Panic Attacks vs. Phobias: Recognizing the Diagnostic Differences

Fear is your body’s way to keep you safe. But sometimes, fear goes too far. It becomes irrational or too strong, and this can lead to panic attacks or phobias. These problems are pretty common. About 19 million people in the US have a phobia, and up to 11% of people have a panic attack each year.

Phobias are intense, unreasonable fears of certain things, places, or activities. Panic attacks are sudden and powerful episodes of fear. They often relate to panic disorder.

In this article, we will explain how panic attacks and phobias are different. Let’s get started.

Symptoms Shared by Both Conditions

Both panic attacks and phobias share similar signs and symptoms. They both come from anxiety, and that’s why their symptoms overlap.

Physical Symptoms

These are changes in your body that can cause sickness or discomfort:

• Chest pain or tightness
• Shortness of breath or difficulty breathing
• A racing heart (tachycardia)
• Trembling or shaking
• Sweating
• Nausea
• Dizziness or headaches
• Feeling faint

Psychological Symptoms

These are feelings and thoughts that make the experience even scarier:

• Fear of losing control
• Feelings of dread
• Fear of dying

How Pain Differs in Both Conditions

Pain is a natural response to stimuli, and feels different whether you’re having a panic attack or dealing with a phobia.

Panic Attack Pain

Panic attacks bring strong physical feelings that can mimic serious health problems. You might feel:

Physical Symptoms

• Chest pain or tightness
• Feeling like you can't breathe
• A racing heart (tachycardia)
• Dizziness
• Shaking or trembling
• Sweating
• Nausea

Psychological Symptoms

• Fear of dying
• Fear of losing control
• Feelings of doom

During a panic attack, your body goes into fight-or-flight mode. Your heart beats faster and you breathe quicker. The pain is usually sharp and goes away when the attack ends. It starts suddenly and can worsen if you breathe too fast, making you feel like you’re choking or dizzy.

Phobia-Related Pain

Phobias don’t usually cause pain like panic attacks. However, you can still feel uncomfortable when you face what you fear. This discomfort comes from anxiety and stress when you confront or think about the feared thing or situation.

Here are the physical and psychological symptoms you might feel:

Physical Symptoms

These changes in your body happen because of fear:

• Chest pain
• Sweating
• Nausea
• Shortness of breath or difficulty breathing
• Rapid heartbeat (tachycardia)
• Trembling or shaking
• Hot flushes or chills
• Headaches or dizziness
• Feeling faint
• Dry mouth
• Numbness or pins and needles
• A need to go to the toilet
• Ringing in your ears

Psychological Symptoms

These thoughts and feelings make the fear worse:

• Fear of losing control
• Fear of fainting
• Feelings of dread
• Fear of dying

This pain occurs when you are near or think about what you fear. It links to the stress of avoiding or dealing with scary situations.

Unlike the quick and intense pain of a panic attack, phobia-related pain happens only in specific situations. It stops when you avoid or leave the scary thing.

Triggers

Triggers cause panic attacks and phobias. Let’s find out what sets them off.

Common Triggers for Panic Attacks

Panic attacks can happen suddenly or come from inside you. These attacks often start because of scary thoughts. This is especially true for panic disorder.

Here are things that can trigger a panic attack:

• Seeing or being near something you’re really scared of, like needles or heights.
• Worrying too much about having another panic attack.
• Dealing with a lot of stress, like losing someone you love or having a serious accident.
• Big life changes, such as getting divorced or having a baby.
• Bad experiences in childhood, like trauma or feeling unsafe.
• Drinking too much coffee, smoking, or using alcohol.
• Having certain health problems or illnesses.

Common Triggers for Phobias

Things around you can trigger phobias. Check out these common triggers:

• Spiders, dogs, or insects
• Heights, storms, water, or darkness
• Needles, medical procedures, or seeing blood
• Being in airplanes, elevators, or small enclosed spaces
• Choking, vomiting, loud noises, or costumed characters
• Seeing someone else’s fear or hearing warnings about dangers
• Past events like accidents or injuries
• Overprotective, overly critical, or anxious parents
• Thinking about or expecting the scary thing

Studies show that people with specific phobias might feel extreme anxiety or even have panic attacks when they face what they fear.

Diagnosis

There are different methods used to differentiate panic attacks from phobias. Each method has its own rules.

Diagnostic Methods for Panic Attacks

To find out if you have panic attacks, doctors follow several steps.

1. First, they ask about your symptoms and your medical history. This helps them understand what you’re experiencing.
2. Next, they do a full physical exam and run tests to make sure your symptoms aren’t from another condition. These tests might include blood tests, heart tests like an electrocardiogram (ECG or EKG), checks for thyroid problems, and tests for breathing issues.

If the tests don’t find a physical cause, doctors look at your symptoms and what might put you at risk. They usually do a psychological evaluation where they talk about your symptoms, fears, stressful situations, relationship challenges, avoidance behaviors, and family history.

You might also fill out a questionnaire and answer questions about alcohol or substance use to help with the diagnosis.

Diagnostic Tests for Phobias

Phobias have their own way of being diagnosed, too. Doctors start with a psychiatric evaluation to build trust and gather your history. They may use the DSM-5-TR criteria, which include a strong fear or anxiety about something specific, like fear of flying, heights, animals, or seeing blood.

For children, this fear might show up as:

• Crying
• Tantrums
• Freezing
• Clinging to someone

The fear usually happens right away and makes them avoid the scary thing or feel very upset when they face it.

The fear is much stronger than the actual danger and persists for six months or more, causing problems in social life, work, or other important areas.

