Anxiety Attack vs. Panic Attack

“Anxiety attack” and “panic attack” are two terms that are frequently used in discussions about mental health. While they are often used interchangeably, they are different conditions with unique characteristics, causes, and treatment approaches. Discover Recovery offers support for panic disorder and anxiety in our dual diagnosis treatment program. Call today for help.

What Is an Anxiety Attack?

An anxiety attack is a period of intense worry or fear that builds gradually, usually tied to a specific stressor or a pattern of ongoing stress. It is not a formal clinical diagnosis. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not list “anxiety attack” as a standalone condition — instead it encompasses experiences of overwhelming anxiety under broader disorders such as generalized anxiety disorder (GAD), social anxiety disorder, and specific phobias.

That clinical distinction matters in a practical way: because “anxiety attack” isn’t a defined diagnosis, there are no standardized diagnostic criteria for it. What people describe as an anxiety attack is typically an episode of anxiety that has peaked — the point where the worry or fear becomes physically and emotionally overwhelming.

Common symptoms of an anxiety attack include:

• Excessive worry about a specific event or generalized concerns
• Racing or intrusive thoughts
• Restlessness or irritability
• Muscle tension
• Trouble concentrating
• Fatigue
• Sleep difficulties
• Nausea or gastrointestinal discomfort
• Shortness of breath or rapid heartbeat

Anxiety attacks tend to build over minutes, hours, or even days. They’re almost always connected to something identifiable — an upcoming presentation, a financial problem, a conflict in a relationship. The intensity can vary widely and may linger long after the triggering event has passed.

What Is a Panic Attack?

A panic attack is different in a fundamental way: it strikes fast, peaks hard, and can happen without any warning or apparent reason.

The DSM-5 recognizes panic attacks as a formal experience and defines them as an abrupt surge of intense fear or discomfort that reaches peak intensity within minutes. They can arise from a calm state or an already-anxious one. Many people describe them as feeling like a heart attack — and that confusion is common enough that panic attacks send thousands of people to emergency rooms every year.

Panic attacks are a core feature of panic disorder, a condition characterized by recurrent, unexpected panic attacks. Panic disorder affects approximately 6 million U.S. adults, according to NIMH data cited by the Anxiety and Depression Association of America (ADAA). Women are twice as likely to be affected as men.

Common symptoms of a panic attack include:

• Sudden, intense surge of fear or terror
• Racing or pounding heartbeat (palpitations)
• Chest tightness or pain
• Shortness of breath or feeling of choking
• Dizziness or lightheadedness
• Sweating or chills
• Numbness or tingling
• Nausea
• Feeling detached from your body (derealization or depersonalization)
• Intense fear of dying, losing control, or “going crazy”

Most panic attacks peak within 10 minutes and resolve within 20–30 minutes, though the aftermath — exhaustion, lingering fear, dread of the next attack — can last far longer. Some people also experience nocturnal panic attacks, which wake them from sleep. These are just as intense as daytime attacks and can be especially disorienting because there’s no obvious trigger.

Neurologically, panic attacks are associated with the amygdala — the brain’s threat-detection system — firing in the absence of actual danger. Anxiety, by contrast, is more closely associated with the prefrontal cortex, which governs anticipatory thinking and worry about future events.

Anxiety Attack vs. Panic Attack: Side-by-Side

Can You Have Both?

Yes, and it’s more common than people realize. Someone living with an anxiety disorder may experience baseline anxiety most of the time, and then have a panic attack layered on top of that anxiety in a moment of acute stress. The two don’t cancel each other out; they can compound. If you’re having both, that’s important diagnostic information for a mental health provider to have.

What Causes Anxiety Attacks and Panic Attacks?

Both conditions involve a combination of genetic predisposition and environmental factors. Specific contributors include:

• Chronic stress — work pressures, relationship conflict, financial strain
• Trauma — past traumatic experiences can create lasting hypervigilance
• Family history — anxiety disorders and panic disorder run in families
• Personality traits — people with high sensitivity to threat or a tendency toward negative thinking are more susceptible
• Medical conditions — hyperthyroidism and cardiac conditions can mimic or worsen both
• Substance use — stimulants, cannabis, and alcohol (especially during withdrawal) can trigger anxiety and panic attacks

The Connection Between Anxiety, Panic, and Substance Use

This connection is more significant than most people expect.

Anxiety disorders and substance use disorders co-occur at striking rates. Decades of epidemiological research show that among people with an anxiety disorder, the 12-month prevalence of a co-occurring substance use disorder is between 33% and 45%, according to data from large-scale U.S. surveys including the National Comorbidity Survey. The bidirectional relationship is especially pronounced with alcohol: epidemiological surveys estimate that between 20% and 40% of people with anxiety disorders have a co-occurring alcohol use disorder, according to a review published in Lancet Psychiatry.

