Am I Having a Panic Attack? Common Questions about Anxiety
By Peggy Loo, PhD
People use terms like anxiety, stress, worry, and panic attacks interchangeably. I’m a big believer in promoting mental health literacy through clarifying terms and definitions. (If only so your therapist has an accurate understanding of what you’re experiencing so they can best help you!) While there are similarities across stress, anxiety, worry, and panic attacks, it is incredibly helpful to know the key differences. With the exception of panic attacks, my patients have said that it is also super helpful to realize that stress, anxiety, and worry can be a completely normative and understandable response to a life situation (meaning that it is not necessarily a problem or something that needs to be “fixed”). It depends on how stress, anxiety, and worry might be impacting your life. So let’s start with definitions of each from a mental health professional’s point of view.
What’s the difference between stress, anxiety, worry, and panic attacks?
Stress is a response to an external pressure or situation. Stress is caused by something outside of yourself, like an important deadline or the subway unexpectedly running late. For example, I would say “I’m stressed because my boss pushed up my deadline” or “That traffic was stressful because I got a late start to my morning”. Since stress is externally triggered and situational, we can often point to the cause of our reaction. More importantly, we can expect that our stress is alleviated when the situation passes. Stress works by telling us about an increased or unexpected external demand upon our energy or resources - which moves us towards managing both more thoughtfully or effectively.
Anxiety is a broad spectrum of physical, mental, or emotional symptoms that can occur in response to an unknown, future occurring scenario. There is a difference between fear and anxiety. Fear is a mental and physiological reaction to a specific, immediate, present-tense threat. Fear is designed to enable survival in the moment. For example, if I unexpectedly encountered a bear while hiking with friends, fear would be an appropriate, survival-oriented response. It would alert me to existing danger so I could protect myself. Anxiety is a mental and physiological reaction to a future scenario or perceived threat. While anxiety might motivate me to protect myself in some ways, I am focused on a threat that has not yet occurred (and may not)! To use my previous example, anxiety would be me fretting about encountering bears while I was packing for my hiking trip.
Worry is a persistent, repetitive, and often uncontrollable chain of thoughts. Worry has more to do with the internal experience of “being in your head”. Worry might be very specific, or it may be quite general and you find yourself hopping from concern to concern in your head. If worry is time limited and specific, sometimes it can work by inspiring us to problem solve or focus on an aspect of the situation we do have control over. However, worry can also easily “spiral” or become overwhelming to the point where we feel like we make no progress or waste time worrying. Worry may be triggered by external events or it may be triggered internally (e.g., by your own thoughts, memories).
Panic attacks are abrupt, intense rush of fear or physical discomfort that can occur in response to a trigger, although at times there may be no identifiable antecedent. People sometimes use the phrase “anxiety attack” - but the term panic attack is what you will hear mental health professionals use. A single panic attack occurs and passes within minutes, not hours or days (unlike worry, anxiety, or stress, which may be long-lasting). Since worry is an internal experience, others around you (and sometimes even you yourself) may not be fully aware that you are worrying - since you might look like you’re simply be walking down the street. Since panic attacks are visceral, bodily experiences, they are impossible to ignore if they’re happening to you. Panic attacks may also be noticeable to others and disrupt your ability to focus on another activity. It’s also important to note that the symptoms of a panic attack shouldn’t be explained by a medical reason (like high blood pressure or the side effects of using a substance). Otherwise we’re talking about a different experience altogether! While one may feel “panicky” or panicked, an experience is categorized as a panic attack by a mental health professional if you experience at least four of the following symptoms:
Palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
A feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded, or faint
Feelings of unreality (derealization) or being detached from oneself (depersonalization)
Fear of losing control or going crazy
Fear of dying
Numbness or tingling sensations (paresthesias)
Chills or hot flushes
Now that you know some of the major differences between stress, anxiety, worry, and panic attacks, let’s return to anxiety.
Anxiety isn’t always a bad thing
I make sure my patients know that some anxiety can be helpful. Anxiety is an arousing, or activating experience. If you are familiar with the Yerkes-Dodson law, which illustrates the relationship between arousal and performance, you know that arousal isn’t a bad thing. Think of the first half of a bell curve shape or upside down letter “U”. Research has shown that increasing arousal positively corresponds with improved performance. A moderate level of arousal causes us to become more alert, attentive, and motivated. For example, let’s say I have a work presentation next week. Not knowing how I will do or what my boss or others may increase my stress levels - however it will also encourage me to prep in advance and pay attention to details that would help me create a successful presentation. As is the case with all of our emotions (yes, all of them) - each has a built-in function that is meant to serve us in a helpful way.
