For the past several days, I’ve been experiencing periods of shortness of breath, fatigue and general soreness. On any normal occasion, I’d dismiss this as part of my generalised anxiety disorder. But now, in our current hellscape, where the symptoms of COVID-19—shortness of breath, in particular—have been drilled into our heads, it’s hard not to jump to conclusions. If you’ve dealt with anxiety yourself, then you know that this is what leads to a spiral: getting fixated on something and becoming increasingly worked up about it, all while assuming the worst possible outcome is about to happen.
Is that shortness of breath an anxiety attack, or the onset of the virus? Is the fatigue a result of not being able to sleep for the past several nights because of my anxiety, or something worse? And is this soreness because I’m constantly clenching every muscle in my body in perpetual fight-or-flight mode, or another type of symptom? If it was just one symptom of coronavirus that would be one thing, but three?
I’m a rational human being who has been writing about mental health and the coronavirus for weeks at this point; surely I’m able to tell the difference between an anxiety disorder I’ve lived with since childhood and a global pandemic. But that’s the thing about anxiety—it makes you question everything, while your brain repeatedly sends your body the message that it’s in imminent danger. And if I have this question, other people probably do too. So, as a public service (and thinly-veiled attempt to calm myself down), I spoke with three psychiatrists about how to tell the difference between the symptoms of a panic attack, general anxiety and COVID-19, and when you should seek medical attention.
Anxiety versus a panic attack
Before we bring in the coronavirus, let’s talk about what a panic attack actually is. “Panic attacks can occur without warning. They are sudden and can happen at any time or place,” Dr. Zlatin Ivanov, a psychiatrist practicing in New York City tells Lifehacker. “Panic attacks are a result of intense fear, which triggers a physical reaction in the body when no real danger is present.” According to the Cleveland Clinic, the symptoms of a panic attack include:
Increased heart rate
Chest pain or discomfort
Trembling or shaking
Feeling that you might be choking
Chills or overheating
Fear that you’re dying or losing control of your mind
A feeling that what’s happening around you isn’t real
So what’s the difference between a panic attack and an anxiety attack? As the Cleveland Clinic puts it: “Anxiety attacks aren’t technically a thing, at least not according to medical terminology. It’s a layperson’s term for a panic attack.” (If you’re experiencing a panic attack, we have a helpful video on how to get through it.)
If you’ve ruled out a panic attack, what about symptoms that don’t necessarily peak and then go away, but slowly crush you under the weight of fear and despair? That’s anxiety, and it comes with its own set of symptoms, including shortness of breath; tightening of the chest; a rapid, pounding heart rate; sweating; occasional chills or hot flashes; headache and shaking, Ivanov explains. In addition, generalized anxiety can also cause difficulty sleeping, fatigue, muscle soreness and in some cases, gastrointestinal issues. Unlike panic attacks, the symptoms of anxiety can stick around for extended periods of time. For example, sometimes I’ll have a rough few hours thanks to heightened anxiety. Other times, it’s a constant, gnawing feeling that can last for weeks or months at a time.
Anxiety, panic attack or COVID-19 symptoms?
OK, let’s break this down. According to the Centres for Disease Control (CDC), the common symptoms of COVID-19 are shortness of breath, fever and cough. The emergency warning symptoms—meaning you should seek immediate medical attention—include trouble breathing, pain or pressure in the chest, new confusion or inability to be woken up, and bluish lips or face, the CDC reports. If you’re hearing some overlap with anxiety and panic attack symptoms, you’re not wrong. “Shortness of breath from COVID-19 and a [panic] attack can present exactly the same,” Dr. Dion Metzger, a psychiatrist practicing in Atlanta, Georgia tells Lifehacker. “This is what makes it tricky.”
Here are a few other factors that will help you figure out what to do next.
Do you have other symptoms?
Though shortness of breath is one of the most-talked-about symptoms of COVID-19, Ivanov points out that it’s important to pay attention to whether you have other symptoms too. “Besides the shortness of breath, coronavirus symptoms are also severe cough and fever,” he explains. “They may appear anywhere between two and 14 days after exposure.”
