Abnormalities of object visual processing in body dysmorphic disorder

Abstract

Background Individuals with body dysmorphic disorder may have perceptual distortions for their appearance. Previous studies suggest imbalances in detailed relative to configural/holistic visual processing when viewing faces. No study has investigated the neural correlates of processing non-symptom-related stimuli. The objective of this study was to determine whether individuals with body dysmorphic disorder have abnormal patterns of brain activation when viewing non-face/non-body object stimuli. Methods Fourteen medication-free participants with DSM-IV body dysmorphic disorder and 14 healthy controls participated. We performed functional magnetic resonance imaging while participants matched photographs of houses that were unaltered, contained only high spatial frequency (high detail) information, or only low spatial frequency (low detail) information. The primary outcome was group differences in blood oxygen level-dependent signal changes. Results The body dysmorphic disorder group showed lesser activity in the parahippocampal gyrus, lingual gyrus, and precuneus for low spatial frequency images. There were greater activations in medial prefrontal regions for high spatial frequency images, although no significant differences when compared to a low-level baseline. Greater symptom severity was associated with lesser activity in dorsal occipital cortex and ventrolateral prefrontal cortex for normal and high spatial frequency images. Conclusions Individuals with body dysmorphic disorder have abnormal brain activation patterns when viewing objects. Hypoactivity in visual association areas for configural and holistic (low detail) elements and abnormal allocation of prefrontal systems for details is consistent with a model of imbalances in global vs. local processing. This may occur not only for appearance but also for general stimuli unrelated to their symptoms.

Holistic versus detailed visual processing in body dysmorphic disorder: Testing the inversion, composite and global precedence effects

“…Our findings are inconsistent with previous studies that have indicated an excessive reliance on, and processing of, details in BDD (Feusner et al, 2007;Stangier et al, 2008;Feusner et al, 2009;Feusner et al, 2010;Feusner et al, 2011;Jefferies et al, 2012). Although methodological differences limit comparisons across studies on visual processing in BDD, there may be several possible reasons why we did not observe impairments in holistic processing in our patient sample.…”

“…Similarly, using unlimited exposure to images of famous people in the upright and inverted orientation, a second study (Jefferies et al, 2012) found evidence of a superior ability of BDD patients to recognize inverted faces compared to controls. These findings further converge with data from neuroimaging studies in BDD, which have also revealed abnormal brain activations during visual encoding of global elements of faces and houses presented on a screen for 3 or 4 seconds (Feusner et al, 2007;Feusner et al, 2010;Feusner et al, 2011). Taken together, it may be argued that whilst individuals with BDD present intact holistic abilities as evident during short stimulus presentations, longer exposure to stimuli may allow patients enough time to engage in a detailed processing style.…”

“…Abnormal brain activation patterns during encoding of global elements of faces and objects (Feusner et al, 2007;Feusner et al, 2010;Feusner et al, 2011) have been taken as additional evidence of an excessive processing of details in BDD compared to controls. Other investigations have attempted to ascertain behavioural evidence of detailed visual processing in BDD using various experimental paradigms.…”

“…Based on the studies suggesting an excessive reliance on, and processing of, details (Feusner et al, 2007;Stangier et al, 2008;Feusner et al, 2009;Feusner et al, 2010;Feusner et al, 2011;Jefferies et al, 2012), we predicted impaired holistic visual processing in BDD. While the inversion face task has been previously tested on a BDD sample (Feusner et al, 2010;Jefferies et al, 2012), to the best of our knowledge, no previous studies have investigated the composite face effect or the global precedence effect in BDD.…”

Social Physique Anxiety and Muscle Dysmorphia

“…This is not entirely surprising given that BDD is associated with executive dysfunction (e.g., difficulties with manipulating, planning and organizing information), attentional biases (Grocholewski, Kliemb, & Heinrichsa, 2012), and visual processing abnormalities. Individuals with BDD tend to encode details rather than holistic or configural aspect of the input from the environment (Feusner, Hembacher, Moller, & Moody, 2011). BDD patients portray some common characteristics of other disorders such as obsessivecompulsive disorder (OCD), anxiety, psychotic, and major depressive disorders.…”