People With Body Dysmorphic Disorder See Their Faces Differently

/ Author:  / Reviewed by: Joseph V. Madia, MD

Brain scans reveal differences in the way the brains of individuals with body dysmorphic disorder, a psychiatric condition that causes patients to believe they appear disfigured and ugly, respond to images of their own faces, according to a report in the February issue of Archives of General Psychiatry.
Body dysmorphic disorder (BDD) affects approximately 1 to 2 percent of the population. Patients with the condition become preoccupied with perceived defects in their appearance. Many are distressed and cannot function normally, about half are hospitalized at some point in their lifetimes and about  a fourth attempt suicide. Despite its prevalence and severe effects, little is known about the underlying brain changes that contribute to the disease.

Jamie D. Feusner, M.D., and colleagues at UCLA's David Geffen School of Medicine assessed 17 patients with BDD and 16 healthy contro participants matched by gender, age and education level. Participants underwent functional magnetic resonance imaging (fMRI) while viewing photographs of two faces--their own and that of a familiar actor--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, which conveys the general shape of the face and relationships between facial features.

Compared with control participants, individuals with BDD demonstrated abnormal brain activity in regions associated with visual processing 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.

The abnormal activation patterns, especially in response to low spatial frequency images, suggest  individuals with BDD have difficulties perceiving or processing general information about faces.

"Clinically, this may account for the impaired ability to perceive the visual gestalt, contributing to distorted perceptions of the individuals' appearance when viewing their face," the authors write. "The individuals may primarily perceive details and are impaired in their ability to contextualize them configurally or holistically."

Some of the patterns appear 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 BDD.

Contact:
Jann Ingmire
312-464-2499
jann.ingmire@jama-archives.org

Review Date: 
September 16, 2010