If someone is experiencing shortness of breath or tightness in the chest—even for prolonged periods of time—but there is no cough along with those symptoms, then this is likely anxiety as a result of high stress levels, Ivanov says. “Whereas the COVID-19 symptoms should also include severe dry cough and fever. The virus affects the lungs and respiratory ways. The anxiety has an effect on the whole body.” (More on that in a minute.)
Do you typically experience anxiety and/or panic attacks?
If you’re an old pro at dealing with periods of anxiety or panic attacks, then Dr. W. Nate Upshaw, a psychiatrist and medical director of NeuroSpa TMS says that you should know how these symptoms feel and already have a plan to deal with them. “If your symptoms are feeling typical, and you don’t have any other medical symptoms of COVID-19 such as fever, cough, or feelings of fatigue, it is probably anxiety and should resolve with your normal interventions,” he tells Lifehacker.
Do you have shortness of breath, but don’t feel particularly anxious?
People who have shortness of breath because of acute medical problems often lack the common symptoms of a panic attack, and sometimes don’t feel severe anxiety at all, Upshaw explains. “They are obviously concerned that their breathing is impaired, but they lack some of the psychological symptoms of panic attacks such as feelings of anxiety, dissociation and catastrophic fears of death,” he says. “Believe it or not, most people with shortness of breath from a medical condition won’t be focused on anxiety. Most people with shortness of breath due to anxiety will tell you they are anxious.”
Is anything helping your shortness of breath?
If you’re experiencing shortness of breath or a tightness in your chest, Metzger says to pay attention to what—if anything—helps to relieve it. “For example, if deep breathing helps you to lessen your shortness of breath associated with anxiety, it should be effective continuously,” she explains. “When a symptom is medically caused as with the shortness of breath with COVID-19, there wouldn’t be much relief seen with anxiety-reducing techniques such as going into an open space or utilising breathing techniques.” So the key here, Metzger says, is not how the shortness of breath presents itself, but whether it can be relieved.
Use the ‘head-to-toe’ method to assess your anxiety and symptoms
Anxiety symptoms have definitely been on the rise since the COVID-19 precautions have begun, Metzger says. To help educate her patients about the possible physical symptoms of anxiety, she uses her “head to toe” method:
“Anxiety can affect us from head-to-toe—meaning we can have headaches, shoulder tension, stomach upset down to tingling in our toes,” she explains. “Do not be alarmed if you see these symptoms, as this anxious response is expected as it’s our human reaction to a pandemic.”
When should you seek medical attention?
The first time I had a full-blown panic attack, I went to an emergency clinic because I thought I was having a heart attack and dying. But now, given the incredible strain on hospitals and other medical facilities thanks to the coronavirus outbreak, it’s not that simple (or safe). “It is important to rule out any shortness of breath due to anxiety prior to going to the ER, as you don’t want to have unnecessary exposure to the virus,” Metzger explains. “The ER is one of the most high-risk places you can go to during this pandemic. I urge all patients to only go to the ER if absolutely necessary, and this goes for children too.” You also don’t want to take beds or space away from other patients who need them more.
However, if someone is experiencing physical symptoms of anxiety (whether or not they have an official diagnosis) including shortness of breath, and they are worried it may be related to a medical problem such as COVID-19, Upshaw recommends getting a medical evaluation. “That is the only way to know for sure,” he says. “Unfortunately, with the COVID-19 epidemic, going to seek medical attention carries the risk of exposure, so the patient may want to see if they can get an evaluation with a doctor by telemedicine. Their primary care doctor should let them know if this is possible. If they feel they are having a medical emergency, they should go to the ER or call 911.”
Don’t ignore your mental health
But just because these symptoms of anxiety or panic attacks may not be signs of COVID-19, that doesn’t mean they’re not legitimate health concerns worthy of your attention right now. “I urge everyone to use this time to reach out to their doctor if the anxiety symptoms become so severe that they’re unable to work, sleep or eat,” Metzger says. “There are medications that can help relieve this anxiety for this uncertain time we’re in right now. This is the time to hit the emergency button and reach out to your doctor for some relief.” Again, telehealth options here are preferable.
Everything is hard out there right now. And if you’re someone experiencing more anxiety or depression than normal, know that you definitely are not alone.