EP 285 - Panic Attacks Or Panic Disorder? (Foundations of Panic #5)

This is episode five in our foundations of panic series . Today we're going to talk about the difference between panic attacks and panic disorder , because it really does kind of matter . I am Drew Linsalata , creator and host of the anxious truth .

I am a therapist and training here in the state of New York in the US of A Specializing in anxiety and anxiety disorders . I am an author , a podcaster and an educator in this community and a former sufferer , because I lived with panic disorder for many years of my life , off and on . I will talk about that today .

Before we get started in this episode , just a quick reminder that the anxious truth is more than just this particular podcast episode or this YouTube video .

If you go to my website at the anxious truthcom , you're going to find books and workshops and courses and all the free social media content and 284 other free podcast episodes and YouTube videos that came before this one . So take a minute , check it out . Go to the anxious truthcom .

Everything is there , much of it , most of it , is free , and even the things that carry a price tag , I think , are relatively low priced . So I hope you find that all helpful and let's get into today's episode . What is the difference between panic attacks and panic disorder ?

Well , it's actually relatively simple , but a lot of times people that are dealing with panic attacks or that have panic attacks will say that they have panic disorder , or people that have panic disorder will just assume that anybody that experiences panic attacks , especially if they are recurring panic attacks , must have panic disorder . But that's actually not true .

Now , this is mind blowing for me because , as a former sufferer , I cannot imagine how somebody could have panic attacks repeatedly and not develop panic disorder , because I developed it .

But now that , as a recovered person , I can see , oh yes , I do understand the difference between panic attacks and panic disorder and of course , as a therapist and training , having learned all these things , there are in fact technical , clinical differences that probably matter , because when you can conceptualize your struggle maybe a bit more accurately and have more

information , it can only be helpful . So think of it this way A panic attack is a discrete event . A panic attack starts , it peaks , it ends . We can talk endlessly about how long it takes for that panic attack to run its course . I know many people will say , if I am awake I am panicking , which is technically not really true and pretty much impossible .

But if you are really struggling with recurring panic attacks and you are terrified of them and you are sort of modifying your life to try not to have them , then there's a really good chance that you would in fact meet the diagnostic criteria for panic disorder . But let's not get ahead of ourselves . We'll get to that .

A panic attack , each panic attack you have , does have a start , a peak , a middle and an end . They all end eventually they really do . And again , we will get to that down the road .

The argument that though no , I continuously panic , but a panic attack is an event , it starts and it ends Panic disorder is what happens when you begin to be excessively worried about the panic attack itself . So , for instance , many , many people in the Western world , many adults in the Western world , in a given year will experience a panic attack .

The prevalence of panic attacks in the West in adult populations is huge . Panic attacks are actually a very common experience . Most adults will have at least one or two in the course of their lifetime . So human beings have panic attacks . It's not a cool thing , probably a flaw in some way , shape or form , but we have them .

A panic attack is a human experience that many , many , many people will have at least once or twice over the course of their lifetimes . Other adults have panic attacks on a reasonably regular basis but they don't develop panic disorder because for them a panic attack is disruptive .

It's inconvenient , it's certainly scary , it certainly leaves them feeling shaken up and , you know , their day is sort of disrupted for sure . But when the panic attack ends , these folks have the ability to sort of move on with their day and continue , maybe in that shaky state , maybe in that tired state .

Maybe they will decide to take the rest of the day off because they recognize that they sort of had a panic attack for a reason .

Maybe they can recognize that they're feeling very stressed or that they're a bit sleep deprived , or that they're under the gun , or that there's a lot going on in their lives and it boiled over into a panic attack and they don't see it as something that necessarily happened to them out of the blue or that was dangerous or that was out of control or that

represented any more than this was a very extreme emotional reaction I had , given the context of my life at the moment . So they can have a panic attack and simply move on from it .

I shouldn't say simply , because that minimizes the experience , but they generally will move on from it and they're not really thinking about that panic attack the day after it happened . It's over . It was really inconvenient , they didn't like it , they don't want it to happen again , but they're not fixated on that panic attack .

So many , many people in the Western world will have that experience once , twice , multiple times in their lives and they will not develop panic disorder . Panic disorder is what happens when you have that first panic attack or maybe those first few panic attacks . I will tell you from my own personal experience .

It really only took three or four panic attacks for me to quickly develop what would have been correctly diagnosed as panic disorder . Usually after that first panic attack or those first few panic attacks , you begin to be so worried about having another one because the state of panic itself felt dangerous . It felt like it was going to harm you .

