Reality attack vs. panic attack

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Fifteen years ago or more, I used to hear the expression "panic attack" quite often.  When someone told me they were having a panic attack, I knew it was something serious, and I had to pay close attention to what they were doing and be extra nice to them.  I don't think that I've heard anyone say "panic attack" for the last decade or more, so I wonder if people aren't having panic attacks any longer, and if so why?  Or has a new term come along to replace "panic attack"?

In contrast, South Koreans have become exceedingly fond of saying that they face what they call "hyun-ta 현타" ("reality attack").  This is a shortened version of "hyunsil tagyuk 현실 타격".  That means facing reality; for example, people use this expression when they come back from vacation and have to go to work the next day.

Having a panic attack is (was? — I don't know if people still have them very much nowadays — is a serious condition accompanied by adverse physical symptoms:

A panic attack is the abrupt onset of intense fear or discomfort that reaches a peak within minutes and includes at least four of the following symptoms: Palpitations, pounding heart, or accelerated heart rate. Sweating. Trembling or shaking. Sensations of shortness of breath or smothering.


Perhaps we can borrow Korean "hyun-ta 현타" ("reality attack") to make up for our apparent loss of "panic attack".

N.B.:  I do not wish to make light of panic attacks.  I'm sure that people still have them, and they must be acutely uncomfortable for those who experience them (I don't know what they're like because I never had one).  It's just that I don't hear people talk about them as much as they used to (indeed, I haven't heard anyone mention "panic attack" for at least ten years).  On the other hand, I often come up against reality attacks (for me they're more like reality checks), such as when I have to get a syllabus ready within one day or turn in grades for thirty papers within one week.  Now I have a word for such episodes.

[Thanks to Irene Do]


  1. C said,

    June 27, 2019 @ 5:07 am

    I was going to say that I think people often call them anxiety attacks now, at least in the UK.

    Then I looked at Google Ngrams for English, British English, and American English, and I'm wrong. Use of panic attack has surged since ~1980, and anxiety attack has bumped along at a lower level since just after WW2.

    A mystery…

  2. C said,

    June 27, 2019 @ 5:11 am

    PS if you add PTSD to the nGRAM, that's also surged since 1980, and way, way more.

    However, PTSD is rather different in cause and maybe symptoms, and possibly panic and anxiety attacks are not direct synonyms either.

  3. Victor Mair said,

    June 27, 2019 @ 5:30 am

    Just came across these:

    "The accusative of panic" (11/7/12) — describes a panic attack with regard to grammar.

    "Stark raven mad" (1/29/05) — on how to keep a panic attack under control

  4. Mark Liberman said,

    June 27, 2019 @ 5:34 am

    You're lucky to live in a world where no one you know has had panic attacks in the past decade. — Google News finds dozens of examples published within the past few weeks. And the NYT index finds 186 stories containing the phrase "panic attack" between 1/1/2000 and 12/31/2009, vs. 296 stories containing the same word between 1/1/2010 and 6/27/2019.

    So in the rest of the world, "panic attacks" have not gone away, lexicographically or otherwise.

  5. John Swindle said,

    June 27, 2019 @ 6:07 am

    Ngrams aside, a Google search on "panic attack" will give a sense of whether they've disappeared from human experience or human discourse.

  6. John Swindle said,

    June 27, 2019 @ 6:43 am

    Said better by Mark Liberman, whose comment I hadn't seen when I ventured forth.

  7. rory said,

    June 27, 2019 @ 7:05 am

    Do you mean you don't hear about it in the media or among your friends? I submit that your friends may just not have panic attacks or want to discuss them?

    Among me and my friends, all of whom have panic attacks, yeah, we still talk about them a lot.

  8. Bill Benzon said,

    June 27, 2019 @ 7:39 am

    FWIW, 15 years ago "The Sopranos" was being broadcast on HBO (1999-2007). Tony Soprano had panic attacks as, we learn eventually, did his father before him. He had one in the opening episode, and that lead him into psychotherapy, the most distinctive motif of the show.

  9. Jacob Reed said,

    June 27, 2019 @ 10:13 am

    I do think that it's more common among younger people now to talk about generalized anxiety; Malcolm Harris's Kids These Days must mention anxiety every other page, whereas "panic" only comes up as part of the phrase "moral panics". Maybe you'd do better looking for "acute anxiety" or (as C suggests above) "anxiety attacks".

  10. Jake said,

    June 27, 2019 @ 10:48 am

    There are 27 million xanax prescriptions in the US (along with 6 million valium and 14 million ativan), presumably somebody's still having them.

