AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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2009 Annual Meeting Abstracts

Visual Information Processing of Faces in Body Dysmorphic Disorder
Jamie Feusner, MD1, Arie Winograd, M.A.2.
1UCLA, Los Angeles, CA, USA, 2Los Angeles Body Dysmorphic Disorder and Body Image Clinic, Los Angeles, CA, USA.

Body dysmorphic disorder (BDD) is a severe psychiatric condition in which individuals are preoccupied with perceived appearance defects. It affects 1-2% of the general population and is found in 6-16% of cosmetic surgery patients. Individuals with BDD may seek cosmetic surgery, often repeatedly and compulsively, and are usually dissatisfied with the outcome.
This disorder results in significant distress, disability, depression, and often suicide. Relative to its severity and prevalence, it is under-recognized and under-studied. Clinical observation suggests that BDD patients focus on details of their appearance (often an aspect of their face) at the expense of configural elements.
The current study is the first neuroimaging study to examine the neurobiological basis of abnormalities in visual information processing in BDD that may underlie clinical symptoms. The objective was to determine whether BDD patients have abnormal patterns of brain activation when visually processing others’ faces with high, low, or normal spatial resolution.
We enrolled twelve right-handed medication-free subjects with BDD and thirteen matched healthy control subjects. BDD subjects and healthy controls underwent functional magnetic resonance imaging (fMRI) while performing matching tasks of face stimuli. Stimuli were neutral-expression photographs of others’ faces that were a) unaltered, b) altered to include only high spatial frequency (fine spatial resolution), or c) altered to include only low spatial frequency (low spatial resolution). The main outcome measure was blood oxygen level-dependent fMRI signal changes in the BDD and control groups during tasks with each stimulus type.
BDD subjects showed greater left hemisphere activity relative to controls, particularly in lateral prefrontal cortex and lateral temporal lobe regions for all face tasks (see Fig. 1). Controls recruited left-sided prefrontal and dorsal anterior cingulate activity only for the high spatial frequency task.
BDD subjects demonstrate fundamental differences from controls in visually processing others’ faces. The predominance of left-sided activity for low spatial resolution and normal faces suggests more detail encoding and analysis rather than holistic processing, a pattern evident in controls only for fine spatial resolution faces. These abnormalities may be associated with BDD patients’ apparent perceptual distortions. The fact that these findings occurred while viewing others' faces suggests differences in visual processing, beyond distortions for their own appearance. These findings have implications for plastic surgeons as evidence that BDD is a neurobiologically-based disorder of perception, which may underscore why cosmetic procedures are largely ineffective (and contraindicated) in this population.
Fig. 1. Statistically significant regions of greater brain activation for the subjects with body dysmorphic disorder compared with control subjects for low spatial frequency faces


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