It was interpreted as a catastrophe , a disaster , something horrible that should never happen again . You develop an intense fear of the state of panic itself , regardless of what it was that triggered those first couple of panic attacks .

And then you begin to fixate continually and incessantly on those panic attacks and you begin to scan and check and wonder when the next one is going to happen . And then you begin to develop an avoidant lifestyle because you are trying to prevent another panic attack from happening . This tends to backfire .

We talked about in the last episode , episode 284 of the podcast , episode four of the Foundations of Panic series . We talked about why avoiding panic triggers tends to backfire in the long run .

But panic disorder is really defined as the fear of panic attacks and the next panic attack , a pervasive and excessive fixation on panic attacks , scanning for them , worrying about them and planning for the next one in an avoidant way . So that's the difference between panic attacks and panic disorder .

It kind of matters because , as it turns out , just having panic attacks doesn't mean that you have panic disorder . So when somebody just automatically assumes that , oh , I have panic attacks , so that means I have panic disorder , that isn't necessarily true .

The disorder is really defined by the impact on one's lifestyle , and that will vary from person to person , because everybody's lifestyle is just a little bit different , right ?

So it's the avoidance , it's the fear of panic attacks , it's the worry about the next panic attack which brings me to something that we should probably discuss , because people who develop panic disorder will tend to be anxious all the time , even though they might not be in full blown panic . That space between panic attacks is certainly not calm .

So people who have , say , generalized anxiety disorder , a state where you might feel an elevated sense of anxiety or just that similar anxiety all day long , will sometimes say , geez , I wish I had panic attacks , because those at least happen and then they're over . But for somebody with panic disorder it's not necessarily always over .

Somebody who develops a severe or a really marked case of panic disorder will often have panic attacks on a regular basis and spends the time in between those panic attacks really anxious , because they're worried about when the next one's going to happen . And you can get caught in loops where you're constantly scanning and checking for signs of panic .

What is my body doing now ? What am I thinking ? Am I afraid ? Is my heart rate starting to get elevated ? Do I have the dreaded depersonalization or derealization ? Do I feel dizzy ? Is my stomach starting to rumble or do I feel a little bit nauseous ?

People with panic disorder will spend all day long in an anxious state because they are in fact worried about the next panic attack , always looking for it and always trying to manage their state and prevent that next panic attack from happening .

And sometimes people with panic disorder will then say well , I must have GAD or generalized anxiety disorder , because I'm anxious all the time . But that isn't necessarily true .

If you're anxious all the time because you're anxious all the time , if you're anxious all the time because you're constantly checking yourself to see how you're doing , to make sure that your anxiety levels aren't rising and elevating toward the level of panic attack , then that wouldn't necessarily indicate that you have generalized anxiety disorder .

So you just have panic disorder . If that is in fact what you have been diagnosed with by a qualified in-person clinician , a therapist or a counselor which , by the way , no one on the internet can tell you if you have panic disorder or not . I consider myself pretty well educated on the topic .

It's something that I actually do professionally , but I could not diagnose you with panic disorder on the internet . So don't let anybody give you a diagnosis unless they actually know you . That's really important .

But people with panic disorder will often get down on themselves because they'll feel like , well , I have panic attacks , then I panic disorder because they put this saying sounds a lot like me . So maybe I do have panic disorder , but I think I also have gag because I'm anxious all the time . Not necessarily it depends on why you're anxious all the time .

People with panic disorder will be , will feel an elevated state of anxiety almost all the time , just because they're always on the lookout for that next attack , panic attack . And if you're interested in more about panic attacks , one place you can certainly check out would be the disorder podcast that I do with my friend Josh Fletcher .

That's at disorderfm , and we did an episode called panic dot dot dot attack where we sort of challenged the notion that a panic attack is in fact an attack . So if you want to check out disorder and listen to that , you can go over to disorderfm .

Another way to learn more about panic attacks would be to check out my panic attacks explained workshop , which you will also find on my website at the anxioustruthcom . It's right on the homepage .

If you want more of a deep dive on mechanics and the mechanics of panic attacks and what they're all about and how they work and what the prevalence is in society and how we should really approach those , then that workshop might be useful to you .

So let's talk about the whole diagnosis thing , because again that can get a little bit sticky because then people will start to feel like they have multiple problems . I have panic disorder and now I think I have gag because I'm always anxious , which isn't necessarily true . We talked about that .

