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The Cutting Edge

Missing the Big Picture

MedMag-FallWinter-TheBigPicturePEOPLE SUFFERING FROM BODY DYSMORPHIC DISORDER (BDD) – a severe mental illness characterized by debilitating misperceptions that one appears disfigured and ugly – process visual information abnormally, even when looking at inanimate objects, a new UCLA study finds. Jamie Feusner, M.D. ’99, director of the Obsessive-Compulsive Disorder Intensive Treatment Program at UCLA, and colleagues found that patients with BDD have less brain activity when processing holistic visual elements that provide the “big picture,” regardless of whether that picture is a face or an object.

“No study until this one has investigated the brain’s activity for visually processing objects in people with BDD,” says Dr. Feusner. “This is an important step to figuring out what’s going wrong in the brains of people with BDD, so we can develop treatments to change their perceptions of themselves.”

The research appears online in the journal Psychological Medicine.

People with BDD tend to fixate on minute details, such as a single blemish or a crook to the nose, rather than viewing their face as a whole. The impact can be unbearable. Sufferers think obsessively about their appearance and engage in repetitive, time-consuming behaviors, such as checking their appearance in the mirror. Many won’t leave the house, some have repeated and unnecessary plastic surgeries, and still others become suicidal. BDD affects an estimated 2 percent of the population and is thought to be especially common in people with obsessivecompulsive disorder.

The study compared 14 BDD patients, both men and women, with 14 healthy controls. Researchers used a functional MRI (fMRI) to scan the brains of subjects while they viewed digital photographs of houses that were either unaltered or altered in ways to parse out different elements of visual processing. One altered set of images included very fine details, such as the shingles on the roof. The other altered images had very little detail and just showed things “holistically,” such as the general shape of the house and the doors and windows.

The researchers found that the BDD patients had abnormal brain activation patterns when viewing pictures of the less-detailed houses.

“The study suggests that BDD patients have general abnormalities in visual processing,” Dr. Feusner says. “But we haven’t yet determined if abnormal visual processing contributes as a cause to developing BDD or is it the effect of having BDD. So it’s the chicken-or-theegg phenomenon.”


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