Anxiety Attack vs. Panic Attack: What’s the Difference?
How to tell them apart, what helps in the moment, and when it is time to get care.
Clinically reviewed by Joseph Lavoie, MSN, APRN, PMHNP-BC · Last reviewed
The short answer
The main difference between an anxiety attack and a panic attack is speed and intensity. A panic attack is a sudden surge of intense fear that peaks within minutes, often with a racing heart, shortness of breath and a sense of doom, and it can come out of nowhere. “Anxiety attack” is not a medical term. People use it for worry and tension that build more slowly, usually around a stressor, and can last much longer at a lower level.
What a panic attack is
A panic attack is a specific, recognized event. The body’s alarm system fires at full strength even though there is no real danger. It comes on fast, usually hits its peak within about 10 minutes, and then fades. The National Institute of Mental Health lists symptoms such as:
- A pounding or racing heart
- Sweating, trembling or shaking
- Shortness of breath, or a feeling of choking
- Chest pain or tightness
- Nausea, dizziness or feeling faint
- Chills or hot flashes, numbness or tingling
- Feeling detached from yourself or like things are not real
- Fear of losing control, going crazy or dying
Panic attacks can happen with an obvious trigger, such as a crowded train or a fear you already know about. They can also happen out of the blue, even during sleep. Many people end up in an emergency room the first time because it feels like a heart attack.
After the attack, many people feel wiped out, embarrassed or afraid it will happen again. That fear of the next attack is often what does the most damage, because it leads people to avoid driving, stores, travel or exercise. Treatment works on both the attacks and the fear of them.
What people mean by an anxiety attack
When people say “anxiety attack,” they usually mean a stretch of heavy worry, dread and tension. It tends to build over hours or days, often around something specific: a work review, a medical test, a hard conversation. You may feel keyed up, irritable and tired, with a tight chest, a sore jaw or an upset stomach.
This kind of anxiety is less explosive than panic, but it can last much longer. It is also the core experience of generalized anxiety disorder, where worry about many things shows up most days for months.
Side by side
| Panic attack | What people call an anxiety attack | |
|---|---|---|
| Onset | Sudden, often within seconds | Gradual, over hours or days |
| Peak | Within minutes | No clear peak; rises and falls |
| How long | Usually minutes; the shaky aftermath can last longer | Can last hours, days or longer |
| Trigger | Can be expected or come out of nowhere | Usually tied to a worry or stressor |
| Intensity | Overwhelming fear, strong body symptoms | Mild to severe worry and tension |
| Medical term? | Yes | No; overlaps with anxiety disorders |
You can have both. Many people with ongoing anxiety also have occasional panic attacks, and a few panic attacks can lead to steady worry about the next one.
What helps in the moment
These steps do not stop every attack, but they help many people ride it out:
- Name it. Tell yourself, “This is panic. It is uncomfortable and it will pass.” Fighting it often makes it stronger.
- Slow your breathing. Breathe in through your nose for about four counts and out slowly for about six. A longer out-breath calms the body.
- Ground yourself. Notice five things you can see, four you can hear, three you can touch.
- Stay put if you can. Leaving every place where panic happens teaches your brain that the place is dangerous.
- Skip extra caffeine and alcohol afterward. Both can make the next few hours worse.
When to call 911: if you have chest pain, trouble breathing or fainting and you are not sure it is panic, get emergency care. This is especially true the first time, if you have heart risk factors, or if the symptoms feel different from your usual attacks. Ruling out a medical cause is always the right call.
When panic or anxiety needs treatment
One panic attack does not mean you have a disorder. Panic disorder is diagnosed when attacks keep happening and you spend at least a month worried about having more, or you change your life to avoid them: skipping the gym, the highway or the grocery store. Ongoing worry that is hard to control and gets in the way of work, sleep or relationships may point to generalized anxiety disorder.
Both are very treatable. Cognitive behavioral therapy (CBT) has strong evidence for panic disorder and generalized anxiety. Medication, most often an antidepressant such as an SSRI, is another option, alone or with therapy. If you are weighing those choices, see therapy vs. medication for anxiety and depression.
At Journey Psychiatric Care, Joseph Lavoie, PMHNP-BC, evaluates and treats anxiety and panic by secure video across Massachusetts, and he offers both therapy and medication management. Read more on the anxiety treatment page.
Frequently asked questions
How long does a panic attack last?
Most panic attacks peak within about 10 minutes and ease within 20 to 30 minutes. You may feel drained, shaky or on edge for a while afterward. If it seems to go on much longer, it may be several attacks in a row or ongoing anxiety.
Can a panic attack hurt you?
A panic attack feels dangerous but is not harmful in itself for most healthy people. The racing heart and fast breathing are the body’s normal alarm response. Because the symptoms overlap with heart and lung problems, get checked if you are not sure what is happening.
Can you have a panic attack in your sleep?
Yes. Nocturnal panic attacks wake people suddenly with a pounding heart and fear. They are fairly common in people with panic disorder. Frequent night attacks are worth raising with a clinician, who may also check for sleep problems such as sleep apnea.
Can anxiety cause chest pain?
Yes. Both panic and ongoing anxiety can cause chest tightness or pain, often from tense muscles or fast breathing. Chest pain can also come from the heart, so get emergency care if it is new, severe, spreads to your arm or jaw, or you are not sure. Once heart problems are ruled out, your clinician can help you manage anxiety-related chest pain.
Is an anxiety attack a real diagnosis?
No. “Anxiety attack” is an everyday phrase, not a diagnosis. A clinician will ask what actually happens to you and may diagnose generalized anxiety disorder, panic disorder, social anxiety or another condition, or none at all.
Why do panic attacks happen for no reason?
Panic attacks can come from stress that has been building, poor sleep, caffeine, some medications, or simply a sensitive alarm system. Sometimes the trigger is a body feeling, such as a skipped heartbeat, that the brain reads as danger. Therapy helps you break that loop.
Should I see a psychiatric provider or a therapist for panic attacks?
Either can help. A therapist can teach CBT skills, and a psychiatric provider can diagnose the condition and discuss medication if needed. Some clinicians, including psychiatric nurse practitioners, offer both. See which one you need.
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