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Panic Attacks vs Panic Disorder: Understanding the Difference, Symptoms, Causes and Treatment
Published At : August 27, 2026
Panic attacks may be distressing. When a person has a panic attack, they will often experience a rapid and extreme increase in their heart rate (often described as racing), shortness of breath, a feeling of tightness in the Chest, dizziness or a feeling of separation from their self or the environment around them, and be firmly convinced that some sort of disaster is occurring.
Some individuals who experience a panic attack may think that they are experiencing a heart attack, others may think they are going to pass out, lose control, die, etc.
Because panic attacks can be very intense many people assume that either having one panic attack or multiple panic attacks equates to having panic disorder. This assumption is not always accurate.
It is essential to understand the distinction between a panic attack and panic disorder. Panic attacks can occur in many different types of medical/psychiatric disorders, however, panic disorder is a distinct type of psychiatric disorder.
What is a panic attack?
A panic attack is a discrete period of time characterized by an abrupt onset of intense Fear or discomfort that reaches its peak within a few minutes and includes somatic and cognitive symptoms.
An individual's panic attack may appear to "come out of nowhere" but panic attacks can also occur after an identifiable stimulus.
During the course of a panic attack an individual may experience:
rapid heartbeat
sweating
tremors
difficulty breathing
sensation of choking
Chest pain/discomfort
abdominal discomfort/nausea
lightheadedness/dizziness
chills/hot flashes
numbness/tangling
detachment from self
unrealistic feelings about the surroundings
fears of loss of control
fears of going crazy
fears of death
These physical manifestations of a panic attack are what typically leads to the majority of individuals who experience their initial panic attack visiting emergency departments or seeking medical evaluation, because they incorrectly assume they are experiencing either cardiovascular or respiratory emergencies.
Therefore, a panic attack should be thought of as an event/symptom rather than an automatic diagnosis for a psychiatric disorder.
Why does a panic attack feel so physically oriented?
The human Body has an innate warning system that helps humans identify threats to safety.
When the brain identifies a perceived threat the "fight or flight" mechanism is triggered. The release of stress hormones occurs as well as increases in heart rate/breathing alterations/muscle tension/focus on identifying potential dangers.
The usefulness of this response is obvious when there is actually a legitimate external threat.
However, the same warning system that would normally provide protection against real harm can sometimes activate in the absence of an immediately apparent physical hazard.
The individual may perceive a rapid heartbeat or difficulty breathing and interpret these perceptions in a catastrophic manner:
"this is bad news for my heart."
"i am going to collapse."
"i won't be able to breathe."
Catastrophic misinterpretations amplify fears which intensify physiological responses. This creates a cycle that continues indefinitely until the individual understands how this process works:
Physical sensation → catastrophic misinterpretation → increased anxiety → more physiological symptoms → even greater anxiety.
Understanding this cycle can provide an individual with a critical first step toward recovery.
What is panic disorder?
Panic disorder is a psychiatric disorder characterized by recurrent panic attacks, especially unexpected panic attacks, and persistent concern regarding future attacks and/or behavioral modifications due to past attacks.
Simplistically stated:
Panic attack = an episode.
Panic disorder = a condition where recurrent panic attacks are associated with persistent worry/Fear and behavioral modifications due to past attacks.
For instance, someone might initially experience a panic attack while riding the subway. Afterward, they may develop continuous thoughts like:
"what if it happens again?"
And subsequently cease utilizing the subway. Later, they may avoid buses, shopping malls, theaters, and other areas where crowds congregate. Inevitably, the size of their universe shrinks— not because these locations are inherently perilous — but because these locations have become linked to the possibility of experiencing another panic attack.
Panic attack ≠ panic disorder
“What if it happens again?”
“if a panic attack occurs while traveling on public transportation (i.e., subway), a person may begin to lose confidence in the safety of public transit systems. They may choose to travel via car instead. Later they will likely also stop using buses, Shopping centers, theaters and all other crowded areas. Eventually their world may shrink down even further – not due to the inherent dangers of these locations, but simply because they has come to associate them with the potential for another panic attack.
Panic attack vs. Panic disorder this is perhaps the greatest distinction between the two terms. A person may suffer a panic attack yet never develop panic disorder.
Panic attacks may occur in individuals suffering from a variety of disorders including:
social anxiety disorder
specific phobias
post-traumatic stress disorder
generalized anxiety disorder
Depression
obsessive-compulsive disorder
Substance-related disorders
medical conditions.
For instance, someone who fears flying may have a serious panic attack while on an airplane. In such cases the individual need not have panic disorder. Similarly, someone with extreme social anxiety may have a panic attack prior to giving a presentation. While the individual suffered a true panic attack, the actual underlying diagnosis may be different.
Expected vs. Unexpected panic attacks
another important term related to panic attacks is whether or not the panic is expected.
An expected panic attack refers to a panic attack experienced while in a situation that you have previously identified as fearful.
