Mental Health

Silent Panic Attack vs Anxiety Attack: What’s the Difference?

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A silent panic attack is not necessarily silent in the literal sense. Instead, it refers to panic attacks that do not outwardly manifest in the typical physical symptoms associated with panic disorders. These covert panic attacks can be incredibly distressing, as the sufferer often feels a sense of intense fear or discomfort, without the physical cues that might otherwise alert others to their distress.

For some people, the term ‘silent panic attack’ might seem like an oxymoron. After all, panic attacks are typically associated with obvious symptoms such as hyperventilation, a racing heartbeat, and a sense of impending doom. But silent panic attacks, while less noticeable on the surface, can be just as debilitating and disruptive as their more conspicuous counterparts.

Understanding silent panic attacks is important not only for those who suffer from them, but also for their friends, family, and healthcare providers. This knowledge can improve early detection, appropriate treatment, and improved quality of life.

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What are Silent Panic Attacks?

A silent panic attack is a type of panic attack without the usual physical symptoms. They are typically characterized by intense feelings of fear or discomfort that peak within minutes. 

Unlike a regular panic attack, however, a silent panic attack might not include symptoms such as heart palpitations, trembling, or sweating. Instead, they often come with more subtle, internal symptoms.

The absence of overt physical symptoms can make silent panic attacks particularly challenging to recognize and diagnose. This can often lead to a delay in seeking treatment, resulting in unnecessary suffering and a lowered quality of life. Therefore, understanding the nature and symptoms of silent panic attacks is crucial.

Symptoms of a Silent Panic Attack

The experience of a silent panic attack can vary greatly from person to person. For some, it may feel like an overwhelming sense of dread or a feeling of being detached from oneself. Others may experience intrusive, racing thoughts, or an intense fear of losing control or going crazy. 

Regardless of the specific manifestations, silent panic attacks are typically marked by a sudden onset of intense fear or discomfort, which can be very distressing to the individual experiencing it. You may find yourself plagued by intrusive, racing thoughts that you can’t seem to shake off. There could be a fear of dying, or a fear of going crazy. 

These are not irrational fears. They are the result of your body’s natural reaction to perceived danger. This is known as the fight-or-flight response, and it is often the driving force behind a panic attack.

The intense fear and distress can interfere with your daily life, making it difficult to work, maintain relationships, or even carry out basic tasks. Unfortunately, because silent panic attacks do not present with the typical panic symptoms, they are often misdiagnosed or dismissed.

Causes of a Silent Panic Attack

The exact cause of silent panic attacks is not completely understood. But some research suggests that silent panic attacks may be linked to changes in the brain, specifically in areas that control the fear response.

Psychological factors can play a significant role in the development of silent panic attacks. For instance, people with a history of trauma or chronic stress may be more susceptible to developing panic disorders. Some personality traits, such as a tendency towards negative thinking or perfectionism, can also increase the risk of experiencing silent panic attacks.

Environmental factors can also increase the risk of silent panic attacks. Many individuals report experiencing their first panic attack during periods of high stress or significant life changes, such as starting a new job, moving to a new city, or after the loss of a loved one.

How is a Silent Panic Attack Different from Other Panic Attacks?

While silent panic attacks and regular panic attacks are both characterized by intense fear or discomfort, there are several key differences between the two. 

The most significant difference is with physical symptoms. Regular panic attacks typically involve physical symptoms such as:

  • heart palpitations
  • shortness of breath
  • trembling
  • sweating

But silent panic attacks often result in psychological symptoms with little to no physical symptoms.

Regular panic attacks are often easier to recognize, both by the person experiencing it and by those around them. Silent panic attacks can be much more difficult to identify because of their covert nature, which makes them harder to diagnose and treat.

Treatment Options for Silent Panic Attacks

Silent panic attacks are treatable. Several effective treatment options exist, ranging from medication to psychotherapy. 

Cognitive-behavioral therapy (CBT) has been shown to be highly effective for treating panic disorders. CBT works by helping you understand and change thought patterns that lead to harmful behaviors or distressing feelings.

Medications, such as selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines, can also be effective in managing silent panic attacks. These medications work by affecting chemicals in the brain involved in anxiety and panic disorders.

Self-help strategies can help you manage silent panic attacks. These include regular exercise, adequate sleep, a healthy diet, and stress management techniques like deep breathing exercises and meditation. But self-help strategies are not a substitute for professional help and treatment.

When to Seek Professional Help for Silent Panic Attacks

If you find that your fear and distress are interfering with your daily life, or if your anxiety is causing you significant distress, it may be time to seek professional help.

If you are experiencing frequent panic attacks, or if your fear of having another attack is causing you to avoid certain situations or places, it’s important to reach out to a mental health professional. Similarly, if your anxiety is leading to depression, substance use, or if you’re having suicidal thoughts, seek help immediately.


The fear and distress of silent panic attacks can be overwhelming, and the lack of physical symptoms can make it difficult to explain your experience to others. But with understanding, recognition, and appropriate treatment, it is possible to manage silent panic attacks and lead a full and fulfilling life.

Author: Giselle Leung, PharmD, BCGP is a registered pharmacist and a freelance medical writer based in New York. She specializes in geriatric pharmacy, which focuses on the complex medication needs of older adults. She has worked with the Peninsula Pharmacists Association and a skilled nursing facility (SNF) in California to create educational handouts and present on various topics to older adults in the community.


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