Doctors also make sure the fear isn’t better explained by another mental disorder, like panic symptoms or traumatic memories. They identify the type of phobia you have, such as an animal phobia, natural environment phobia, blood-injection-injury phobia, situational phobia, or other specific fears.

Treatment

Managing panic attacks and phobias involves different approaches. Let’s explore how each condition is treated.

Treatment for Panic Attacks

To handle panic attacks, a combination of therapy, medication, and lifestyle changes works best.

Psychotherapy

One of the most effective therapies is Cognitive Behavioral Therapy (CBT). CBT helps you identify and change the thoughts that trigger panic attacks. A common method used in CBT is exposure therapy. Here, you slowly face the things that make you panic in a controlled setting. This helps you build confidence and reduce fear over time.

It might take a few weeks, but CBT can lower how often and how badly you experience panic attacks.

CBT has been studied extensively, and research suggests there is strong evidence supporting its use with treatment of phobias and panic attacks. As such, it remains a consistent part of treatment for panic disorder.

CBT works best when combined with other treatments tailored just for you. Psychotherapy plays a key role alongside medications like Selective Serotonin Reuptake Inhibitors (SSRIs). Using tools like the Severity Measure for Panic Disorder helps doctors keep track of your progress and adjust the therapy to fit your needs.

Another study also agrees that CBT is the best form of psychotherapy for anxiety disorders, including panic disorder. They recommend using psychological therapy, medication, or a mix of both, especially when someone is struggling.

Medications

Medications can ease the physical and emotional symptoms of panic attacks. Doctors might prescribe:

1. Selective Serotonin Reuptake Inhibitors (SSRIs): Medications like fluoxetine (Prozac) and sertraline (Zoloft) are generally safe and effective in preventing panic attacks. These medications are used long term to help reduce the frequency and severity of panic attacks.
2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Venlafaxine (Effexor XR) helps prevent and reduce panic symptoms.This is also a consistent, long term medication used on a daily basis.
3. Benzodiazepines: Drugs such as alprazolam (Xanax) and clonazepam (Klonopin) provide quick relief for panic symptoms when they arise, but are used only for a short time due to their addictive nature. The general goal is to manage panic disorder in a way that benzodiazepines are rarely used.
4. Beta-Blockers: These help control physical symptoms of anxiety and panic, like a racing heart. This class of medications can be used alone or in combination with other medications to control symptoms. Beta-blockers are not typically prescribed first line for treatment, but can be useful in the right setting.

Your doctor will choose the best medication based on your symptoms and medical history. Treatment may take several weeks to kick in. It’s common to meet with your provider regularly while your medication is being titrated to the appropriate level.

Treatment for Phobias

Phobias can be treated using several effective methods, each specific to your specific fears. Here are the main treatments that can help you overcome your fears

Exposure Therapy

Exposure therapy is the most effective treatment for phobias, with success rates between 80-90%. This therapy involves gradually facing what you’re scared of in a safe and controlled environment.

It usually starts with small steps, like looking at a picture, and slowly moves to more direct interactions, such as being near or touching the feared object.

Each session is customized to fit your needs, helping you build confidence and reduce your fear over time.

Cognitive Behavioral Therapy (CBT)

CBT helps you identify and change the thoughts that make you scared. For example, if you have claustrophobia, CBT can help you rethink your fears about small spaces.

CBT often includes exposure therapy to maximize its effectiveness. By changing negative thoughts and learning coping strategies, CBT can significantly reduce your anxiety and help you manage your fears better.

Mindfulness Therapy

Mindfulness therapy is excellent, especially for social phobias. This approach focuses on being present and aware of your current experiences without judging them. By practicing mindfulness, you can improve how you handle stress and anxiety.

Techniques like deep breathing and staying calm in the moment help you manage your fears more effectively, giving you greater control over your emotions.

Virtual Reality (VR) Therapy

Virtual Reality Therapy is an exciting and innovative way to treat phobias. It creates a realistic but safe environment for exposure therapy. This is especially useful for fears that are hard or expensive to recreate in real life, like fear of flying.

VR therapy can be as effective as traditional methods or enhance their results. Its convenience and versatility make it a promising option for the future of phobia treatment.

Studies show that Virtual reality exposure therapy (VRET) works just as well as traditional exposure therapy. VRET is effective for different fears, like heights (acrophobia), social anxiety, and fear of flying. Even after the therapy, many people still feel better months later.

Wrap Up

You might experience similar symptoms with both panic attacks and phobias, such as chest pain and a racing heart. However, panic attacks come on suddenly and can be triggered by stress or caffeine, while phobias are linked to specific fears like spiders or heights.

Treating panic attacks often involves therapy, medication, and making lifestyle changes like reducing caffeine. For phobias, exposure therapy, cognitive behavioral therapy, and other techniques can help you overcome your fears.

FAQs About Panic Attacks vs. Phobias

Can you have both a panic attack and phobias?

Yes, you can experience both. A phobia might trigger a panic attack when you face what you fear. For example, if you fear flying, being on a plane might lead to a sudden panic attack.

How can you help someone during a panic attack?

Stay calm and reassure them. Encourage slow, deep breaths and let them know you’re there for support. Avoid judgment and give them space if they need it.

How can you help someone during a panic attack?

Stay calm and reassure them. Encourage slow, deep breaths and let them know you’re there for support. Avoid judgment and give them space if they need it.

What’s the difference between fear and a phobia?

Fear is a natural response to danger, while a phobia is an intense, irrational fear of something specific. A phobia can interfere with your daily life, unlike normal fear.

What is the difference between agoraphobia and panic disorder?

Agoraphobia involves fear of situations where escape might be difficult during a panic attack, while panic disorder involves recurring, unexpected panic attacks.