Example: someone with a specific phobia of dogs may experience a panic attack when confronted with a dog.
On the other hand, an unexpected panic attack occurs when there is seemingly no identifiable reason for the panic.
An example would be: a person may be sitting in their living room watching tv, and suddenly begins experiencing rapid heart beat, shortness of breath, and a fear of dying.
Unpredictable attacks are characteristic of individuals diagnosed with panic disorder. However, merely experiencing an unpredictable panic attack is insufficient to determine if the individual has panic disorder. The clinician must assess the overall clinical picture.
What happens after a panic attack?
Following a panic attack, some individuals quickly regain control over themselves and resume normal functioning. Others find that their thoughts regarding their panic attack are so distressing that they create more anxiety than was originally experienced during the panic attack.
Individuals may begin asking themselves questions such as:
"why did this happen?"
"will it happen again?"
"what if i'm in a place where i won't be able to get help?"
"what if i pass out in public?"
These types of questions can lead to an increase in the level of anxiety. As a result, many people will begin engaging in behaviors which provide temporary relief; e.g., taking medications "just in case," keeping track of their pulse, avoiding exercise, accompanying someone when going anywhere, etc.
These behaviors may provide momentary relief; however, they can ultimately contribute to increasing the belief that these situations are dangerous.
Panic disorder & Agoraphobia
many individuals who experience panic disorder also experience Agoraphobia. However, although the two disorders often co-exist, they are distinct entities.
Agoraphobia is defined as a fear or avoidance of places or events where leaving those places or escaping from those events could be problematic due to fear of having an incapacitating or embarrassing panic attack.
Examples of such environments include:
public transportation
large crowds
Shopping centers
open spaces
being away from home alone
waiting in lines
Although an individual with panic disorder may avoid agoraphobic situations due to fear of experiencing another panic attack, Agoraphobia can also exist independently.
Treatment plans should incorporate therapy addressing both the panic symptoms and the avoidance behavior if both are present.
Why do panic attacks occur?
There is no singular cause for developing panic disorder. It typically results from an interplay of biological predispositions, psychological characteristics and external stressors.
Some individuals are biologically more prone to respond physiologically to stimuli with increased intensity (e.g., heightened heart rate).
Psychological factors contributing to development of panic include:
catastrophic misinterpretations of physical sensations (e.g., attributing lightheadedness to heart failure)
high levels of anxiety sensitivity
previous traumatic or stressful experiences
excessive preoccupation with illness or injury
learned fear responses
Environmental contributors to panic disorder include major life stressors (e.g., divorce) relationship conflicts; Work-related tension; inadequate Sleep; Substance abuse; and/or recent significant lifestyle alterations.
Caffeine and certain stimulant drugs/substances can exacerbate/simulate panic symptoms in vulnerable individuals.
Thus, it's essential to obtain a comprehensive history of an individual's experiences in order to rule-out possible organic causes for what appears to be psychological phenomena.
Panic attacks can resemble medical emergencies because panic attacks can cause Cardiac chest pain, respiratory problems (dyspnea), arrhythmia, and dizziness; clinicians must frequently evaluate for potential medical conditions -- especially when presenting symptoms are unusual or unexplained by the patient's past medical history.
Potential medical conditions that may manifest similar symptoms as those found in patients suffering from panic attacks include cardiovascular disease, pulmonary disease, endocrinopathy, neurological conditions, medication side effect(s)/withdrawal symptom(s), and/or drug-induced toxicity/withdrawal.
A new episode of chest pain, loss-of-consciousness (fainting), dyspnea requiring assistance from oxygen or inhaler, etc. Should not always immediately be labeled as anxiety. Each patient's age, medical history, findings upon physical exam and clinical presentation will dictate the appropriate diagnostic evaluation(s) required to ensure accurate diagnoses.
How is Panic disorder diagnosed?
Panic disorder diagnosis is mostly based upon the clinical assessment of a patient.
In order to diagnose Panic disorder, a psychiatrist or other similarly qualified clinician will ask questions concerning:
What Panic episodes "feel" like
How quickly they start
If the episodes are "expected" or "unexpected"
How often the episodes occur
What the person is afraid of while experiencing the episodes
Is there always a concern regarding future episodes
Are the persons behaviors changing due to the episodes
Are the person avoiding certain places or situations due to the episodes
Is there some other psychiatric disorder that would explain the symptoms
Is substance abuse, medication use or any medical disorders affecting the symptoms?
The clinician may also utilize standardized diagnostic criteria or symptom rating scales where applicable.
Panic disorder treatment
Fortunately, Panic disorder is a highly treatable illness.
Both psychological Therapy (psychotherapy), and/or pharmacotherapy, or a combination of these two therapies depending upon the level of severity and individual circumstances, can be employed to treat Panic disorder.
