Intranasal oxytocin modulates higher order social cognition in body dysmorphic disorder

Abstract

Background: Body dysmorphic disorder (BDD) is a psychiatric disorder with specific impairments in social cognition related to excessive concerns about one's appearance. Individuals with BDD have difficulty identifying emotional expressions and attribute internal factors for others' emotional expressions in self-referent (but not other-referent) scenarios. Given the role of oxytocin in regulating social approach behavior and social salience, we hypothesized that oxytocin would improve biases in emotion recognition, attributions, and threat interpretations in individuals with BDD, compared to healthy controls (HCs). This is the first study to examine the effects of oxytocin in people with BDD.Methods: Eighteen participants with BDD and 16 HCs received a single dose of 24 international units of intranasal oxytocin (Syntocinon R ) or matching placebo in a randomized, placebocontrolled, within-subject crossover design. Participants completed the Emotion Recognition Task and Interpretation Questionnaire 45 min after administration. Results:Oxytocin, relative to placebo, did not improve emotion recognition accuracy in either selfreferent or other-referent contexts for individuals with BDD. However, oxytocin led to greater internal attributions in other-referent contexts for those with BDD compared to HCs. Rather than reducing self-blame, oxytocin led to other-directed blame. Oxytocin did not impact threat interpretations in BDD. Conclusions:Oxytocin may only impact specific aspects of higher order social cognition in BDD and may have unwanted effects on emotion attributions. Our results caution its clinical use in BDD. K E Y W O R D Sbody dysmorphic disorder, emotion recognition, other, oxytocin, self, social cognition

Disturbed interoception in body dysmorphic disorder: A framework for future research

“…One potentially fruitful line of research may be to examine the role of a dysfunctional oxytocin system. Initial studies of oxytocin in BDD have been conducted (Fang et al, 2020(Fang et al, , 2019Grace et al, 2019a), although findings are mixed and more work is needed to determine precisely how oxytocin influences BDD. Oxytocin plays a key role in current models of brain function, and it has been proposed that a disturbance of the oxytocin system early in development disrupts the integration of interoceptive and exteroceptive information that is fundamental to the production of effective generative models of the self (Quattrocki and Friston, 2014).…”

Body dysmorphic disorder: a treatment synthesis and consensus on behalf of the International College of Obsessive-Compulsive Spectrum Disorders and the Obsessive Compulsive and Related Disorders Network of the European College of Neuropsychopharmacology

“…Patients who received SPT were subsequently offered BDD-NET and all but four accepted. A 2-year follow-up of 88 of the 90 people who had received BDD-NET (two were lost to follow-up) showed persistence of gains for BDD symptoms and global functioning but not the quality of life ( Enander et al ., 2019 ).…”

“…Oxytocin receptors are present in the limbic and reward-related regions of the brain, including the amygdala; the amygdala is a key region in the 'social brain', and these areas are associated with social cognitive performance. Fang et al (2019) administered intranasal oxytocin (24 international units) or placebo to 18 BDD patients and 16 healthy controls, using a within-subject cross-over design. They failed to find an effect of oxytocin on emotion recognition accuracy for either self-or other-referent tasks.…”

“…Thus, the study of Grace et al (2019b) provides promising data and suggests that oxytocin should be further investigated as a novel intervention for those with BDD. Such studies need to be cognizant; however, of the concerns raised by Fang et al (2019) based on their pilot treatment study findings.…”