But people will start to get down on that because they feel like the diagnosis of two anxiety disorders and see how we're sort of leading into today's sub topic , which is the term anxiety disorder , that two anxiety disorders are certainly worse than one , but that isn't really necessarily true too .

So while we're talking about panic disorder today , I want to at least acknowledge that the term anxiety disorder is a is a categorical term . So in diagnostic circles we use the term anxiety disorder to describe a group of particular mental health issues that all share similar ideology and development and symptoms and they're related right .

So we use the term anxiety disorder not as a diagnosis

. So nobody watching this has anxiety disorder . People watching this may have an anxiety disorder or maybe multiple diagnosis , but diagnosable anxiety disorders . But it's not necessarily correct . It's just semantics . It doesn't matter . But again , the more information you have , the better equipped you can be to advocate for yourself .

It wouldn't necessarily be clinically proper to say I have anxiety disorder . You know we talk all the time on disorder the other podcast and on this on this podcast about a disordered state of anxiety . That is true , but there is no clinical diagnosis called anxiety disorder . I have anxiety disorder .

You may have an anxiety disorder , one of which may be panic disorder . Agoraphobia is in there . Social anxiety disorder is in there . There's a bunch of them in the category . Ocd is actually not officially in the anxiety disorder category anymore . It has its own categories .

But the point here when we talked about the term anxiety disorder , is that they're also closely related . Yet there's actually a huge amount of overlap between them . Anybody with one anxiety disorder probably has a reasonably high probability of at least at some point being able to be diagnosed with a second or even third anxiety disorder .

But don't get too down on yourself there , because that doesn't necessarily mean anything . They're so closely related , that the presentations begin to overlap . That's why I specifically talked about the relationship between panic disorder and GAD , because people will just think well , I'm anxious all the time , so that means I have GAD .

But that isn't clinically correct and it doesn't matter anyway , because if you develop panic disorder , there's a chance that you may begin to exhibit signs and symptoms of things like OCD or social anxiety disorder . You may develop a agoraphobia from there .

It doesn't mean that you have these multiple problems like oh I have a broken leg and now I have a broken arm and now I have a concussion . That isn't the way this works . If you have what anxiety disorder , like panic disorder for instance , there's a good chance that you will exhibit the symptomology of other anxiety , so disorders too .

But that's because they are in a category called anxiety disorders . It's not a diagnosis called anxiety disorder . Again , it's just semantics . Is that going to change anybody's life ?

No , but it can be helpful because , again , the more well informed you are , I think , the better off you are in terms of seeking treatment and advocating for yourself and making your decisions . So I just sort of wanted to pass that along . So if you are having recurring panic attacks , do you have panic disorder . Well , again on the internet .

I can't possibly tell you that because they don't really know you , but the things to look for would be beginning to be obsessed or always fixated on the next panic attack , continually analyzing , thinking about and replaying the last panic attack , continually checking how your body is doing , how you're feeling . Am I anxious more ? Am I afraid ?

Am I seeing any of those dreaded symptoms that start to indicate that my anxiety level is rising ? And I must stop that because I cannot possibly have allow another panic attack to ever happen again . Am I beginning to avoid things in my life because I think that those are panic triggers ?

And again , if you go back to episode 284 of this podcast , we talked about that triggers and avoiding triggers and why that's a bad idea .

If you are very fixated on the state of panic itself , trying to frantically find ways to manage it and micromanage your body and your mind and biological processes that you may have no control over , because you just want desperately to never panic again , because you are terrified of having that experience , then you may in fact meet the clinical requirements , or you

may meet those clinical criteria for being diagnosed with panic disorder , but know that you can in fact have multiple panic attacks and not develop panic disorder . That is possible , and I will wrap this one up by telling you about what the experience of a recovered person is , because I 100% , absolutely had panic disorder throughout the 25 year period in my life .

For sure , there were three or four periods that were much worse than others , but I would have met that clinical definition for a very long time in my life . Now it is possible for me to have a panic attack now and then it's been about a year since I had one . There's a lot going on in my life right now .

There was a death in my family a couple of weeks ago . I did experience what I think may have been a panic attack about two weeks ago , but it's contextual and guess what ? When it was over , it doesn't matter to me . I didn't think about it an hour later . I was often about with my day and I understand the context that it's in .

