Am I having an anxiety attack?

Anxiety is often a key response to stressors in the environment. It is a response that can lead to self-preservation. However, when one has persistent worry and fear that is out of proportion to the situation at hand, or for a prolonged period, then one may consider a possible diagnosis of anxiety disorder.

What are the symptoms and types of anxiety disorder?

Anxiety disorder includes symptoms of restlessness, inability to sleep well, irritability, fatigue, muscle tension, and difficulty concentrating.

There are many types of anxiety disorders, depending on how long the symptoms have been happening and their causes. When symptoms of anxiety, such as a constant fear of something terrible happening without an apparent reason, persist for more than six months, then one may consider the possibility of having generalized anxiety disorder.

There may be obvious triggers for some types of anxiety disorders. For example, social anxiety disorder is triggered by speaking in public or interacting with strangers. Separation anxiety disorder causes symptoms when a person is away from home or loved ones. Some may have specific phobias, like closed spaces, crowds, or public transport. However, there are times that these symptoms simply come without warning.

Symptoms of panic attacks:

When anxiety disorder symptoms escalate in intensity out of proportion to the stressors, it may become a panic attack. Strictly speaking, the DSM-5 does not recognize the term “anxiety attack,” but this may be interpreted as increased intensity of symptoms of worry, distress, or fear. The onset of intense anxiety can result in a panic attack. Still, a panic attack can also come out of the blue without a particular trigger. Repeated panic attacks are known as panic disorder.

  • The symptoms of a panic attack can last as long as ten minutes with at least four of the following:
  • An uncomfortable awareness of one’s heartbeat (palpitations)
  •  Coldness, pins-and-needles sensation, or numbness of the hands and feet (paresthesias)
  • A feeling that you are not in touch with reality (depersonalization or derealization)
  • Upset stomach (in the form of diarrhea, difficulty swallowing, nausea, or constipation)
  • Intense fear of dying
  • Fear of losing control
  • Light-headedness
  • Chest pain or tightness
  • Chills
  • Choking
  • Profuse sweating
  • Shaking
  • Shortness of breath
  • Shaking or trembling

Anxiety and panic symptoms can overlap with other diseases

As one may notice, many of these symptoms may appear to be very somatic or physical. Chest tightness can often be confused with a heart attack but could also be a symptom of anxiety. An upset stomach, gastrointestinal reflux, difficulty swallowing food or water, diarrhea, or constipation can be anxiety symptoms. Other symptoms, like insomnia or uncontrollable crying, can also be symptoms of depression and may coexist with anxiety disorders. Tics, which can be likened to shaking, can also be a symptom of Tourette’s syndrome. Shaking or trembling can be related to hyperthyroidism. To get a clear picture of the causes of one’s symptoms, it is always essential to have a medical workup with a physician.

Why do anxiety disorder or panic disorder cause these symptoms?

The symptoms of anxiety and anxiety attacks are caused by increased activation of the sympathetic nervous system – a physiologic mechanism so that our body can engage in “fight or flight.” The heart rate increases to raise the amount of circulating blood. The gastric system ceases to digest food so that energy is directed towards activities that need urgent movement. Muscles tense and twitch in preparation for an attack.

How do I know if I have an anxiety disorder?

A standardized questionnaire can help screen whether a person is experiencing emotional distress enough to warrant a consult with a physician. One example is the GAD-7 screening tool that allows one to score mild, moderate, moderately severe, or severe anxiety. A score of 10 or higher may warrant a call to a psychiatrist to help assess the possible lifestyle improvements and, if necessary, medications to help one cope with anxiety better. Telemedicine consults have been a great tool to initiate a conversation with a physician to manage anxiety better.

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  • Wilkerson R. The truth about ‘nervous tics’ [Internet]. Novant Health | Healthy Headlines. 2018 [cited 2021Apr9]. Available from:
  • Le T. First aid for the USMLE step 1 2021. New York: McGraw Hill; 2021.
  • Spitzer R, Williams J, Kroenke K. Self-Test for Anxiety [Internet]. Michigan Medicine University of Michigan. Available from:

About the Author

Pauline Del Mundo, MD

Ma. Paulina Francesca A. Del Mundo, M.D. is a physician and researcher at the University of the Philippines – College of Medicine. She has worked as a consultant for projects in telehealth, occupational medicine, and medical education.

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