Anxiety or Panic Disorder? What Is the Difference?

A racing heart, difficulty breathing, a constant sense that something bad is about to happen, the fear of losing control…

Although anxiety and panic disorder are sometimes used interchangeably in everyday language, they do not mean the same thing. Intense anxiety can be present in both; however, the way the anxiety arises, how long it lasts and the symptoms the person experiences can differ from one another.

What Is Anxiety?

Anxiety is, at its core, a natural emotion that prepares us to face danger. For this reason, not every experience of anxiety means there is a psychological disorder.

For example, it is entirely normal to feel anxious before an important exam, a job interview or an uncertain life event.

However, when anxiety intensifies, becomes difficult to control and clearly affects a person's daily life, the possibility of an anxiety disorder may be considered as part of a clinical assessment.

In Generalised Anxiety Disorder, for instance, a person may experience excessive and hard-to-control worry about different areas of life such as health, work, financial matters, relationships or the future.

This anxiety may be accompanied by restlessness, becoming easily fatigued, difficulty concentrating, irritability, muscle tension and sleep problems.

What Is a Panic Attack?

A panic attack, on the other hand, is a state in which intense fear or discomfort rises abruptly. During a panic attack a person may experience the following symptoms:

• A racing heart
• Sweating or trembling
• Shortness of breath
• Tightness in the chest
• Dizziness
• Numbness or tingling
• Fear of losing control
• An intense fear of dying

Because these bodily symptoms are so intense, a person may sometimes believe they are having a heart attack, are about to faint or are completely losing control.

Does Having a Panic Attack Mean You Have Panic Disorder?

No. This is an important distinction.

Experiencing a panic attack at some point in life does not, on its own, mean that a person has been diagnosed with panic disorder.

In panic disorder, recurrent and unexpected panic attacks are accompanied by ongoing worry about the possibility of another attack, or by marked changes in the person's behaviour related to it.

For example, a person may think:

and, because of this thought, stop using the metro. Over time, the number of situations they avoid may grow, and the person's world may gradually become narrower.

What Is the Core Difference Between Anxiety and Panic Disorder?

Put most simply, in generalised anxiety the worry is usually a persistent state of concern that spreads across many areas of life.

In panic disorder, one of the core clinical features is recurrent, unexpected panic attacks and the fear of experiencing these attacks again.

These two conditions can also occur together in the same person.

How Does CBT Explain the Panic Cycle?

From the perspective of Cognitive Behavioural Therapy (CBT), how bodily sensations are interpreted can be important in maintaining panic symptoms. For example:

In this way, a cycle can form: bodily sensation → threat interpretation → increased anxiety → stronger bodily sensation.

Constantly checking one's heartbeat, needing someone else to always be present, or avoiding certain situations may feel safe in the short term; in the long term, however, it can contribute to the fear persisting.

The Meaning of Anxiety From a Psychodynamic Perspective

The psychodynamic approach, in turn, seeks to understand not only how the symptom arises but also what the anxiety is connected to within the person's psychological world.

Themes such as separation, loss, control, dependency, anger, closeness or rejection may be linked to intense anxiety in some people.

For this reason, therapy may explore not only the question “How can we reduce the anxiety?” but, in some cases, also the question “Why does this anxiety arise particularly under these circumstances?”

When Might Professional Support Be Considered?

Professional assessment may be considered if anxiety or panic attacks are affecting daily life, relationships, or work and academic functioning; if the person has started to avoid certain situations; or if the fear of having another panic attack is markedly limiting their life.

In particular, physical symptoms such as chest pain, shortness of breath or fainting that appear for the first time or are unusually severe should not simply be assumed to be “just a panic attack”; medical evaluation should be sought when necessary.