It wasn't a mystery and it didn't present a threat or a challenge to me in any way . It was disruptive . It's certainly scary when it happens .

I don't want them to happen , but it's also possible for somebody who does have a diagnosis of panic disorder or any anxiety disorder or related condition , to get to the point where they still may develop periods of elevated anxiety and panic but do not qualify for the diagnosis anymore . Why ? Because , as I said earlier , it doesn't impact your lifestyle anymore .

Panic attacks literally have zero impact on my life as a recovered person .

At this point and I'll speak for other recovered person people because that would be the way we would define that recovered state If I was working with you as your therapist and you got to the point where maybe you had a panic attack once in a while but you just sort of shrugged it off as an unpleasant experience that you don't like and went on with your day

and no longer had restrictions in your life because of that panic , or you didn't spend any amount of time considering it or having it weigh in as an option in the decisions you make , as a factor in the decisions you make in your life , then you would no longer qualify to be diagnosed as with panic disorder and we'd probably be done and when you wouldn't need

therapy anymore for that particular problem .

So not only is it possible for people to have panic attacks and never develop panic disorder , but it is possible to have panic disorder and then overcome that and achieve a fully recovered state where it is possible that you might panic once in a while but not have panic disorder , because those panic attacks no longer create restrictions or avoidances in your life

and it's simply a non-issue or a non-factor . Why ? Because now you see the panic attack as a discrete event .

Let's tie it back to the beginning of this little talk , where it has a beginning , it peaks , it has an end and it's over , and one panic attack is just simply not connected to the next , for me as a recovered person , for other recovered people and for people in the world who do have recurring panic attacks but never develop the disorder .

So , as you can see , it's not as simple as saying that panic attacks equal panic disorder . There is no such thing as being diagnosed as anxiety disorder . You may have an anxiety disorder , you may have multiple anxiety disorders . That sort of doesn't matter , because they all start to blend together anyway . So don't look at anxiety disorder diagnoses as additive .

Now I have multiple different problems to solve . That's not necessarily true . They're all related . That's why we grouped them together in a diagnostic classification or category . And even if you do get diagnosed with panic disorder or another anxiety disorder or disorders .

It is , in fact , possible to recover from those things and get back to the point where a panic attack has a beginning , a middle , an end . They don't get connected and they don't impact your life anymore . So what do we got here ?

That's about 17 or 18 minutes on the difference between panic attacks and panic disorder , the proper way to use the term anxiety disorder .

This probably won't change anybody's life significantly , but I think all the as much good information as you can have that's correct , that's actionable , that you can rely on , that isn't based on just what people sort of think this is the way we actually use these terms in the clinical world I think can be helpful as you work on your recovery and as you begin

to conceptualize this , especially if you're new to this , if panic attacks are new for you , if you're not sure what's going on , definitely go back and watch episode one through four of the Foundations of Panic series here on this podcast of this YouTube channel . And yeah , that's pretty much the end of this one .

You know it's over because you can hear the music .

That's the way I end all of these podcast episodes , and I will also end with the usual little closing , which is , if you're watching this as a YouTube video and you kind of dig it , then hit the subscribe button and the notification bell so you know when I upload new content Definitely like the video if you like it .

I mean , if you don't like it , you can out . Like it , that's okay . I understand you're entitled to your opinion and if you have a question or a comment , by all means leave it below and I will be happy to interact with you as soon as I possibly can .

I can't get to the comments always right away , but I do go back and read all the comments and I try to respond to as many as I possibly can .

If you're listening as a podcast episode , especially an Apple podcast or Spotify , then if you dig the podcast , leave a five star rating and or even take a second and maybe write a little review , because it helps other people find the podcast and then other people get the help that they want .

If you are looking for more information again , check my website at the anxious truthcom for all of the goodies that I have on offer there , free or otherwise , and also check out the disordered podcast that I do with Josh Fletcher . That's a really good podcast that's at disorderedfm .

And as always , I'll remind you that , no matter how hard you may be struggling today and how difficult it may seem and how it may seem like you're never going to get better , any little tiny step that you can take in the direction of recovery and away from your fear and I don't mean avoiding or stopping your fear , but facing that fear and learning a little

bit more today how to move through it a little bit more productively than you did yesterday that step counts . They all add up over time . Suddenly you see that things are different . You cannot have imagined that they could have been different for you . I believe that you can do it and I just want to leave you with that little bit of encouragement .

So thanks for hanging out . We'll see you again in the next episode . Take care .