If you are living with panic attacks or experiencing anxiety, you are not alone. Around 40 million people will be affected by an anxiety disorder in America this very year (2021)[1].
General anxiety disorder (GAD) and panic disorder are among the most common types of anxiety disorders that affect mental health. Although they share a number of symptoms, they are fundamentally different conditions [2].
We guide you through the minefield of mental disorders and explain all the confusing information out there.
Key Takeaways
- Recurring panic attacks are a sign of a panic disorder and not of GAD.
- You may have both GAD and a panic disorder with recurrent panic attacks that can result in fear of losing control.
- Difficulty falling asleep is a symptom of anxiety disorders.
- Chest pain is a worrying symptom but can be attributed to one of the physical symptoms of anxiety disorders.
- There are other therapies available now if you experience anxiety, not just antidepressants.
Defining Generalized Anxiety Disorder and Panic Disorder
Anxiety disorders are a selection of mental health disorders that are typified by specific feelings of anxiety, fear of losing control, and/or overarching distress. They can exhibit a great deal of detrimental control over the life of the subject.
It should be noted that anxiety disorders are characterized by a number of similar characteristics (feelings and emotions) as well as physical symptoms. Therefore, it is important to differentiate between some terminology:
Fear is a physiological and emotional response to current experiences and circumstances that the subject believes to be either harmful in some way or deeply unpleasant, or both [3].
Anxiety is a distressing, uncomfortable emotional state based around an amorphous, almost nebulous, fear. The cause of this fear is the perception of future events that may be either unavoidable or harmful to the subject, or both.
The two most common anxiety disorders in America at the moment are generalized anxiety disorder (GAD) and panic disorder. They affect around 6% of the population over their lifetime [1].
Generalized Anxiety Disorder (GAD)
General anxiety disorder is a chronic, long-lasting disorder (6 months or more). It is characterized by a general feeling of anxiety with no coherent focus or root cause [4].
The anxiety has its base in everyday life. A general hyperfocus of routine daily tasks and a persistent excessive worry that there is something amiss. Common themes include money, work, family, children, or health.
Generalized anxiety disorder can manifest in a number of ways:
- Chronic headaches.
- Digestive issues like diarrhea or stomach discomfort (abdominal distress).
- Fatigue.
- Chest pain/nausea.
- Irritability.
- Muscle tension and/or chest pain.
- Restlessness.
- Sleep issues.
Comorbidity with a panic disorder is also quite common. It can also be concomitant with other anxiety disorders such as social anxiety disorder, obsessive-compulsive disorder, and substance abuse disorder [5].
It can often occur with mood disorders such as major depressive disorder, major depression, or other psychiatric disorders. It is this associated comorbidity that can make treatment regimes complicated.
Depending on the onset, it may be expressed as selective mutism in adults or as selective mutism in children.
Your doctor will also be aware that there are a number of medical conditions that may mimic some of the symptoms of generalized anxiety disorder. He or she may do blood tests to rule these out.
Who do you think is more likely to experience anxiety?
Panic Disorder
Panic disorder is typified by sudden onset panic attacks that may spontaneously occur. The individual attacks may lack an apparent or obvious trigger and literally appear ‘out of the blue’ [6].
There are a number of distressing physical symptoms that accompany a panic attack. Please note, this list is not exhaustive. Speak to your health care provider if you are worried.
Panic symptoms can include [7]:
- Chest pain or discomfort, heart palpitations, pounding heart, or accelerated heart rate.
- Chills or hot flashes.
- Feeling dizzy, unsteady, light-headed, or faint.
- Excessive sweating, trembling, or shaking.
- Feelings of choking, sensations of shortness of breath, or smothering.
- Numbness and tingling sensations (paresthesias).
As always, if you have cardiac involvement, you should speak to your doctor. They may be signs of another underlying condition that needs investigation.
A panic attack may also have a range of mental symptoms associated with it:
- Feelings of unreality or being detached (derealization or depersonalization).
- Fear of losing control or "going crazy".
- Intense fear.
- Social phobia.
- Fear of dying.
The randomness of the onset of the attacks leads to one of the main issues with panic disorders. The very fact that recurring panic attacks are a symptom means they become a source of rising stress.
Rising stress levels can trigger an attack. It means that panic attacks can become a rather unwanted, self-fulfilling prophecy. The more you feel like you will have one, means that you will. You can ‘think yourself sick’.
People with panic disorders may develop concomitant conditions, most commonly agoraphobia, social anxiety disorder, and obsessive-compulsive disorder.
The intense fear of the next panic attack and a losing control fear may lead the individual to seek to avoid situations where the attacks may strike.
