panic disorder vs. generalized anxiety disorder
Anxiety is a broad word that gets thrown around so much it can lose meaning. Someone says they have anxiety and it could mean constant worry, it could mean physical panic attacks, or it could mean both. Two of the most commonly mixed up diagnoses are Panic Disorder and Generalized Anxiety Disorder. On paper they overlap, but in real life the difference changes everything about how a person experiences their day.
The Tempo of the Anxiety
The biggest distinction is tempo.
Generalized Anxiety Disorder runs in the background like static. The worry is there most days, often all day, and jumps from topic to topic. It is diffuse and persistent.
Panic Disorder is episodic. Most of the day might feel manageable, until suddenly, out of nowhere, the body goes into full alarm mode: pounding heart, air hunger, dizziness, trembling, a rush of “I’m dying” or “I’m losing control.” Between attacks, people may actually feel fine but live in dread of the next one.
That difference in tempo is often the first clue. GAD wears you down slowly, Panic Disorder ambushes you.
What the Mind Does
The content of thoughts also separates the two.
GAD thoughts usually have a storyline: finances, work, health, relationships, daily responsibilities. The brain keeps chewing on “what if” scenarios. Even when a worry resolves, another one fills the space.
Panic thoughts explode after the body surges. People often do not start with a narrative fear, but rather with a sensation: chest tightness, skipped heartbeat, lightheadedness. The mind scrambles to explain it, which is when thoughts like “I’m about to faint” or “this is a heart attack” rush in.
In other words, in GAD the thought drives the feeling. In Panic Disorder the feeling drives the thought.
The Body Tells on Itself
This is one of the overlooked differences.
People with GAD often describe muscle tension, restlessness, stomach issues, fatigue. The body is stressed but rarely reaches a full adrenaline dump.
Panic Disorder is visceral. Surges of adrenaline flood the system. Pupils dilate, sweat breaks out, the body shakes. It is the same physiology as being chased, except there is no external danger.
This is why panic attacks are so often mistaken for medical emergencies. Emergency rooms are full of people who thought they were having a heart attack when in fact it was panic.
Anticipatory Fear vs Baseline Worry
Another subtle point is what happens between episodes.
In GAD, worry is the baseline. If life is calm for five minutes, the brain goes looking for the next thing to stress about.
In Panic Disorder, the between times can actually feel normal, but a shadow lingers: fear of fear itself. The next attack becomes the focus. This anticipatory anxiety can be as disabling as the panic attacks themselves.
Why It Gets Missed
The overlap is real. Many people with GAD experience occasional panic attacks when their worry peaks. Many with Panic Disorder develop ongoing anxiety about when the next attack will come. But the ratio matters. If daily life is dominated by constant worry across multiple domains, it is GAD. If life is marked by sudden spikes of terror and dread of the next one, it is Panic Disorder.
Why the Distinction Matters
The treatments can look similar on the surface — SSRIs, therapy, lifestyle interventions. But the focus differs:
For GAD, therapy often centers on identifying cognitive distortions, tolerating uncertainty, and retraining chronic worry habits.
For Panic Disorder, the gold standard is exposure to the sensations themselves. Learning to sit with a racing heart without catastrophizing, retraining the body to stop misinterpreting normal arousal as danger.
Miss the diagnosis and you miss the target. Someone with GAD given only interoceptive exposure might feel misunderstood. Someone with Panic Disorder given endless cognitive restructuring might never break the cycle of bodily fear.
Takeaway
Both GAD and Panic Disorder can wreck quality of life, but they are not interchangeable. One is like being nibbled at all day by dozens of small worries. The other is like being ambushed by a lion out of nowhere. Knowing which battle you are fighting is the first step to fighting it well.