Abnormalities of visual processing and frontostriatal systems in body dysmorphic disorder.
BACKGROUND
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.


METHODS
Case-control study.


METHODS
A university hospital.


METHODS
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).


METHODS
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.
Feusner
Jamie D
JD
Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA. jfeusner@mednet.ucla.edu
Moody
Teena
T
Hembacher
Emily
E
Townsend
Jennifer
J
McKinley
Malin
M
Moller
Hayley
H
Bookheimer
Susan
S
D000328:Adult; D057215:Body Dysmorphic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D016022:Case-Control Studies; D003342:Corpus Striatum / Q000503:physiopathology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology*; D006801:Humans; D007406:Interview, Psychological; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000503:physiopathology; D010468:Perceptual Disorders / Q000453:epidemiology* / Q000503:physiopathology*; D012720:Severity of Illness Index; D014796:Visual Perception / Q000502:physiology*; D055815:Young Adult