Panic attacks triggered by mirrors, bright lights, social situations
panicking every time you are in bright light, or near a mirror. Imagine
sweating, shaking and being short of breath because you feel like people
are staring at your nose, your hair or your skin. Researchers at Rhode
Island Hospital have found that such cued panic attacks impact nearly 30
percent of patients with Body
Dysmorphic Disorder (BDD). The paper is published in the current
issue of the Journal of Psychiatric Practice.
BDD is a common, often severe, and under-recognized body image disorder.
People with BDD experience distressing or impairing preoccupations with
perceived flaws in their appearance and are obsessed with the belief
that something is wrong with how they look, when in reality they look
normal. More than 75 percent of people with BDD feel life is not worth
living or think about suicide in their lifetime, and approximately 25
percent have a history of a suicide attempt.
In a study of patients with BDD, researchers found that 28.9 percent
reported lifetime panic attacks triggered by BDD symptoms, most commonly
by the feeling that others were looking at or scrutinizing the perceived
appearance defects, looking in the mirror at the perceived defects and
being in bright light where perceived defects would be more visible. The
most common panic attack symptoms were palpitations, sweating, shortness
of breath, trembling or shaking and fear of losing control or going
“Patients who have the added burden of panic attacks have more severe
lifetime BDD, social anxiety, depressive symptoms and poorer quality of
life than those with BDD who do not have BDD-triggered panic attacks,”
said Katharine Phillips, M.D., lead author of the study and director of
the Body Dysmorphic Disorder program at Rhode Island Hospital.
Additionally, patients with BDD-triggered panic attacks were more likely
to be unemployed, to have been hospitalized for psychiatric issues, and
to have had suicidal ideation due to BDD symptoms.
“We found that the BDD-cued panic attacks were triggered by common
situations – social situations, mirrors and other reflective surfaces
and bright lights,” Phillips said. “By experiencing this panic, it is
possible that these patients will become even more fearful and anxious
and may try to avoid these common situations in the future.”
Researchers suggest that panic attacks triggered by such situations may
be a clue to clinicians of the presence of this often-secretive
disorder. Since BDD-triggered panic attacks are associated with greater
morbidity, including suicidal ideation, patients with cued panic attacks
may warrant closer clinical monitoring, Phillips added.
The study was funded by the National Institute of Mental Health
(grant #R01-MH60241 and 5-K24-MH063975) and by a grant from the American
Foundation for Suicide Prevention. Phillips’ principal affiliation is
Rhode Island Hospital, a member hospital of the Lifespan health system
in Rhode Island. Other researchers involved in the study were William
Menard, BA; and Andri Bjornsson, Ph.D., both of the department of
psychiatry Rhode Island Hospital. Phillips is affiliated with The Warren
Alpert Medical School of Brown University.