This fear can lead people to avoid social situations and increase to a point where they fear leaving their own house. The act of leaving your house, or safe zone, can be enough to trigger an attack in severe cases.
In what age group do you think panic disorder is most common?
How Are Panic Disorder and Generalised Anxiety Disorder Different?
GAD and panic disorders are different in both source and presentation. Both share symptoms, and both have a limiting effect on a person's lifestyle. Both can affect a person socially and financially (ability to work).
Without control, both can affect the ability of an individual to function in a workplace, either due to fatigue, lack of concentration, or fear of onset of panic attacks.
Both are markedly different conditions, but, confusingly, comorbidity of the two is common. This leads to long-term, chronic GAD with acute panic attacks. This is obviously very debilitating.
In a comorbid presentation like this, the person may have progressively worsening difficulty with a work/life balance, forming and maintaining relationships, and affect family life.
Is Panic Disorder an Anxiety Disorder?
Yes, panic disorder is a form of an anxiety disorder. It is one of a number of related conditions with similar symptoms that fall under the same umbrella term of ‘Anxiety Disorder’.
See here for the types of anxiety disorders such as obsessive-compulsive disorder and social anxiety disorder.
Can You Have Generalized Anxiety Disorder With Panic Attacks?
Yes, you can, absolutely. The presentation of GAD (diagnostic criteria) does not include panic attacks, but having panic attacks does not mean that you do not have generalized anxiety disorder.
A common comorbidity with GAD is a panic disorder or social anxiety disorder. The fact that the two can be linked and have similar terminology leads to confusion and conflation regarding the two conditions.
Your health care professional can explain the links to you and how to manage them.
Treating Panic Disorder and Generalized Anxiety Disorder
If you have been diagnosed with one of the anxiety disorders, there are a number of interventions available to you. Your doctor will treat the physical symptoms as well as the mental health issues that you have.
Even though the anxiety disorders are different, they can both be treated in the same way. They can be treated with cognitive behavior therapy as well as with medications [8].
Your doctor will discuss ways on how to overcome anxiety and manage anxiety symptoms, excessive worry, and feelings of losing control.
With cognitive behavioral therapy, you will learn to identify life stressors, traumatic events, and the physical causes of excessive worry. You will learn to manage obsessive thoughts and reduce symptoms of anxiety and panic.
In both, the key is to manage the base stress levels. This can help prevent the negative feedback loop that results in a panic attack or the rising stress levels of GAD.
Identify and Avoid Triggers
Part of your therapy will be how to identify and avoid triggers, specific stressors that contribute to panic attacks, and the progression of GAD.
The focus is stopping the next panic attack by cognitive restructuring and cognitive behavioral therapy. The sudden onset of a panic attack can be mitigated by monitoring levels of anxiety and panic (a rapid heartbeat or heart palpitations, for example).
You will also learn how to help someone with anxiety or having a panic attack. You will learn how to manage fear in yourself and in others.
Therapy
As mentioned, professional treatment is a multi-faceted approach. First, you will learn to recognize a panic attack, panic symptoms, and their onset. Second, you will manage feelings of losing control [9].
In concert with this, your doctor will suggest medication. There are a number of drugs available for therapy.
A change in diet and exercise is recommended as part of treatment. Normalizing sleep patterns, reducing caffeine intake, and stopping smoking also can help [10].
There are a number of treatment regimes that are popular; see our Betterhelp review and Talkspace review.
Prescription Medication
Your doctor will assess you and, after discussion, decide on a treatment plan for you. This will depend on your presentation and issues regarding how you experience anxiety [11].
Antidepressants such as SSRIs and SNRIs are front-line medications, as are some of the benzodiazepines and the azapirones. A second-line treatment may include GABA analogs or tricyclic antidepressants [12].
If you have any questions about your medications, please speak directly to your physician. Be sure to mention any other medicines or non-traditional medications or supplements that you are taking.
Relaxation Techniques
Professional treatment for mental disorders are now increasingly focusing on the whole body approach. It is recognized that the phrase “healthy body, healthy mind” is a truism. Relaxation therapy is now a first-line treatment [13].
Studies have looked at Swedish massage, acupuncture, ayurvedic medications, and exercise as possible ways to reduce anxiety.
Taking supplements has also been investigated. Lavender therapy, chamomile, and kava have all been investigated as ways to reduce stress and anxiety [14].
FAQ
Is Panic Disorder the Same as Generalized Anxiety Disorder?
No, the two are not the same. Both are types of anxiety disorders (which leads to some confusion), but both present very differently.
Can You Have GAD and Panic Disorder?
Yes. You can suffer from both, and it is actually quite common. Excessive worry and mental health issues can lead to a panic attack.
