You might listen to people talking about panic attacks and anxiety attacks like they’re the same thing.
However, this is when things start to get confusing because panic attacks are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), whereas an anxiety attack isn’t.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American) or the International Statistical Classification of Diseases (ICD-11) (WHO / European) for health, research and diagnoses purposes.
Using either one will hinge upon their geographical area and in some cases, personal preference.
Think of it as the A to Z book for the brain that pinpoints information on mental illness, for diagnoses purposes in mental health.
An anxiety attack and panic attack is a good analogy like the diagnostic books previously mentioned above because both are different but still have similarities between them.
Both activate the fight or flight response. Causing an overwhelming rush of physical symptoms with racing heartbeats, and trouble breathing. Indicative of a panic attack in most cases.
An anxiety attack often comes in reaction to a stressor. There can be a specific trigger, such as an exam, workplace issues, a health issue, or a relationship Problem.
For example, you are walking down a dark alley and hear footsteps. You start to feel fearful, apprehensive at the start, and your body begins to respond to a potential threat from the sound.
In your mind, you begin to imagine the worst possible outcome from sexual assault, to an alien invasion, and the worry becomes overwhelming and real, which can feel like an attack.
However, when the stressor goes away, the anxiety attack does too. Anxiety attacks usually peak within 10 minutes, and they rarely last more than 30 minutes.
But during that short time, you may experience terror so severe that you feel as if you’re about to die or lose control.
Symptoms of an anxiety attack include:
- A surge of overwhelming panic
- A specific trigger
- Heart palpitations or chest pain
- Feeling like you’re going to pass out
- A feeling of losing control or going crazy
- Trouble breathing or choking sensation
- Hot flashes or chills
- Trembling or shaking
- Nausea or stomach cramps
- Feeling detached or unreal
Because of these physical symptoms, anxiety sufferers often mistake their disorder for a medical illness. They may visit many doctors and make numerous trips to the hospital before their anxiety disorder is finally recognised.
What causes anxiety attacks?
These factors include:
- Genetic/hereditary/biological factors
- Short-term emotional triggers, such as grief
- Lack of assertiveness
- Maintaining causes (dysfunctional beliefs, avoiding certain situations)
- Substance withdrawal
- Certain medications
- Chronic and/or severe illness
- Certain substances can also trigger an anxiety attack symptom, including caffeine and cannabis.
Excessive or fast breathing is commonly described as hyperventilation. It is usually the result of acute anxiety and can lead to the patient having a panic attack.
Hyperventilation is when you breathe in more oxygen than you need, and breathe out the carbon dioxide (C02). Hyperventilation also causes a “paradoxical effect” that makes it feel like you’re not getting enough air, which then causes you to breathe in even more oxygen than you need and makes the attack even worse.
Just to be clear, excessive or fast breathing is commonly described as hyperventilation. It is usually the result of acute anxiety and can also lead to the patient having a panic attack.
Once again, “anxiety attack” is not a clinical term. It’s a term used to describe periods of more intense anxiety that go beyond traditional anxiety experiences.
The goal in treating hyperventilation is to raise the carbon dioxide level in the blood. There are several ways to do this:
- Reassurance from a friend or family member can help relax your breathing. Words like “you are doing fine, you are not having a heart attack and you are not going to die” are very helpful.
- It is extremely important that the person helping you remain calm and deliver these messages with a soft, relaxed tone.
- To increase your carbon dioxide, you need to take in less oxygen. To accomplish this, you can breathe through pursed lips (as if you are blowing out a candle) or you can cover your mouth and one nostril, breathing through the other nostril.
- The use of a paper bag is no longer advocated. As it can cause dangerously low oxygen levels.
- If anxiety or panic has been diagnosed, see a psychologist or psychiatrist to help you understand and treat your condition
Does breathing into a paper bag work?
Breathing into a paper bag doesn’t help every case of hyperventilation. Furthermore, many things can cause hyperventilation in an individual, including a heart attack or an asthma attack.
Breathing into a paper bag to treat these types of cases of hyperventilation can be counter-productive, and may even be fatal to the individual. For this reason, this method is no longer taught in first aid courses.
While the strategy makes sense, it could be perilous to breathe into a paper bag without knowing the exact cause of a particular hyperventilation episode.
Let’s look at a case study from my file to illustrate my point. I was walking along the second-floor corridor of large hospital heading towards the staff cafeteria for lunch with a colleague.
Suddenly, a woman in her early 30’s collapses in front of us.
- She appeared to be in some stress, in a state of hyperventilation.
- Hand-on chest.
- We assumed, she wasn’t staff or a patient from the ward, by her attire.
- The cardiology and neurology wards were only a short distance away.
Communication was difficult initially; my colleague started to look inside the woman’s bag, was she being mugged. Not at all, merely looking for some clues, like medication.
Why would this be important?
1. An epi-pen injection would indicate we had a possible anaphylaxis situation. Remember, I said we were on our way to the canteen, and one in four individuals have a severe allergic reaction in their lives.
2. What if there was an asthma inhaler (usually blue) pump, would therefore indicate an asthma attack in progress. Asthma attacks kill three people in the UK each day. Was she there as an outpatient for her condition?
