14th Aug 2023

These terms are often used interchangeably and misinterpreted, particularly in mainstream media.

So it’s good to work out what they are, and how they are different.

An anxiety attack is a term often used to describe symptoms of anxiety when feelings of worry or nervousness are bubbling away for a period of time, and then they start to grow. When these feelings are experienced at a heightened level it can activate the body to respond to the perceived threat which leads to the likelihood of many different symptoms to be experienced, which are listed below. These symptoms occur due to the fight or flight response being activated. The function of these symptoms and how they relate to the brain and nervous system are discussed in detail further down. 

Symptoms

• Nausea

• Sweating

• Racing heart

• Light headedness / feeling dizzy 

• Tightness in the throat or sensation of choking

• Dry mouth

• Shaking 

• Difficulty breathing or shortness of breath

• Chest pain or discomfort

• Feeling hot or cold

Anxiety Attack

An anxiety attack is a “subjective way” of describing the experience of anxiety, meaning it is how people come to understand, make sense of, and describe what is happening to them. 

Similarly, the terms emotional ‘meltdown’ and ‘a mental breakdown’ are also a “subjective way” of describing the experience of intense emotions. Often, they are used to describe intense feelings of anxiety, sadness etc. but these terms are not a clinical term that psychologists refer to, rather the emotions of those experiences are explored from the individual experience and can sometimes be aligned with a clinical diagnosis. This may include a panic attack, anxiety disorder, or major depression just to name a few. 

Anxiety attacks, however, are not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but panic attacks are. This is due to the description of an anxiety attack being subjective, a way that people often describe their experience when trying to make sense of what is happening to them, but for psychologists and mental health professionals they are often a way of describing a panic attack.

The physical symptoms of anxiety are triggered by either a situation, or certain stressors - when we are exposed to the feared situation, event, stimuli etc. it then activates the fight flight response. It can also include the anticipation of an event and it can build over time. 

People commonly report that their experience of an anxiety attack lasts for up to 30 minutes. An example of how people can describe experiencing an ‘anxiety attack’ may be having a social event coming up, and you are feeling quite anxious about who you will know, who you will chat to and what people may think of you. As the date of the event slowly starts to approach your anxiety naturally begins to build up in anticipation of what may happen and what it will be like. On the morning of the event, you notice your anxiety is very intense and as you get into the car to drive to the place, you’re feeling so anxious that your mind perceives the event to be a threat and it activates anxiety (perhaps to the point of feeling panic) where you experience some of the symptoms listed above. We could describe this experience as symptoms of anxiety bubbling up and eventually leading to a panic attack.

If these types of experiences were to continue and be persistent it can lead to an anxiety disorder being diagnosed. More specifically, in the scenario above it may lead to a diagnosis of social anxiety disorder if these intense feelings of anxiety, or panic attacks, only occurred in the context of social events and started to have an impact on someone’s life.  

Panic Attack

A panic attack is an overwhelming fear that comes on suddenly and unexpectedly. A panic attack on average last a few minutes. An example of experiencing a panic attack may be sitting in class and your teacher randomly selects you to read/present something in class - automatically you feel extremely anxious and scared of this situation to the point where again, the mind has perceived this to be a threat/danger, and the body is responding accordingly and you experience the symptoms listed above.

Another example may be if someone has a particular phobia, a common one may be spiders (Arachnophobia) and suddenly a big spider appears near you and instantly your mind interprets this as a threat, subsequently activating the body into the fight flight response, causing the symptoms listed previously. 

“up to 40% of Australians will experience a panic attack at some point in their life” – reachout.com 

Why do people experience Panic Attacks?

There can be many reasons why someone experiences a panic attack, although experts do not have a concrete answer for each case. It can include a multitude of different contributing factors, and some of the reasons can include the role and function of the brain and nervous system.