People with anxiety disorders such as GAD develop panic disorder. It occurs frequently and is often linked.
Are Panic Attacks Part of GAD?
No. Panic attacks are not a symptom of GAD. There is often confusion as panic disorders and GAD are both types of anxiety disorders.
It is quite common to have both GAD and panic disorder, which makes repeated panic attacks common. They are related to panic disorders, however, and not linked to GAD.
Is Panic Disorder Worse Than Anxiety?
No, there is no comparison here. Both are anxiety disorders, and both will negatively impact the mental health of the sufferer.
Panic disorders present as acute attacks, whereas GAD is a long-term chronic issue. It is the classic ‘apples and oranges’ scenario.
Conclusion
It is good to see that mental health issues are losing their stigma. Whether it is one of the anxiety disorders or panic disorders you are suffering from, the effects are profound and life-changing.
Do not feel that you should suffer alone. If you have any of the symptoms above, see your health practitioner.
Effective treatment now includes a wide range of therapeutic approaches that do not just rely on medication. Great strides have been made with CBT and multi-approach programs that prevent relapse.
References
- Terlizzi EP, Villarroel MA. Symptoms of generalized anxiety disorder among adults: United States, 2019. NCHS Data Brief, no 378. Hyattsville, MD: National Center for Health Statistics. 2020. https://www.cdc.gov/nchs/products/databriefs/db378.htm
- Bystritsky, Alexander et al. “Current diagnosis and treatment of anxiety disorders.” P & T : a peer-reviewed journal for formulary management vol. 38,1 (2013): 30-57.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628173/
- Diagnostic and Statistical Manual of Mental DisordersAmerican Psychiatric Association (5th ed.). Arlington: American Psychiatric Publishing. 2013. pp. 189–195.https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596
- Diagnostic and statistical manual of mental disorders : DSM-5 (5th ed.). Washington, D.C.: American Psychiatric Association. 2013. p222 https://www.psychiatry.org/psychiatrists/practice/dsm
- American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 208–217, 938,https://pubmed.ncbi.nlm.nih.gov/17548747/
- Craske, Michelle G.; Kircanski, Katharina; Epstein, Alyssa; Wittchen, Hans-Ulrich; Pine, Danny S.; Lewis-Fernández, Roberto; Hinton, Devon (February 2010). "Panic disorder: a review of DSM-IV panic disorder and proposals for DSM-V". Depression and Anxiety. 27 (2): p93–112. https://pubmed.ncbi.nlm.nih.gov/20099270/
- Taylor, C Barr. “Panic disorder.” BMJ (Clinical research ed.) vol. 332,7547 (2006): 951-5. doi:10.1136/bmj.332.7547.951 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1444835/
- Strawn, Jeffrey R.; Geracioti, Laura; Rajdev, Neil; Clemenza, Kelly; Levine, Amir (July 2018). "Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review". https://pubmed.ncbi.nlm.nih.gov/30056792/
- Clinical handbook of anxiety disorders : from theory to practice. Bui, Eric., Charney, Meredith E., Baker, Amanda W. Cham: Humana Press. 2020. https://searchworks.stanford.edu/view/13497876
- Hunot, V.; Churchill, R.; Silva de Lima, M.; Teixeira, V. (2007-01-24). "Psychological therapies for generalised anxiety disorder". https://pubmed.ncbi.nlm.nih.gov/17253466/
- Strawn, Jeffrey R.; Geracioti, Laura; Rajdev, Neil; Clemenza, Kelly; Levine, Amir (July 2018). "Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review" https://pubmed.ncbi.nlm.nih.gov/30056792/
- Barić, Hrvoje; Đorđević, Veljko; Cerovečki, Ivan; Trkulja, Vladimir (2018-03-01). "Complementary and Alternative Medicine Treatments for Generalized Anxiety Disorder: Systematic Review and Meta-analysis of Randomized Controlled Trials"
- Manzoni, G. M., Pagnini, F., Castelnuovo, G., & Molinari, E. (2008). Relaxation training for anxiety: a ten-years systematic review with meta-analysis. BMC psychiatry, 8, 41. https://doi.org/10.1186/1471-244X-8-41
- Ebrahimi H, Mardani A, Basirinezhad MH, Hamidzadeh A, Eskandari F. The effects of Lavender and Chamomile essential oil inhalation aromatherapy on depression, anxiety and stress in older community-dwelling people: A randomized controlled trial. Explore (NY). 2021 Jan 9:S1550-8307(21)00001-X. doi: 10.1016/j.explore.2020.12.012. Epub ahead of print. PMID: 33454232. https://pubmed.ncbi.nlm.nih.gov/33454232/
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