Your heart pounds, your chest tightens, and for a few minutes you are certain something is very wrong — then it passes. Or maybe it never spikes like that, but a low hum of worry follows you through the day and will not switch off. Both experiences are real, both are common, and both get better with the right care.

People often ask us whether what they are feeling is “just anxiety” or “a panic attack,” and whether it counts as something to get help for. Here is how we think about the difference.

What panic and anxiety actually are

Anxiety is the body’s built-in alarm system. In the right amount it keeps us safe. It becomes a disorder when the alarm fires too often, too strongly, or at the wrong times, and starts to interfere with daily life.

A panic attack is a sudden surge of intense fear or discomfort that peaks within minutes and comes with strong physical symptoms. Panic disorder is when those attacks keep happening unexpectedly, and a person spends at least a month worrying about the next one or changing what they do to avoid one.

Generalized anxiety disorder (GAD) is different. It is persistent, hard-to-control worry across many areas of life — work, health, family, money — more days than not, lasting months. The American Psychiatric Association’s diagnostic manual, the DSM-5-TR, describes each of these as distinct conditions, though they often travel together.

How they differ — speed and shape

The simplest way to tell them apart is speed and shape:

Many people have both, and that is normal. The point is not to self-diagnose from a table, but to notice the pattern so you can describe it to a clinician.

Signs and symptoms

During a panic attack, people often notice a pounding heart, sweating, shaking, shortness of breath, chest tightness, dizziness, a sense of unreality, and a fear of losing control or even dying. The physical symptoms are so strong that many people first go to the emergency room certain they are having a heart attack.

With ongoing anxiety, the signs are quieter but steady: restlessness, trouble concentrating, muscle tension, irritability, disrupted sleep, and worry that is hard to turn off.

A picture of what this can look like

Consider someone in their thirties who, over two months, has three episodes where — out of nowhere — their heart races, their hands go numb, and they feel like the room is closing in. Each passes in about ten minutes. Soon they start avoiding driving alone, in case it happens on the highway. That avoidance, as much as the attacks themselves, is part of what turns panic attacks into panic disorder. (This is a fictitious example, not a real patient.)

How it’s understood and evaluated

Diagnosis happens with a clinician — not by scoring yourself on a checklist. We listen to the pattern, ask about physical health, and rule out other causes that can mimic anxiety, such as thyroid problems, heart rhythm issues, or heavy caffeine use.

It helps to know how common this is. The National Institute of Mental Health estimates that about 2.7% of U.S. adults have panic disorder in a given year, and roughly 19% have some anxiety disorder. These are among the most common health conditions there are — not a character flaw, and not something you should have to “push through” alone.

We keep this framed the way Native Hawaiian health traditions do: through lōkahi — balance across the connected parts of a life, including body, mind, spirit, and ʻohana (family). Anxiety is rarely just “in your head”; it lives in the naʻau (the gut, the inner self) and touches sleep, relationships, and daily rhythm. Care works best when it tends to the whole picture, not one symptom.

How we treat it — and how we approach it at OhanaPsych

The evidence here is strong and reassuring. Cognitive behavioral therapy (CBT) — a structured, skills-based talk therapy — is a first-line treatment for panic and anxiety, and medications in the SSRI and SNRI families are also first-line and effective. For many people the two together work better than either alone. Medications tend to work faster; therapy tends to build skills that last.

We tailor the plan to the person. Some people start with therapy, some with medication, many with both. If you want to read more about the specific conditions, see our pages on panic disorder care in Hawaiʻi, anxiety treatment, and social anxiety disorder care.

Getting care by telehealth

About 85% of the care we provide is by telehealth, and anxiety care is one of the best fits for it. A first tele-psychiatry visit is a conversation: we get your history, talk through what you have been experiencing, and build a plan together. Research shows that CBT delivered by video works about as well as in-person CBT for panic disorder, so distance across the islands does not have to mean less effective care.

A few medications are controlled substances and may involve extra steps or an in-person visit, and the federal telehealth rules for those are still being finalized (current flexibilities are extended through the end of 2026). We provide care to patients located in Hawaiʻi, and language assistance is available. If you are not sure whether your situation fits telehealth, just ask us.

When to seek help now

If you ever have chest pain, trouble breathing, or symptoms you are not sure about, treat it as a possible medical emergency and call 911 — panic and a heart problem can feel alike, and it is always okay to get checked.

If you are struggling with thoughts of suicide or a mental health crisis, help is available 24/7:

• 988 Suicide & Crisis Lifeline — call or text 988 (chat at 988lifeline.org)
• Hawaiʻi CARES — call or text 988; from outside the 808 area code, 808-832-3100
• Emergency: call 911

Medically reviewed by George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP — President & Owner, OhanaPsych. This article is general health education. It is not a substitute for a personal evaluation by a qualified clinician who knows your situation, and reading it does not create a provider–patient relationship. If you think you may have a medical or mental health condition, reach out to us or another licensed provider. In an emergency, call 911.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Curtiss, J. E., Levine, D. S., Ander, I., & Baker, A. W. (2021). Cognitive-behavioral treatments for anxiety and stress-related disorders. Focus, 19(2), 184–189. https://doi.org/10.1176/appi.focus.20200045

National Institute of Mental Health. (n.d.). Panic disorder. U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/statistics/panic-disorder

National Institute of Mental Health. (n.d.). Any anxiety disorder. U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder

Papa Ola Lōkahi. (n.d.). Mental and behavioral well-being. https://www.papaolalokahi.org/program/mental-and-behavioral-well-being

Hawaiʻi CARES. (n.d.). Crisis & suicide. State of Hawaiʻi, Department of Health. https://hicares.hawaii.gov/how-we-help/crisis-and-suicide/