Anxiety and panic attacks: what they are, how they differ and a psychosomatic reading

Two experiences that look alike, but aren't the same

A racing heart, shortened breath, the feeling that something is wrong: anxiety and panic attacks share many signals in the body, and it's easy to confuse them. Yet they describe two different experiences, and understanding the difference helps you feel less frightened.

In this article we look at what anxiety is, what a panic attack is and how they differ. Then we look at how psychosomatics talks about them, through the reading of the Scuola Riza (an Italian school of psychosomatic medicine), which invites us to listen to the symptom as a message, without blame and always alongside medical care.

In short: anxiety is a state of alert that rises and falls, often tied to a worry. A panic attack is a sudden wave of very intense fear, which usually peaks within a few minutes. Neither is dangerous in itself, but both deserve to be listened to. If you'd like to take stock of how you're doing, at the end you'll find the free test and the anxiety assessment kit.

What anxiety is

Anxiety is an emotion we all know. It's a state of alert, like that of an animal that scents danger and gets ready to face it. In small doses it's useful: it pushes us to act, to prepare, to look for solutions. The word itself comes from the Latin angere, meaning to squeeze or choke, the same root as "anguish": the lump in the throat is already in its name.

Anxiety involves body and mind together:

• In the body: palpitations, muscle tension, shortness of breath, nausea, dizziness, sweating, stomach and bowel problems.
• In the emotions: nervousness, irritability, a sense of inadequacy, sometimes being quick to tears.
• In the thoughts: excessive worry, difficulty concentrating, fear of not coping or of losing control.
• In behaviour: restlessness, hesitation, a tendency to avoid whatever worries you.

When it stops being useful

Anxiety becomes a problem when it's out of proportion to what's happening, when it lasts even after the cause has passed, when willpower alone can't master it and when it limits your work, relationships or sleep. In these cases we speak of anxiety disorders: the main ones include generalised anxiety disorder, panic disorder, phobias and social anxiety. Only a professional can say whether a disorder is present, and which.

For a closer look at how anxiety shows up and how to regulate it, you'll find the complete guide in Anxiety in the body.

What a panic attack is

A panic attack is a sudden wave of very intense fear or discomfort, often arriving without warning, even in calm moments: sitting at the table, in the car, walking into a shop. It usually peaks within a few minutes and eases over twenty or thirty minutes, often leaving you tired and drained.

It can include physical and psychological signals:

• In the body: palpitations, chest pain or pressure, laboured breathing or a feeling of choking, dizziness, sweating, hot flushes or chills, trembling, tingling, nausea, feeling faint.
• In the mind: fear of losing control, of "going mad" or of dying, a sense of unreality, of strangeness or of being detached from yourself.

A single attack, or a few over a lifetime, are more common than you might think. It doesn't mean you have a disorder.

When we speak of panic disorder

We speak of panic disorder when the attacks recur and, for at least a month, there is persistent worry that another one will come, or a change in behaviour to avoid it. People who live with it often develop anticipatory anxiety, the "fear of fear", and begin to avoid the places or situations associated with the attacks: restaurants, shops, crowded transport, travelling alone. And so life shrinks, sometimes down to the four walls of home. When the avoidance concerns places from which it would be hard to get out or to get help, we speak of agoraphobia.

Watch out for the loop: heightened attention to what's happening in the body (the heartbeat, the breath, a pain) makes anxiety rise, which amplifies the physical sensations, which confirm the fear that something is wrong.

An important caution: chest pain, fainting or difficulty breathing should always be checked by a doctor, especially the first time or if they feel different from usual. In case of severe chest pain or sudden difficulty breathing, call 112 or your local emergency services.

Anxiety and panic attacks: the differences

The simplest way to tell them apart is to look at how they arrive, how long they last and what comes with them.

	Anxiety	Panic attack
How it arrives	Gradually, often tied to a worry	Suddenly, even for no apparent reason
Intensity	From mild to strong, rising and falling	Very intense, like a wave
Duration	Hours, days or long periods	Peaks within a few minutes, usually 20–30 minutes in all
Dominant thought	"What if something happens?", worry about the future	"I'm about to die / go mad / lose control", immediate fear
Body	Tension, shortness of breath, stomach, disturbed sleep	Palpitations, choking, dizziness, trembling, tingling, detachment
Afterwards	Worry that carries on	Tiredness and fear that it will happen again

They are two points on the same line rather than two separate worlds: anxiety can be the ground on which a panic attack grows, and a panic attack can leave anticipatory anxiety behind it. You can experience one without the other, or both.

Want to understand better what you're going through? In the test section of the site you'll find the free test on anxiety and panic: it takes a few minutes and it isn't a diagnosis, but a starting point you can bring, if you wish, to a session.

Take the free test

Why anxiety and panic happen

There's no single cause. The most widely accepted hypotheses point to an interweaving of biology, life history and ways of reacting.

