Abnormalities of Visual Processing and Frontostriatal Systems in Body Dysmorphic Disorder | Psychiatry and Behavioral Health | JAMA Psychiatry | JAMA Network
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Original Article
February 2010

Abnormalities of Visual Processing and Frontostriatal Systems in Body Dysmorphic Disorder

Author Affiliations

Author Affiliations: Department of Psychiatry and Biobehavioral Sciences (Dr Feusner, Mss Hembacher and Moller, and Mrs McKinley) and Center for Cognitive Neuroscience (Drs Moody and Bookheimer and Ms Townsend), David Geffen School of Medicine, University of California, Los Angeles.

Arch Gen Psychiatry. 2010;67(2):197-205. doi:10.1001/archgenpsychiatry.2009.190

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.