The amygdala is a part of the brain that is responsible for processing fearful and threatening stimuli. Its function is to detect threat and activate the body to manage the threat. Part of this process is that it activates “the fight flight” response through a release of hormones, this is what we call the activation of the sympathetic nervous system. When the sympathetic nervous system is activated, it causes a few different physical changes to occur inside the body. These physical changes that do occur are there for a reason, with the main purpose of them being to protect you! For example, the heart starts beating faster to pump the blood around the body in preparation to fight; we start sweating to help control body temperature, as sweat evaporating can cool the body; adrenaline is released to give us a burst of energy and it also speeds up heart rate and can tense the muscles; Our pupils also dilate to ensure vision is good; our blood circulation is redirected to our big muscle groups (arm muscles and leg muscles) and away from unnecessary bodily functions and areas (digestion, fingers and toes, top level brain activities such as flexible and creative thinking).

The experience of these bodily changes can feel quite overwhelming and scary in the moment, especially when it seems there is no context behind the function of them, and it can commonly lead to people having health concerns (such as I’m having a heart attack), which adds more worries and anxiety about the changes that are happening to their body during that time.   

Thus, it can lead to people fearing the experience of future panic attacks which can lead to then developing what we call panic disorder (this is explained in detail below). 

Some people are at a heightened risk of experiencing a panic attack due to their family history, adverse childhood experiences, and other mental health conditions such as anxiety and depression. 

It is normal for people to experience anxiety, and 2 out of 5 of us will experience a panic attack, and in some cases, this can develop into a panic disorder.

What is a Panic Disorder?

A panic disorder is a persistent fear and worry about having other panic attacks. This fear can lead to avoidance of situations where the attack may have occurred previously. It can also include a heightened fear about the consequences of having a panic attack. 

Panic disorder can eventuate from having repeated panic attacks. Specifically, it also includes these further experiences on top of the physical changes listed previously;

1. De-realisation &/or De-personlisation (feeling numb, detached, or floaty)

2. Fear of a heart attack, or losing control, or going crazy etc. 

3. The judgement of the panic attack as ‘bad’ and therefore doing, or not doing, things so as to avoid experiencing them again.

4. This pressure to avoid or minimise panic attacks then feeds into the cycle of fearing having another attack which feeds into more experiences of anxiety and panic.

“Around 5% of Australians experience panic disorder in their lifetime” - Beyond Blue.

Diagnosis and Treatment

Panic disorder, as well as panic attacks, can be identified and diagnosed by a psychologist and other mental health professionals. 

The DSM-V (Diagnostic and Statistical Manual) criteria are used as standardised ways to diagnose an individual based on their presenting symptoms and their duration. 

Treatment for Panic Disorder commonly includes psychological therapy for e.g., Cognitive Behavioural Therapy (CBT) and exposure therapy. The aim of these approaches would be to restructure the cognitions related to anxiety and panic, understand what may be causing your panic attacks, and learn strategies for how best to deal with them happening. Exposure therapy would focus on exposing yourself to the situations or stimuli that you and your amygdala may view as a threat, using strategies to manage your symptoms, and then building evidence that ‘nothing bad happened’ whilst experiencing a panic attack. This then teaches the amygdala that this situation/stimulus does not need to be viewed as a threat, and over time helps to lessen the experience of panic attacks.

The treatment for a panic attack firstly addresses the individuals’ views around the attack, improving their insight into what is happening in their body and the reasons behind their physical symptoms. Subsequently, we begin to learn that the physical symptoms of anxiety and panic do not mean danger, which then stops further activation of the fight or flight response. Common methods of treating panic attacks and feelings of anxiety are to utilise breathing and relaxation exercises.

However, it is also important to note, that there are times when the message of needing to calm yourself down may reinforce that the physical symptoms are dangerous and something that we need to get rid of.  Therefore, your mental health clinician would then support you through alternate approaches so as to ride the waves of your symptoms, as the most important part of treatment is to reinforce that experiencing anxiety and panic attacks is not dangerous.

Final Thoughts

Regardless of what we call it, experiencing anxiety or a panic attack can feel incredibly scary!

The physical changes that occur in the body can be confusing, overwhelming, and very confronting. An important reminder for when/if these symptoms occur is to remember that the body is trying to protect you during that time, and not harm you. The body is responding to the perceived threat, and if we can thank it for doing its job and assure our minds that we are not in any danger currently, then in most cases it will naturally begin to return to its normal state (aka homeostasis). 

Please remember: There is always support and guidance out there, so if you do feel that you require some support navigating this experience please reach out, we are more than happy to help! 

Georgia.