The neuroscientific and psychophysiological side

The brain and body have a system dedicated to recognising danger and reacting quickly. Anxiety and panic can be seen as this system at work when the alarm goes off too easily, or for too long. Here are the main pieces:

System	What it normally does	What is observed in anxiety and panic
Amygdala	Detects threat and sets off the alarm in fractions of a second, before conscious evaluation	In studies it often appears more reactive, even to neutral stimuli
Prefrontal cortex and hippocampus	Assess the context ("is there really a danger?") and put the brakes on the alarm	Control over the amygdala may be less effective
Insula	Registers the body's internal signals (heartbeat, breath, stomach)	Greater attention and sensitivity to bodily sensations, more readily read as danger
Autonomic nervous system	The sympathetic branch speeds up heart and breath and prepares for action; the parasympathetic brings back calm	Sympathetic activation comes more easily and the return to calm is slower
Stress axis	The hypothalamus and pituitary activate the adrenal glands, which release cortisol and adrenaline	If it stays active for a long time, it can keep you on alert and disturb sleep and energy
Neurotransmitters	Noradrenaline (alertness), serotonin (modulating mood and anxiety), GABA (the brake)	Imbalances in these systems have been associated with anxiety; the picture is complex and can't be reduced to a "chemical imbalance"

The fast route and the slow route. A stimulus (a noise, a sensation in the chest) reaches the amygdala by a fast route, which sets off the alarm, and the cortex by a slower route, which evaluates it. That's why your heart can race before you understand why. If the evaluation arrives and says "this isn't dangerous", the alarm switches off; if it doesn't arrive, or arrives weakly, the alarm stays on.

The autonomic nervous system. On alert, the sympathetic system releases adrenaline and noradrenaline: the heart beats harder, breathing speeds up, the muscles tense, digestion slows, the skin sweats. These are the sensations we recognise as anxiety. They're unpleasant, but not dangerous: the adrenaline peak can't last indefinitely, which is one of the reasons a panic attack burns itself out.

The stress axis. Faced with a threat, the hypothalamus sends a signal to the pituitary gland, which stimulates the adrenal glands to produce cortisol. In the short term this is useful; when stress goes on for a long time, this system can stay under strain and contribute to tiredness, disturbed sleep and greater reactivity. Here too, the findings vary greatly from person to person.

Breathing and carbon dioxide. The brain controls breathing partly by measuring the amount of carbon dioxide in the blood. According to one hypothesis about panic, in some people the sensors that detect it are especially sensitive and set off a "suffocation alarm" even when there's no danger at all. You breathe faster and more deeply (hyperventilation), the carbon dioxide level drops too far and dizziness, tingling, numb hands and a sense of unreality appear. The body reads these sensations as confirmation of danger, and the loop closes.

The false alarm. This is why panic can be described as a very sensitive alarm system that goes off for nothing. With repetition, the brain learns to associate panic with the places, the moments and even the sensations that came before it: anticipatory anxiety is born, and with it the avoidance that keeps the problem going.

Genetics. Family and twin studies indicate a hereditary component of moderate size: a predisposition, not a destiny.

The brain can change. The alarm circuits are plastic. Research suggests that psychological work, regulation experiences and, where appropriate, medication decided together with your doctor can change how they function over time. Not everything comes down to willpower, and that doesn't make it unchangeable.

These are hypotheses, not certainties, and no biological finding on its own explains why one person develops anxiety or panic. The presence of a biological mechanism doesn't rule out psychological work: on the contrary, the two levels work together.

The psychological and life side

• Stressful events: many people report a period of intense stress, a loss or a major change before onset, particularly the loss of significant people.
• Bonds and loneliness: feeling alone in the face of difficulties can make them seem bigger and less manageable, and feed anxiety.
• Anxiety as a signal: psychoanalysis, from Freud onwards, has read anxiety as a signal of internal danger, a conflict between what we feel or desire and what we feel we can allow ourselves.
• Thoughts that keep the loop going: fear of the body's sensations and of the attack itself can keep the system on alert.

For a closer look at the most common causes, see the dedicated section in Anxiety in the body.

The psychosomatic view: the symptom as a message

Psychosomatics, as read by the Scuola Riza, starts from a simple idea: body and mind are not separate, and a symptom can also be a way in which the body is telling us something. It doesn't replace the medical or psychological explanation: it sits alongside it, adding one more question. What is it trying to tell me?

The symbolic psychosomatic view is not a causal explanation and not a diagnosis: it's an interpretive key that offers a language for questioning the symptom, with respect for the person and always alongside medical and psychological care. It never attributes responsibility or blame to the person who is suffering. It orients and guides us like this:

Anxiety: the life we aren't living

In this reading, anxiety is a warning bell. It signals that we're living very much "in our heads": planning everything, keeping everything under control, living among duties and obligations, while our vital energy, desires and the emotions we neglect press to find room. Anxiety tells us that we're struggling.

Symptoms, too, have a possible symbolic meaning:

• A wildly pounding heart can be a heart protesting because we don't listen to its rhythms.
• A knotted stomach and difficult digestion can recall a constraint we're enduring.
• Difficulty breathing can speak of an unbalanced exchange between the inner world and the outer one.

