Body dysmorphic disorder is characterized by a preoccupation with a defect in appearance which is either imagined or a slight physical anomaly.  I recently read an interesting article about this subject. I must admit that I have noticed anxiety symptoms (although sometimes subclinical) in my clients with eating disorders or body image issue. The authors of this article address the treatment of social anxiety symptoms in the successful treatment of body dysmorphic issues.

A social anxiety is the fear, and typically avoidance, of social or performance situations that may cause embarrassment.  Typically, those dealing with a social anxiety understand that their fear is excessive and may at time endure the anxiety provoking situation with great difficulty.

Understanding this anxiety is the first step to treatment. In counseling, we can address the social anxiety through focused exposure exercises, restructuring negative self-statements, and extreme negative interpretations of social cues. Typically, the decrease in anxiety symptoms corresponds to a decrease in body dysmorphic symptoms and an increase in quality of life.

Kelly, M.M., Walter, C., & Phillips, K.A. (2010). Social anxiety and its relationship to functional impairment in body dysmorphic disorder. Behavior Therapy, 41, 143-153.