Think about how your body reacts when you’re in a stressful situation. Your heart may race, or maybe you start sweating. That may not be all — especially if you also get nauseous or short of breath. If things feel bad enough, you might wonder if you’re having a panic attack. They’re more common than you’d think; some 11 percent of Americans experience one each year. Panic attacks can also recur, and the fallout is gendered: Women who have them are more likely to develop a panic disorder.
Not every response to a stressful situation is a panic attack, however. How can you know if you’re having a full-blown panic attack or regular anxiety? When should a doctor assess what’s going on?
We talked with experts to learn how patients can tell the difference between a panic attack and anxiety — and how to get help.
Anxiety
Causes and symptoms
Anxiety is a feeling of worry or fear, and it can be caused by any number of stressful day-to-day situations — a problem at work, a big test or a disagreement with a friend.
“We all get all anxious,” says Dr. Tochi Iroku-Malize, a family physician in Bay Shore, New York, and president-elect of the American Academy of Family Physicians. “Anxiety is normal.”
Anxiety can be helpful when it causes us to pay attention to dangerous situations. It evolved originally to keep us safe. Anxiety might manifest as racing thoughts, a rapid pulse or even an upset stomach. Typically, however, it doesn’t prevent you from consistently and successfully carrying on with your everyday activities.
Diagnosis
People who worry occasionally about regular situations or specific events have run-of-the-mill anxiety, which almost everyone experiences. If you live with a general, persistent feeling of dread, however, you might have an anxiety disorder, and there are several types. People with generalized anxiety disorder, for example, may feel constantly on edge, irritable and unable to sleep.
Treatment
For basic, occasional anxiety tied to life events or situations, techniques like deep breathing, acupuncture, meditation and yoga are a good place to start for relief.
For people with more severe anxiety or an anxiety disorder, doctors often recommend psychotherapy, such as cognitive behavioral therapy, which can train you to respond differently to stressful situations.
Another option for treating an anxiety disorder is medication. SSRIs, or selective serotonin reuptake inhibitors, like Zoloft or Prozac, can help people feel less anxious.
Panic Attack
Causes and symptoms
Unlike general anxiety, panic attacks are sudden episodes of intense fear, accompanied by physical responses, when in actuality there’s no real and present threat. Panic attacks typically come on without any warning. Someone experiencing a panic attack might feel like they’re dying or having a heart attack.
“These are actually attacks where the person is engulfed in a paralyzing fear, with a physical expression of that fear,” says Iroku-Malize. “It’s an intense period, and then it goes away.”
Panic attacks often don’t have a trigger that you can pinpoint. For someone with a lot of stressors in their life, sometimes reaching their stressor limit can prompt an attack. Symptoms of a panic attack often imitate real medical issues, and can include heart palpitations, shortness of breath, sweating, chest pain, fatigue, an upset stomach and a headache that can last for minutes or hours.
While some people will have one panic attack and then never have one again, others go through multiple attacks and worry about when the next will come. “It’s a vicious cycle that continues on and on,” says Iroku-Malize.
Diagnosis
If you think you’ve had one or multiple panic attacks, check in with your doctor. “You should never feel ashamed or embarrassed talking with your doctor about it, even if it’s just one attack,” Iroku-Malize says.
A doctor will likely start by asking about your symptoms, how many panic attacks you’ve had and how often. When Dr. Neda Gould, director of the Mindfulness Program at Johns Hopkins, meets with patients who’ve had panic attacks, she first suggests a physical exam, with lab work if needed, to make sure there are no underlying medical issues at play. For example, if someone is complaining of episodes accompanied by chest pain, she wants to rule out an undiagnosed heart problem.
“If you’re okay physically but you modify your lifestyle because you fear another panic attack, you should look into treatment,” Gould says. If left untreated, panic attacks can lead to a full-blown phobia: an excessive, irrational fear of a situation or a place which you then avoid at all cost. This can be a major sign of a panic disorder.
Treatment
Counseling and medication are the two main ways to treat panic attacks or a panic disorder.
Cognitive behavioral therapy, or CBT, trains people who have panic attacks how to better cope with the attacks when they come and to realize in the moment that the episodes are not fatal. A doctor might ask you to keep a panic attack diary, where you monitor your daily mood, symptoms and the situations you find yourself in.
Through therapy, people can learn how to slow their breathing during an attack and to relax their muscles. Exposure therapy helps people who have panic attacks understand that while symptoms are uncomfortable, they’re not fatal. Say a person is afraid of being dizzy during a panic attack; a therapist might spin them around in a chair so they can safely experience dizziness.
“If you commit to treatment, these are absolutely treatable diagnoses,” Gould says.
For people who are resistant to therapy or who haven’t found it helpful, medications like an antidepressant or anti-anxiety drug can also help. “Sometimes a medication can even get someone to the point where they’re more receptive to therapy,” Gould says.