacks with no clear trigger. For instance, some people experience panic attacks in the context of drug and alcohol use or due to medical conditions such as hyperthyroidism (an overactive thyroid, which can lead to heightened anxiety), Dr. Potter explains. People who have post-traumatic stress disorder and are confronted by a trigger can have panic attacks, as can someone with social anxiety who’s in a situation that stokes their fear. Since the panic attacks in these scenarios have underlying sources, rather than coming on randomly for no reason, they don’t qualify as panic disorder.
Another essential diagnostic criterion for panic disorder: The episodes are so terrible and distressing that, for at least one month after having a panic attack, you have persistent concern about having another one. If you have panic disorder, you may also start avoiding certain places or activities in an attempt to ward off subsequent attacks. This is called agoraphobia. “Your world starts shrinking because you are constantly afraid of having another panic attack,” says Dr. Potter.
Maybe, after reading this far, you’ve realized what you were calling anxiety attacks don’t qualify as panic attacks. That doesn’t mean you’re not struggling enough to deserve help.
Other mental health conditions can have overlapping symptoms with panic attacks. For example (and unsurprisingly), generalized anxiety disorder (GAD), a mental health condition categorized by extreme, unnecessary worry that impedes your life, can cause issues such as fear about everyday things, trembling, sweating, feeling out of breath, and stomach aches, according to the NIMH.
Don’t subject yourself to the lie that if you “just” have moments of extreme anxiety, not full-blown panic attacks, you should be able to deal. If you feel like your anxiety is affecting your life, it’s worth seeking help, period. In fact, similar treatment methods can help both anxiety and panic attacks.
While panic attacks are absolutely frightening, thanks to treatment like therapy and medication, they’re not invincible.
Here’s what may help if you think you’re suffering from panic attacks or some other form of anxiety:
Cognitive behavioral therapy, often considered the gold standard for anxiety conditions, works to retrain your thoughts and actions in situations that make you anxious.
CBT can be particularly effective in treating panic attacks and, specifically, agoraphobia that stems from panic. As part of CBT, you may engage in a technique called exposure therapy, where a mental health professional might intentionally bring on symptoms of a panic attack to habituate you to them. For instance, if the dizziness really agitates you, a therapist might have you spin you around. If a racing heart is what worries you most, they might ask you to jog in place. Then you’ll work together to change your reaction to these triggering sensations, including with methods like deep breathing.
“One of the biggest pieces of treatment for panic is actually being able to say, ‘This is a panic attack, these are physical symptoms,’ and not doing anything [extreme] to make it go away,” says Dr. Potter. “It seems kind of counterintuitive, but that basically removes the fear aspect and kind of settles things down.”
This obviously might be scary, but under the supervision of a professional, exposure therapy really can be a helpful way of gaining control over your panic. “Often, when you break that connection—‘these symptoms are bad, I need to get rid of them’—and look at them more as ‘OK, this is bad, but I can tolerate it,’ they begin to dissipate over time,” says Gould.
There’s nothing wrong with using medication to treat panic attacks or anxiety. It’s an option for a reason.
Docs often turn to antidepressants called selective serotonin reuptake inhibitors (SSRIs) to target anxiety and panic symptoms, says Dr. Potter. These work by obstructing how easily your brain reabsorbs serotonin, a neurotransmitter that can affect your mood, the Mayo Clinic explains. Tricyclic antidepressants, which hinder reabsorption of the neurotransmitters serotonin and norepinephrine (this is implicated in your fight-or-flight response, are another common option for both panic attacks and anxiety, according to the DSM-5.
Then there’s a group of medicines called benzodiazepines that can rapidly decrease panicky feelings by working as a sedative, the Mayo Clinic explains. The biggest issue with them is that, if used frequently, you can build up a tolerance as well as a dependence. “If every time a person has a panic attack, they think they need to have that medication, it can become a band-aid treatment,” says Gould. That’s why she often likes to think about benzos as a better option for once-in-a-blue-moon situations, like if heights petrify you and you’re about to take a trip to the top of the Empire State Building.
Beyond that, your doctor might recommend lifestyle changes to combat your panic, the Mayo Clinic explains. If, say, having too much caffeine gets your heart racing in a way that can lead to a panic attack, cutting back might do wonders for your mental health.
Clearly, there’s no one-size-fits-all treatment for panic attacks. But, as Dr. Potter emphasizes, they are treatable.
It might take some trial and error to figure out how to deal with your panic attacks (especially when it comes to your meds since every drug can come with side effects). The best strategy will likely be a multifaceted blend of lifestyle changes, therapy, and medication that get you closer to living life with less fear.