Panic: a jolt that asks to be heard

In the same reading, a panic attack is a protest against a balance that has been built by force. It arrives suddenly, like lightning, and calls into question a way of life in which the "breath of life" may be missing. The racing heart, the spinning head, the breath that stops can be read as a symbolic invitation to "die" to a way of being in order to be "reborn" closer to what you truly feel.

The name itself comes from Pan, the Greek god of nature and instinct, wild in appearance, who according to myth let out terrifying cries at anyone who disturbed his rest. The psychologist James Hillman read panic as what happens when we keep our instinctive side at a distance: the exiled, caged god bursts into everyday life with a language of anguish, trembling and suffocation. Seen this way, panic is not only an enemy, but also a wake-up call inviting us to value our inner life again and to stop trying to be the conductors of our own orchestra.

What this means in practice

This reading doesn't offer ready-made answers: it offers a question to bring into your work on yourself. It can help you ask, with curiosity and without judgement:

• Where am I keeping everything under control?
• Which emotions (anger, sadness, desire) do I find it hard to make room for?
• How much space do the body, rest and pleasure have in my life?
• Who is close to me that I can tell how I feel?

Answering isn't a task to do alone: it's material for a session, a psychological pathway or a guided body-based space.

The closer look at the psychosomatic reading of symptoms, with strategies, is in the article 4 effective strategies for managing psychosomatic symptoms.

If it's happening right now

A panic attack, however frightening, passes. A few simple gestures can help you stay with the moment:

• Remind yourself what it is: "A wave is rising, it's intense, but it passes." Putting a name to what's happening reduces the fear of fear.
• Lean on something: feel your feet on the ground and your back against a support.
• Breathe out slowly: a small breath in and a slow breath out, without forcing. Breathing a lot and deeply can make dizziness and tingling worse.
• Look around: quietly name a few things you can see.

Don't fight the sensation and don't run away at all costs: both strategies tend to confirm to the body that there was a danger.

For a broader guide to regulation gestures, see Anxiety in the body.

Frequently asked questions

What's the difference between anxiety and a panic attack?

Anxiety is a state of alert that rises and falls, often tied to a worry. A panic attack is a sudden and very intense wave of fear, which usually peaks within a few minutes. They're two points on the same line: anxiety can prepare the ground for panic, and panic can leave anticipatory anxiety behind.

Can a panic attack make you go mad or be dangerous?

No. It's a very frightening experience, but a panic attack in itself doesn't make you lose your mind and isn't dangerous: the activation peaks and then eases. The fear of going mad or dying is part of the attack itself.

How long does a panic attack last?

The peak intensity is usually reached within a few minutes and the episode runs its course in twenty or thirty minutes, often leaving tiredness behind. The fear that it will happen again can last much longer.

How can I tell whether it's panic or a heart problem?

On your own, it isn't possible to tell them apart with certainty. If it's the first time, if the chest pain is severe or different from usual, or if you have difficulty breathing, call 112 or your local emergency services, or go to A&E. Afterwards, talk to your doctor to rule out physical causes.

Does anxiety go away on its own?

Sometimes it eases once the stressful period that triggered it has passed. If, on the other hand, it has lasted for weeks, holds you back or leads you to avoid situations, psychological support can help you understand its meaning and find your balance again.

What does it mean to read panic from a psychosomatic perspective?

It's a symbolic interpretive key that invites you to ask what the symptom is trying to say, without attributing blame and always alongside medical and psychological care. It's neither a diagnosis nor a causal explanation.

When to ask for help

It's worth talking to a professional if:

• panic attacks keep coming back or you fear another one will;
• you avoid places or situations for fear of feeling unwell;
• anxiety has lasted for weeks and is affecting your sleep, work or relationships;
• you notice you're constantly checking your body (heartbeat, breathing) for fear that something is wrong;
• you feel you can no longer manage it on your own.

If your physical symptoms are new or intense, talk to your doctor first, to rule out other causes. In case of severe chest pain, sudden difficulty breathing or thoughts of harming yourself, call 112 or your local emergency services, or go to A&E.

Where you can start

• If you want to understand better how you're doing: in the test section of the site you can take the free anxiety test. It isn't a diagnosis, but it can help you bring into focus what you're feeling. If you're already in touch with me, you'll find the anxiety assessment kit in your private area. Take the free test →
• If you want to talk about it: the discovery call is a free first meeting where you can share what brings you here and work out together which pathway makes sense for you. Book the discovery call →
• If you want to start from the body: Balance and group somatic art therapy are guided experiences that work on regulation and presence. They don't replace individual psychological support. Discover Balance → · Discover somatic art therapy →

This article is for information only and does not replace a medical or psychological assessment.

About the author

Francesca Peruzzi, clinical psychologist with a Jungian and psychosomatic orientation, and art therapist. She is registered with the Order of Psychologists of Lombardy, Italy (no. 21385). She helps people recognise the language of the body and build a sense of safety, with an approach that brings together mind, body and creativity.

Last updated: 9 October 2026.