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Rhode Island Hospital Study finds Cued Panic Attacks Common, Occurring in Nearly 30 Percent of Patients with Body Dysmorphic Disorder


Panic attacks triggered by mirrors, bright lights, social situations  

girl-mirrorImagine 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 crazy.

“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.