Psychotherapy
Cognitive behavioral Therapy (CBT) is among the most well-established psychological treatments for Panic disorder.
Individuals treated using CBT, learn to understand how their Cognitive processes (thoughts) influence the development of physiological responses (physical sensations) which then contribute to emotional states and ultimately lead to behavioral patterns.
Using this type of approach, a person may discover that they are developing catastrophizing thought patterns (e.g.) "my heart rate is high; therefore i am going to die of a heart attack".
Through the process of Therapy, the individual learns to interpret bodily sensations differently in a less distorted manner.
Exposure-based methods, done properly and at an acceptable pace, are often used as part of the therapeutic process to assist the individual in reducing their fear of bodily sensations and of those environmental stimuli that they associates with Panic.
Pharmacotherapy
SSRIs and SNRIs are commonly utilized as antidepressants for treating Panic disorder in the long term.
The selection of which medication(s) to prescribe depends upon many factors including but not limited to:
level of symptom severity
individual's previous response to treatment
presence of co-occurring psychiatric illnesses
co-morbidity related to various medical conditions
medication side effects
patient preferences
Use of benzodiazepines can rapidly alleviate acute anxiety and Panic symptoms but should be carefully considered since they can lead to several serious side effects including tolerance, dependency, sedation, and withdrawal.
In general, benzodiazepines are not considered suitable long-term monotherapies for Panic disorder. Therefore, before initiating any medication regimen, patients should receive their prescription from a qualified prescriber who monitors their response to treatment.
What can be done during a Panic attack?
one of the main goals during an episode is not necessarily eliminating all symptoms immediately.
It is helpful for you to tell yourself: "this is really uncomfortable; however the sensation will go away."
Slow your activity instead of resisting each sensation you experience.
Some individuals find comfort in:
Moving to a safe place that allows them to relax comfortably
Relaxing tight muscle groups
Breathing calmly rather than making quick, big breaths
Focusing their attention on what is happening around them now rather than past events or worries about the future
Avoiding frequent checks on pulse or blood pressure
Reminding themselves that Panic symptoms rise and fall.
Taking deep breaths is usually not effective in reducing dizziness or paresthesias caused by changes in co2 levels; therefore, calm comfortable Breathing is generally more desirable than forced hyperventilation.
When should someone seek professional help?
Seeking professional assistance is especially important if an individual experiences:
Recurrent Panic attacks
Persistent fear of another Panic attack occurring
Avoidance of regular daily functions as a result of experiencing Panic attacks
Work/school/relationship problems resulting from the impact of Panic attacks
Visits to emergency rooms multiple times because of unknown causes of their symptoms
Significant depression or hopelessness
Alcohol/substance use as coping mechanisms for anxiety
Symptoms interfere with functioning in daily life
When someone develops early intervention for panic disorder, it can break the cycle of developing increased restrictions on how individuals with panic disorders avoid and experience panic.
Panic attack vs Panic disorder: Understanding through examples
To make this distinction for you, I'll describe two different individuals who experienced a single panic attack.
One individual (Person A) had a panic attack during a stressful time frame in their life; once the symptoms were over they was able to identify why these symptoms occurred, and Person A did not develop persistent fear or avoidance behaviors after the panic attack. This is referred to as a panic attack.
The other individual (Person B) had multiple episodes of unexpected panic attacks. After each episode, Person B spent considerable amounts of time thinking about when the next episode would occur. Due to the fear of another episode occurring, Person B developed avoidance behaviors, such as avoiding exercise, traveling alone and going into public areas where there might be crowds.
Therefore, based upon both the frequency of panic attacks and the pattern of those episodes, as well as whether or not Person B was experiencing persistent worry regarding future episodes and if Person B's behavior was being controlled by the fear of having another episode, this clinical presentation is far more indicative of panic disorder than Person A's presentation.
In conclusion, it is not merely the frequency of panic attacks that makes a difference, but the unpredictable nature of them; whether or not the person is worried about having another episode; whether or not they have been changing their daily activities to avoid situations that may cause them to have an additional episode. In addition to these factors, it is necessary to consider possible alternatives that could explain the symptoms.
A second note
Having a panic attack can be frightening. However, experiencing panic symptoms does not mean that the individual "has lost their mind," is "weak" or cannot manage stress. Panic symptoms are real and represent the interaction among the brain, the autonomic nervous system, thought processes, and physical sensation.
Conversely, not all panic attacks indicate panic disorder. Therefore, the critical issue is: Is this person experiencing an isolated panic episode, or has the fear of a panic episode become so overwhelming that it controls their lifestyle?
If an individual continues to have panic episodes and/or exhibits behaviors associated with panic (avoidance of certain things; anxiety anticipating another episode), anticipatory anxiety prior to an episode occurring, or significant functional impairment due to either an inability to function normally or excessive distress, then a psychiatric evaluation can assist in determining an accurate diagnosis and selecting appropriate treatment options.