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| The Mirror Lie: Body Dysmorphic Disorder |
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| SciMed - Soc & Psych | |||
| TS-Si News Service | |||
| Wednesday, 03 February 2010 15:00 | |||
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Los Angeles, CA, USA. The distorted self-image of people with body dysmorphic disorder could result from abnormal visual processing by the brain. Everyone checks themselves in the mirror now and then, but that experience can be horrifying for individuals suffering from body dysmorphic disorder, or BDD, a psychiatric condition that causes them to believe, wrongly, that they appear disfigured and ugly. These people tend to fixate on minute details — every tiny blemish looms huge — rather than viewing their face as a whole. The inaltered images above are those used in the study. Patients with body dysmorphic disorder underwent an fMRI while viewing neutral-expression photographs of their own face and a familiar face that were unaltered (r), altered to include only low detail (m), or altered to include only high detail (l). Researchers at UCLA now have determined that the brains of people with BDD have abnormalities in processing visual input, particularly when examining their own face. Further, they found that the same systems of the brain are overactive in both BDD and obsessive-compulsive disorder, suggesting a link between the two. The research appears in the journal Archives of General Psychiatry.
"People with BDD are ashamed, anxious and depressed," said Dr. Jamie Feusner, an assistant professor of psychiatry and lead author of the study. "They obsess over tiny flaws on their face or body that other people would never even notice. Some refuse to leave the house, others feel the need to cover parts of their face or body, and some undergo multiple plastic surgeries. About half are hospitalized at some point in their lifetimes, and about one-fourth attempt suicide." Despite its prevalence — BDD affects an estimated 1 to 2 percent of the population — and severe effects, little is known about the underlying brain abnormalities that contribute to the disease. To better understand its neurobiology, Feusner and colleagues examined 17 patients with BDD and matched them by sex, age and education level with 16 healthy people. Participants underwent functional magnetic resonance imaging (fMRI) while viewing photographs of two faces — their own and that of a familiar actor — first unaltered, and then altered in two ways to parse out different elements of visual processing. One altered version included only high–spatial frequency information, which would allow detailed analysis of facial traits, including blemishes and hairs. The other showed only low–spatial frequency information, conveying the general shape of the face and the relationship between facial features. Compared to the control participants, individuals with BDD demonstrated abnormal brain activity in visual processing systems when viewing the unaltered and low–spatial frequency versions of their own faces. They also had unusual activation patterns in their frontostriatal systems, which help control and guide behavior and maintain emotional flexibility in responding to situations. Brain activity in both systems correlated with the severity of symptoms. In addition, differences in activity in the frontostriatal system varied based on participant reports of how disgusting or repulsive they found each image. Basically, how ugly the individuals viewed themselves appeared to explain abnormal brain activity in these systems. The abnormal activation patterns, especially in response to low-frequency images, suggest that individuals with body dysmorphic disorder have difficulties perceiving or processing general information about faces. "This may account for their inability to see the big picture — their face as a whole," Feusner said. "They become obsessed with detail and think everybody will notice any slight imperfection on their face. They just don't see their face holistically." Some of the patterns, said Feusner, also appear to be similar to those observed in patients with obsessive-compulsive disorder, supporting hypotheses that the two conditions share similar neural pathways. However, future studies are needed to further elucidate the causes and development of body dysmorphic disorder. FundingThe research was supported by the National Institute of Mental Health (NIMH), the Obsessive-Compulsive Foundation, a research grant from UCLA, the National Center for Research Resources, the National Institutes of Health (NIH), the Brain Mapping Medical Research Organization, the Brain Mapping Support Foundation, the Pierson–Lovelace Foundation, the Ahmanson Foundation, the William M. and Linda R. Dietel Philanthropic Fund at the Northern Piedmont Community Foundation, the Tamkin Foundation, the Jennifer Jones-Simon Foundation, the Capital Group Companies Charitable Foundation, the Robson Family and the Northstar Fund.
ParticipantsOther authors on the paper include Teena Moody, Emily Hembacher, Jennifer Townsend, Malin McKinley, Hayley Moller and Susan Bookheimer, all of UCLA.
CitationAbnormalities of Visual Processing and Frontostriatal Systems in Body Dysmorphic Disorder. Jamie D. Feusner, Teena Moody, Emily Hembacher, Jennifer Townsend, Malin McKinley, Hayley Moller, Susan Bookheimer. Arch Gen Psychiatry 2010; 67(2): 197-205.
Abstract Context. Body dysmorphic disorder (BDD) is a psychiatric disorder in which individuals are preoccupied with perceived defects in their appearance, often related to their face. Little is known about its pathophysiology, although early research provides evidence of abnormal visual processing. Objective. To determine whether patients with BDD have abnormal patterns of brain activation when visually processing their own face with high, low, or normal spatial resolution. Design. Case-control study. Setting. A university hospital. Participants. Seventeen right-handed medication-free subjects with BDD and 16 matched healthy control subjects. Intervention. Functional magnetic resonance imaging while viewing photographs of face stimuli. Stimuli were neutral-expression photographs of the patient's own face and a familiar face (control stimuli) that were unaltered, altered to include only high spatial frequency (fine spatial resolution), or altered to include only low spatial frequency (low spatial resolution). Main Outcome Measure. Blood oxygen level–dependent signal changes in the BDD and control groups during each stimulus type. Results. Subjects with BDD showed relative hyperactivity in the left orbitofrontal cortex and bilateral head of the caudate for the unaltered own-face vs familiar-face condition. They showed relative hypoactivity in the left occipital cortex for the low spatial frequency faces. Differences in activity in frontostriatal systems but not visual cortex covaried with aversiveness ratings of the faces. Severity of BDD symptoms correlated with activity in frontostriatal systems and visual cortex. Conclusions. These results suggest abnormalities in visual processing and frontostriatal systems in BDD. Hypoactivation in the occipital cortex for low spatial frequency faces may indicate either primary visual system abnormalities for configural face elements or top-down modulation of visual processing. Frontostriatal hyperactivity may be associated both with aversion and with symptoms of obsessive thoughts and compulsive behaviors.
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