The relationship runs in both directions. Someone experiencing panic attacks or chronic anxiety may turn to alcohol or other substances to self-medicate — to feel calmer, to sleep, to take the edge off. Over time, substance use changes how the nervous system functions and can worsen the very symptoms it was meant to quiet. Alcohol withdrawal, for example, is a known trigger for panic attacks. Stimulants can induce anxiety symptoms even at low doses.

If anxiety or panic attacks are part of your life and substance use has become a coping mechanism, addressing both together — not sequentially — is the most effective approach. Treating anxiety without addressing substance use, or treating substance use while leaving anxiety untreated, leaves the feedback loop intact.

What to Do During an Anxiety or Panic Attack

Knowing what you’re experiencing can reduce its intensity. Here’s what helps in the moment:

During a panic attack:

• Acknowledge it. Remind yourself: this is a panic attack. It will pass. I am not in danger.
• Focus on your breathing. Slow, deliberate exhales — longer than your inhales — activate the parasympathetic nervous system.
• Ground yourself. Name five things you can see, four you can touch, three you can hear. This brings attention out of your nervous system and into your environment.
• Don’t flee if you can help it. Avoidance reinforces the pattern — the brain learns that escape was what resolved the danger.

During an anxiety attack:

• Identify the stressor. Naming what’s driving the anxiety reduces its hold.
• Slow the thoughts. Write down the worry, then challenge whether it is realistic or likely.
• Move your body. Physical activity can burn off the physical tension underlying anxiety.
• Reduce stimulants. Caffeine and nicotine both amplify anxious arousal.

Treatment: What Actually Helps

Treating Anxiety Attacks

Cognitive-behavioral therapy (CBT) is the most well-evidenced treatment for anxiety disorders. It helps identify distorted thought patterns and build more accurate, less anxiety-provoking ways of interpreting situations. Research consistently shows it reduces both the frequency and severity of anxiety episodes.

Medications may be used alongside therapy. SSRIs (selective serotonin reuptake inhibitors) and SNRIs are first-line options for long-term management. Benzodiazepines can reduce acute anxiety but carry a dependence risk and are generally recommended only for short-term use.

Lifestyle interventions — regular aerobic exercise, consistent sleep, reduced caffeine — have meaningful effects on baseline anxiety levels.

Treating Panic Disorder and Panic Attacks

CBT with exposure-based components is the gold standard for panic disorder. Interoceptive exposure — deliberately inducing mild panic sensations in a controlled setting — teaches the nervous system that the sensations are not dangerous.

Medications — SSRIs, SNRIs, and in some cases TCAs (tricyclic antidepressants) — are effective for panic disorder. As with anxiety, benzodiazepines can provide short-term relief but are not a long-term solution.

For co-occurring substance use, integrated dual diagnosis treatment that addresses both conditions simultaneously is strongly supported by clinical consensus. Treating one condition in isolation is less effective and increases relapse risk for both.

When to Seek Help

Reach out to a mental health professional if:

• You’ve had one or more panic attacks and find yourself preoccupied with when the next one might happen
• You’re avoiding people, places, or situations to prevent triggering an attack
• Symptoms are disrupting your sleep, work, or relationships
• Physical symptoms — chest pain, shortness of breath — are recurring
• You’re using alcohol or substances to manage anxiety or panic symptoms
• Self-care strategies have stopped working

A professional can distinguish between anxiety disorder and panic disorder, rule out medical causes, and recommend a treatment plan matched to your specific experience.

Frequently Asked Questions

What is the main difference between an anxiety attack and a panic attack? Anxiety attacks build gradually and are typically tied to a specific stressor. Panic attacks strike suddenly and reach peak intensity within minutes — often without any clear trigger.

Can you have both anxiety attacks and panic attacks? Yes. Someone with an anxiety disorder can also experience panic attacks. The two can occur together and tend to compound each other.

Can panic attacks happen during sleep? Yes. Nocturnal panic attacks wake people from sleep and are just as intense as daytime attacks. They’re more common than most people realize and are not the same as nightmares.

How long does a panic attack last? Most panic attacks peak within 10 minutes and resolve within 20–30 minutes. The exhaustion and fear of another attack can persist for hours afterward.

Can anxiety and panic attacks lead to substance use? Yes. Many people turn to alcohol or other substances to manage anxiety or blunt the fear associated with panic attacks. This self-medication pattern is well-documented and can develop into a co-occurring substance use disorder.

When should I seek professional help? If you’ve had a panic attack and are worried about the next one, if attacks are interfering with daily functioning, or if you’re using substances to cope — those are clear signals to reach out. You don’t have to wait until things feel unmanageable.

Getting Support at Discover Recovery

Panic disorder and anxiety disorders frequently co-occur with substance use disorders. Discover Recovery’s dual diagnosis treatment program addresses both conditions simultaneously — not sequentially — using evidence-based modalities including cognitive-behavioral therapy (CBT), EMDR, and medication-assisted treatment where appropriate.

If you or someone you care about is managing anxiety or panic attacks alongside substance use, we can help you understand your options.

Call us at 866.719.2173 — or verify your insurance online to take the first step.