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Why the Mirror Lies

MedMagSpring10-Mirror LiesEVERYONE CHECKS THEMSELVES IN THE MIRROR now and then, but that experience can be horrifying for individuals suffering from body dysmorphic disorder, or BDD, a psychiatric condition that causes them to believe, wrongly, that they appear disfigured and ugly. Now researchers at UCLA have determined that the brains of people with BDD have abnormalities in processing visual input, particularly when examining their own face. The research was published in Archives of General Psychiatry.

“People with BDD are ashamed, anxious and depressed,” says Jamie Feusner, M.D., assistant professor of psychiatry and lead author of the study. “They obsess over tiny flaws on their face or body that other people would never even notice. Some refuse to leave the house, others feel the need to cover parts of their face or body, and some undergo multiple plastic surgeries.”

To better understand the neurobiology of BDD, Dr. Feusner and colleagues examined 17 patients with the disorder and matched them by sex, age and education level with 16 healthy people. Participants underwent functional magnetic resonance imaging while viewing photographs of two faces – their own and that of a familiar actor – first unaltered and then altered in two ways to parse out different elements of visual processing. Compared to the control participants, individuals with BDD demonstrated abnormal brain activity in visual processing systems when viewing the unaltered and low-spatial frequency versions of their own faces. They also had unusual activation patterns in their frontostriatal systems, which help control and guide behavior and maintain emotional flexibility in responding to situations. Brain activity in both systems correlated with the severity of symptoms. In addition, differences in activity in the frontostriatal systems varied based on participant reports of how disgusting or repulsive they found each image. Basically, how ugly the individuals viewed themselves appeared to explain abnormal brain activity in these systems.

The abnormal activation patterns, especially in response to low-frequency images, suggest that individuals with BDD have difficulties perceiving or processing general information about faces. “This may account for their inability to see the big picture – their face as a whole,” Dr. Feusner says. “They become obsessed with detail and think everybody will notice any slight imperfection on their face. They just don’t see their face holistically.”


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