Body Dysmorphic Disorder refers to the experience of being excessively concerned about and preoccupied by a perceived defect in one’s physical features. Unlike eating disorders, which mainly affect women, nearly as many men as women have body dysmorphic disorder. Body dysmorphic disorder is often related to childhood traumas like being teased about one’s looks, parental neglect, distress over parents’ divorce, or emotional, sexual or physical abuse. Recent research, abstracted below, also points to neurobiological underpinnings.
Abnormalities of Visual Processing and Frontostriatal Systems in Body Dysmorphic Disorder
Jamie D. Feusner, MD; Teena Moody, PhD; Emily Hembacher, BA; Jennifer Townsend, BA; Malin McKinley, MA; Hayley Moller; Susan Bookheimer, PhD
Arch Gen Psychiatry. 2010;67(2):197-205.
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.
Jamie D. Feusner; Teena Moody; Emily Hembacher; Jennifer Townsend; Malin McKinley; Hayley Moller; Susan Bookheimer, Abnormalities of Visual Processing and Frontostriatal Systems in Body Dysmorphic Disorder, Arch Gen Psychiatry. 2010;67(2):197-205.