  11. Mitch Harris said,

    June 27, 2019 @ 11:26 am

    Also, who's not updating the corpora behind Google Books? It's 2019, and 2012 is the most recent update (but still not the default). Did Google just leave all that on a server running, while the interns that built it are doing sentiment analysis to promote YouTube videos?

  12. J.W. Brewer said,

    June 27, 2019 @ 11:59 am

    The wiki article for alprazolam (best known by the brand name Xanax) says it's "most commonly used in short term management of anxiety disorders, specifically panic disorder or generalized anxiety disorder (GAD)." Now "panic disorder" is apparently not actually a synonym for "panic attack" but means something like "the condition of being prone to recurrent panic attacks" but there nonetheless could be contexts where either "X disorder" or "X attack" could plausibly be used and their relative frequency of use thus might shift. Of course if the disorder is being successfully medicated, the attacks themselves may not be happening (and thus won't be talked about) but the disorder may still be there (and thus may be talked about) and will functionally be presumed to be there unless/until the patient-plus-doctor are willing to find out what happens if the medication is discontinued.

  13. Kristian said,

    June 27, 2019 @ 2:33 pm

    Actually panic disorder means having panic attacks and therefore becoming negatively affected in one's life in general (e.g. restricting one's behavior because one tries to avoid triggering a new panic attack); it doesn't mean being prone to panic attacks.

  14. maidhc said,

    June 27, 2019 @ 3:52 pm

    In my limited perception, what has changed is that the term "panic attack" is now limited mostly to actual panic attacks, whereas 15 or 20 years ago it was a term that was flung about a lot more loosely to refer to things that were not really panic attacks in the medical sense.

  15. Chris C. said,

    June 27, 2019 @ 5:20 pm

    I suspect your perception of "panic attack" frequency has more to do with your choices of media and social interaction than actual prevalence. I hear it all the time – or rather I see it mentioned online, typically by younger people.

  16. Terpomo said,

    June 27, 2019 @ 7:13 pm

    For anyone who cares, the words 현실 타격 would be written in hanja as 現實 打擊; presumably the abbreviation would be written as 現打.

  17. Philip Taylor said,

    June 28, 2019 @ 5:24 am

    Chris C ("I suspect your perception of "panic attack" frequency has more to do with your choices of media and social interaction than actual prevalence") — I think you are probably right. Although I think I know what a panic attack is [1], I don't think I have ever heard anyone say that they experienced one, nor do I recall ever seeing mention of one in writing. Or perhaps we Britons are simply more stoic and don't go in for such things.
    [1] I assume that a panic attack is a manifestation of such extreme and sudden fear that the brain is unable to decide amongst fight, flight or some more appropriate response.

  18. Ellen K. said,

    June 28, 2019 @ 8:54 am

    Maidhc makes a good point. How much we hear the term "panic attacks" isn't just related to how many people have panic attacks, how much they talk about their panic attacks, and what they call them, but also how many people use the term for things that aren't really full out panic attacks.

    I wonder in particular if people having a PTSD attack are more likely to refer to it as such (or at lease reference PTSD, with or without "attack") whereas in the past they might have called it a panic attack.

  19. Jerry Friedman said,

    June 28, 2019 @ 9:06 am

    As a community-college teacher, I work with a lot of young people. Some of them talk about their test anxiety, but I've never heard them mention panic attacks or anxiety attacks. (The terms seem to be synonyms.) I've heard it once or twice in reference to people my age or older. I admit my contact with younger people on line is mostly limited to a relatively small number of Facebook friends and to forums on chess and birdwatching, neither of which is a likely place to mention one's panic attacks.

    Philip Taylor: The Wikipedia article will tell you, citing the American Psychiatric Association, that "In Europe about 3% of the population has a panic attack in a given year while in the United States they affect about 11%."

  20. Philip Taylor said,

    June 28, 2019 @ 9:10 am

    To learn that even 3% of the population suffer from at least one panic attack in a single year is disturbing; to learn that 11% of the population of the United States experience at least one in a single year is very disturbing indeed.

  21. VV said,

    June 28, 2019 @ 11:23 am

    'I wonder if people aren't having panic attacks any longer, and if so why? Or has a new term come along to replace "panic attack"?'

    This is such a stunning example of how different individual (speech and social) communities can be, and how careful we should be not to generalize our experience within them. Both the term and the phenomenon "panic attack" are common in my personal experience.