3. Did she find a Nitro-glycerine Spray/vasodilator spray inside the bag?
If this was found, are we dealing with a possible episode of angina? (chest pain). We were only a short distance from the cardiology ward, and heart disease can be inherited. She was observed, holding onto her chest.
However, also keep in mind that the symptoms could also be indicative of an overdose.
It wouldn’t be advisable to give her more if this was the case. Would you then consider calling out the CRASH Team in this case?
At what point would you consider this?
It was a nasty question to ask, fear of overreacting, better that, and saving a life because the emergency staff in the hospital or outside in the street arrived in time.
Special note: Hyperventilation leads to chest pain, and even though the individual is not experiencing a heart attack, they fear they are. This can add to the sense of panic and make the symptoms worse.
She made a complete recovery, explaining that her father was in the nearby ward, having had a stroke.
She was worried about his recovery over the last few days because he appeared to be slowly deteriorating with each passing day. Having entered the main building a few minutes earlier, she was apprehensive that his bed would be empty.
This was common practice if a patient dies, the body would have been taken away to the hospital mortuary.
She did try phoning the ward in the morning for a progress report but didn’t receive an answer. She was fearful that he might have passed away without her knowledge throughout the night and did not have the opportunity to say goodbye.
The closer she got to the ward entrance, the greater the anxiety became, dreading the worst possible outcome, which climaxed as we passed each other in the corridor.
It made for an interesting conversation over our lunch break, even though I teased her about looking for money rather than medication in the woman’s handbag.
Panic attack, doesn’t come in reaction to a stressor. It’s unprovoked and unpredictable. During a panic attack, the individual is frozen with terror, fear, or apprehension. They may worry that they are going to die, or lose control or have a heart attack.
Panic attacks often strike out of the blue, without any warning, and sometimes with no apparent trigger. They may even occur when you’re relaxed or asleep.
A panic attack may be a one-time occurrence, although many people experience repeat episodes.
They typically last between 20 to 30 minutes, and rarely more than an hour. The longer it lasts, the longer it will take to return to a normal level of functioning.
Anxiety attacks can happen in situations where you least expect it and can result in a wide range of distressing physical and psychological symptoms.
Anxiety attack symptoms tend to mimic many of the same symptoms as a heart attack and can come on you without warning. You don’t need to diagnose an anxiety disorder to suffer from an anxiety attack; they don’t discriminate and can strike anyone.
Here are five signs that you might be experiencing an anxiety attack.
1. Sudden Terror or Sense of Impending Doom
One of the most common signs of an anxiety attack is the overwhelming fear or sense of impending doom. The terror that you experience can be paralysing and result from the adrenaline flooding your body due to the perception of immediate danger.
2. Chest Pains
This is the most common symptom that might have you feeling like you have a heart attack.
The pains you feel in your chest during a panic attack can be severe and choking if you are experiencing chest pains, its best to get checked out by the doctor to rule out a heart attack.
3. Difficulty Breathing
A panic attack can have you struggling to breathe correctly, or you may feel like you have to gasp for air. With high levels of anxiety, you can end up hyperventilating, which can cause an imbalance in the carbon dioxide levels in your body, as previously explained. This can lead to dizziness and other symptoms.
4. Increased Heart Rate
When you are experiencing an anxiety attack, your body responds as if it is facing imminent danger. Nervous signals activate the fight-or-flight response in your body, which produces a rush of adrenaline in your bloodstream. This surge in hormones causes many symptoms, including an increased heart rate, making you think that you are suffering from a heart attack.
5. Feeling Out of Control
The intense fear and physical symptoms you experience during a panic attack can often leave you feeling out of control.
This can significantly heighten the fear that you are already suffering and may lead you to feel disconnected from yourself.
The surrounding environment may feel distorted or foggy.
The symptoms that you may be experiencing during a panic attack are much like the fight-or-flight response that is encountered during a dangerous situation.
Still, they tend to come from nowhere when you are dealing with an anxiety attack. Fortunately, there are several things that you can do to help alleviate your symptoms and stop the panic attack in its tracks.
Panic and anxiety attacks may feel similar, and they share a lot of emotional and physical symptoms. Shown in the chart below.
You can experience both an anxiety and a panic attack at the same time.
For instance, you might experience anxiety while worrying about a potentially stressful situation, such as an important presentation at work. When the situation arrives, anxiety may culminate in a panic attack.
Panic disorder (PD): This involves at least two panic attacks accompanied by the constant fear of future episodes. People with panic disorder may lose a job, refuse to travel or leave their home, or altogether avoid anything they believe will trigger an attack of anxiety.
What differentiates a panic attack from other anxiety symptoms is the intensity and duration of the symptoms. Other people suffering from panic attacks don’t know they have a real and highly treatable disorder.
Some are afraid or embarrassed to tell anyone, including their doctors or loved ones about what they are experiencing for fear of being seen as a hypochondriac.
Suppose you have this or any symptoms of anxiety that is impeding on your life at this moment. Please consult your doctor or contact your nearest mental health clinic, immediately. This information can be found online or from any health clinic receptionist.
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The number of people who experience anxiety attacks outside of panic disorder is nearly impossible to estimate as many go unreported. Still, it's safe to estimate that well over 10 million people in the U.S. experience panic attacks in a single year. That is a lot of panic and anxiety attacks. You're not flawed if you experience them.
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