Where it gets tricky is when the emotion overrides its helpful function. When this happens, we end up being hindered rather than helped by our feelings. This is often the case for anxiety. Think of the second half of the bell curve. When there is too much arousal, performance goes down or is impaired, often because we are physiologically flooded (with adrenaline or cortisol), emotionally dysregulated, and mentally scattered. This negative type of experience is more often what we think of when talking about anxiety, which is when it presents in its more distressing, extreme forms. Again, while some anxiety can be helpful, experiencing overwhelming anxiety erodes our emotional and physical health over time. Remember that anxiety is a future-oriented, so an unfortunate side effect of anxiety is that we are distracted and hardly present, or living in the present.
Signs you might have an anxiety disorder
Most new or unexpected situations require adjustment, which can understandably cause some mild anxiety or stress. However, these emotions are usually proportionate to the context, shorter-term, and eventually resolve themselves as you adapt. Even if it is uncomfortable at times to worry or stress, people are often able to creatively problem solve, reach out for support or resources, and manage without significant negative consequences. However, if you are experiencing ongoing symptoms of anxiety or notice that your anxiety is starting to affect your physical health, work, or personal life - or if it starts to last months (versus days or weeks) - it may mean that you have what is called an anxiety disorder and benefit from counseling with a mental health professional.
Some examples of more significant anxiety symptoms are:
Persistent feeling of apprehension or dread
Ruminative thinking or racing thoughts that feels out of control
Imagining the worst-case scenario
Poor concentration or high distractibility
Increased heart rate or chest tightness
Shortness of breath
Feeling “keyed up”, jittery, or on edge
Difficulty falling asleep or staying asleep
Muscle tension or soreness
Upset stomach or knots in your stomach, intestinal or stomach problems not explained by a health condition
Increased or decreased appetite, weight gain or loss
Sometimes serious anxiety manifests for one person in somatic, or physical ways; for others, they describe “spiraling” and racing thoughts. For most, anxiety is often a combination of both physical and cognitive symptoms. Since the experience of anxiety can be such a broad one, it’s not surprising that anxiety is the most common mental health concern reported by adults in the United States, affecting one in five adults, or nearly 20% of individuals over 18 years of age.
Don’t panic: anxiety disorders are very treatable
Generalized anxiety disorder, social anxiety disorder, panic disorder, various phobias, and obsessive-compulsive disorder are all types of anxiety disorders that present differently or affect various parts of your life. Each can feel debilitating but they are highly treatable and respond positively to psychotherapy and at times, medication. Sadly, despite research that clearly illustrates how treatable anxiety disorders can be, only about 35% of adults seek professional support.
Can therapy help anxiety?
Therapy for anxiety can be tremendously beneficial. First of all, experiencing strong anxiety often makes us feel out of control, incompetent, exhausted, or sabotaged by our own bodies and minds - which is an awful way to feel. Working with a therapist helps you remember that you are not alone, and that things can get better. Therapy can demystify what anxiety is and act as a stabilizing source of support while you learn to make changes that lessen the unwanted effects of anxiety in your life. These changes may include recognizing and replacing unhelpful ways of thinking, learning skills that counteract anxiety and encourage groundedness, and creating personalized strategies that replace unproductive ones. One of the toughest things about anxiety is that we often unknowingly reinforce or exacerbate anxiety in our efforts to manage it. Remember that anxiety is an activating experience, and can even feel like a protective instinct (e.g., if I’m panicking, there’s probably good reason, so I’ll keep it up) However, much of anxiety treatment is meant to slow you down and decelerate your mind and body, which can feel unnatural or counterintuitive.
Therapy for anxiety can increase self-awareness about your symptoms or triggers and build confidence that you can manage your anxiety successfully. In therapy you may also discover additional resources, such as support groups, psychotropic medication, or lifestyle changes known to reduce anxiety. These resources can further re-instill a sense of hope and agency that chronic anxiety threatens to extinguish. While seeking therapy for anxiety can and often provides immediate and significant relief, the ultimate goal of therapy is to develop the resiliency to cope with life’s stressors without sacrificing the ability to experience joy, gratitude, or calm.
Sometimes anxiety can feel like a regular part of your daily life or even who you are - but that does not need to be the case! If you are interested in professional support for your anxiety, reach out to us and we’d love to connect.
About the Therapist: Dr. Peggy Loo is a licensed psychologist who specializes in anxiety disorders. To manage her stress, she often watches comedies, jogs, deep cleans, or searches for the perfect salty snack.