  22. Philip Taylor said,

    June 28, 2019 @ 1:44 pm

    VV — in the light of your personal experience, would you say that my assumption that "a panic attack is a manifestation of such extreme and sudden fear that the brain is unable to decide amongst fight, flight or some more appropriate response" is reasonably accurate, or is there a more accurate / better way to describe one ?

  23. Andreas Johansson said,

    June 28, 2019 @ 1:58 pm

    My experience is similar to Professor Mair's: I seem to be hearing less of panic attacks than I did ten or fifteen years ago. Since they've apparently haven't become less common or talked about in general, I guess that simply reflects my (rather significantly) changed circumstances since then.

    The very large difference in incidence between Europe and the US is intriguing; it presumably can't be genetic.

  24. John Swindle said,

    June 28, 2019 @ 3:22 pm

    To mental health professionals Panic Disorder is a mental disorder and panic attacks are a symptom. DSM-5, the diagnostic and statistical menual of the American Psychiatric Association, attempts to define these things and is reflected in current English-language Wikipedia articles on them.

    But we may not be mental health professionals treating mental illness. We may describe our friends' and neighbors' mental or behavioral aberrations in different terms and our own in still other terms, even if we're trying to ascribe armchair psychiatric diagnoses. And we know language changes over time. I don't think people have stopped saying they have panic attacks, at least where I live, but to notice such changes and try to verify them is completely reasonable.

    Now, have people started saying they have PTSD?

  25. Victor Mair said,

    June 28, 2019 @ 4:24 pm

    "Now, have people started saying they have PTSD?"

    That's a great question! The answer, for me at least, is a resounding yes!

    As I wrote in the o.p., 15 years ago I heard "panic attack" all the time, but during the last five years or so, I don't think that I've heard it spoken even once — even though the sort of people with whom I associate hasn't changed much. On the other hand, as you suggest, I'm hearing PTSD all the time, and in circumstances similar to what I heard for "panic attack" in the past: heard it just yesterday and at least five times this month, whereas 15 years ago I never heard PTSD uttered even once. That's my own experience.

    BTW, 15 years ago I often heard people talk about depression, and I still hear them talking about it today in about the same proportion. It can be highly debilitating in terms of people carrying out tasks that are expected of them (both by others and by themselves). Being a professor who advises students who are under high levels of stress, I know first-hand the pressure they endure and do my best to help them through the most difficult periods.

  26. John Swindle said,

    June 28, 2019 @ 7:20 pm

    The hope with something like DSM-5 is that standardized vocabulary will allow comparison of like to like and make it possible to figure out which treatments work. But if I'm the patient I want a diagnosis that's socially acceptable if not trendy. trendy (I've been blessed with one or two.)

  27. Chandra said,

    June 29, 2019 @ 4:31 pm

    @Philip Taylor – Not exactly. Panic attacks tend to be a sort of delayed response to distress that often paradoxically happen when the person finally feels safe, and there is no immediate cause to fight or flee. The initial symptoms are often only physiological – sudden increase in heartbeat, cold sweats, shaking – which then lead to feelings of fear and dread because they seem to have come out of nowhere for no obvious reason. So it's like you're going about your day as usual, when suddenly your nervous system kicks into "danger" mode and you have no idea why.

    As for British stoicism, my guess is that in a culture that discourages emotional expression, it's likely that people still have panic attacks, they are just less likely to talk about and/or seek help for it.

  28. Robot therapist said,

    June 29, 2019 @ 6:50 pm

    "Now, have people started saying they have PTSD?"

    They have certainly started saying they have OCD, when they mean they are a bit fussy. (Real OCD is a horrible and often disabling thing).

  29. Kristian said,

    June 29, 2019 @ 11:19 pm

    Panic attack is defined thus in Kaplan and Sadock's Comprehensive Textbook of Psychiatry

    "A panic attack is a sudden, intense rush of fear, anxiety, or impending doom that reaches a peak very quickly and is associated with at least 4 of 13 physical and cognitive symptoms (e.g., shortness of breath, dizziness, heart palpitations, fear of dying, fear of going crazy or losing control). Panic attacks may be cued by a specific situation, as when someone who is afraid of snakes encounters one, or they may be unexpected and perceived by the individual as coming out of the blue."

    They don't seem to list all thirteen symptoms anywhere. This is almost the same definition Dr Mair gives in the original post. The definition doesn't say that the cause has to be psychological, so I guess a heart attack involving these symptoms would also count as a panic attack, even though no one talks that way.

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