Panic Attacks in Those with Body Dysmorphic Disorder

Almost 30 percent of those with body dysmorphic disorder have panic attacks triggered by thoughts that others are negatively judging their bodies according to a study published in the Journal of Psychiatric Practice in May, 2013.

What is Body Dysmorphic Disorder?

Body dysmorphic disorder (BDD) is a body-image disorder. Those with BDD intensely dislike one or more of their body parts. It could be their nose, forehead, face, mouth, hair, legs, feet or any other body part. Those with BDD spend hours each day obsessing over this perceived flaw in their appearance and will go to great lengths to try to hide or camoflauge it, including:

• Using clothes or makeup to hide the body part
• Excessuve grooming
• Excessive exercise
• Surgery
• Changing clothes excessively

In addition, some people with BDD find it difficult to look in a mirror or constantly check their appearance in the mirror. They believe that other people find this perceived flaw ugly, very unsightly or disgusting. Some find it hard to go out in public, missing school or work, because they are sure others will stare at them. These perceived flaws are usually nonexistant or slight imperfections/defects, such as a scar or birthmark.

BDD often begins in adolescence and affects males and females equally. About one percent of the U.S. population has BDD.

BDD and Panic Attacks

According to the study, close to 30 percent of those with BDD had a history of panic attacks that were triggered by symptoms of BDD. About two-thirds of those with panic attacks reported that feelings of panic resulted from the belief that others were scrutinizing the perceived flaw. Almost forty percent indicated panic attacks were triggered when they looked in a mirror and close to one-fourth felt panic when in bright light because they felt their flaw would be more noticeable to others.

Much like panic disorder symptoms, those with BDD reported:

• Heart palpitations
• Sweating
• Shortness of breath
• Shaking
• Fear of going crazy

Those who had BDD triggered panic attacks were more likely to have severe BDD symptoms and suffer from social anxiety and/or depression. They reported a lower quality of life than those with BDD who did not have panic attacks. They were less likely to have a job and many reported at least one prior hospitalization for psychiatric reasons and were more likely to have suicidal thoughts.

Treatment of BDD Triggered Panic Attacks

It is important to differentiate panic attacks that are triggered by symptoms of BDD from those that "come out of the blue." When panic attacks are not attached to symptoms of BDD, it might signal that there are two separate disorders - BDD and panic disorder. While treatment is similar for both, the focus of treatment might be different based on the underlying cause of the panic attacks.

When panic attacks are a result of BDD symptoms, treating the BDD should help to reduce or eliminate the panic attacks. According to the authors of the study, treatment might include serotonin reuptake inhibitors (SRIs) and cognitive behavioral therapy aimed at reducing symptoms of BDD. However, some people might also benefit from anti-anxiety medications, such as benzodiazepines, to help with the panic attacks.

For those with both BDD and panic disorder, treatments should be geared toward treating both illnesses at one time. Cognitive behavioral therapy can be geared to look at and improve symptoms of both BDD and panic disorder. In these cases, treating only the BDD will probably not improve the panic attacks.

References:

"Body Dysmorphic Disorder (BDD)," Date Unknown, Staff Writer, Anxiety and Depression Association of America

"Cued Panic Attacks in Body Dysmorphic Disorder," 2013, May, Katharine A. Phillips, William Menard, Andri S. Bjornsson, Journal of Psychiatric Practices, 19(3): 194-203