Individuals suffering from body dysmorphic disorder (BDD) experience peculiar misperceptions of their appearance, most often of the face or head. With convictions of disfigurement and ugliness, they typically have poor insight or even delusional beliefs, as well as obsessive thoughts and compulsive behaviors, anxiety, and depression. These combine to result in significant difficulties in functioning, as well as depression, suicide attempts (25%), and psychiatric hospitalization (50%). Despite this severity, relatively few studies of the neurobiology, or even treatment studies, have been conducted in BDD. This underscores a critical need for research seeking to identify targets for intervention based on pathophysiological mechanisms. To-date, background research conducted by our group has provided early insights into neurobiological mechanisms that may contribute to these perceptual distortions, including prominent abnormalities in visual processing systems. These, along with evidence from neuropsychological and psychophysical tests of visuospatial and visual processing, have contributed to the development of a model of diminished global/holistic processing and enhanced detail processing, attributed to both ?top-down? and ?bottom-up? disturbances in perception. However, there remain gaps in the understanding of the neurobiology that may hinder the rational development of novel and effective treatment strategies. Studies thus far have primarily been cross-sectional and few have explored the effects of visual manipulation in order to probe for dynamic abnormalities. Accordingly, this study aims to illuminate the pathophysiology underlying perceptual distortions in BDD using two novel visual modulation techniques: a) attention modulation (?top-down?) and brief image presentation (?bottom-up?) to probe the visual system. We will enroll 34 individuals with BDD and 34 healthy controls, who will undergo two experiments involving viewing photographs of their face while being scanned using functional magnetic resonance imaging (fMRI). In the attention modulation experiment, they will be given instructions and training to hold their gaze constant in order to increase fixation duration and decrease scanning of appearance details, which we hypothesize will increase dorsal visual stream (global/holistic processing) and decrease ventral visual stream (local/detail processing) activation in the brain. In the second experiment we will test whether brief face viewing time increases activity in dorsal visual areas. Results from this study will advance our understanding of the neurobiological basis of perceptual distortions in BDD and identify neurobiological treatment targets for future testing of novel, translational perceptual retraining treatments.

Public Health Relevance

There is a critical need for research in body dysmorphic disorder (BDD) to identify targets for intervention based on pathophysiological mechanisms. Accordingly, this study aims to illuminate dynamic pathophysiological mechanisms underlying perceptual distortions in BDD using two novel visual modulation techniques. In addition, understanding how aberrant visual processing could be modified with these techniques is an important step toward developing new treatment components for BDD, as persistent perceptual distortions of appearance contribute to poor insight and delusionality, which limits engagement in treatment and additionally puts individuals at risk for relapse.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Exploratory/Developmental Grants (R21)
Project #
1R21MH110865-01A1
Application #
9313611
Study Section
Adult Psychopathology and Disorders of Aging Study Section (APDA)
Program Officer
Chavez, Mark
Project Start
2017-05-05
Project End
2019-04-30
Budget Start
2017-05-05
Budget End
2018-04-30
Support Year
1
Fiscal Year
2017
Total Cost
$231,000
Indirect Cost
$81,000
Name
University of California Los Angeles
Department
Type
Schools of Medicine
DUNS #
092530369
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Tadayonnejad, Reza; Deshpande, Rangaprakash; Ajilore, Olusola et al. (2018) Pregenual Anterior Cingulate Dysfunction Associated with Depression in OCD: An Integrated Multimodal fMRI/1H MRS Study. Neuropsychopharmacology 43:1146-1155
Motivala, Sarosh J; Arellano, Maria; Greco, Rebecca L et al. (2018) Relationships between obsessive-compulsive disorder, depression and functioning before and after exposure and response prevention therapy. Int J Psychiatry Clin Pract 22:40-46
Boedhoe, Premika S W; Schmaal, Lianne; Abe, Yoshinari et al. (2018) Cortical Abnormalities Associated With Pediatric and Adult Obsessive-Compulsive Disorder: Findings From the ENIGMA Obsessive-Compulsive Disorder Working Group. Am J Psychiatry 175:453-462
Khalsa, Sahib S; Adolphs, Ralph; Cameron, Oliver G et al. (2018) Interoception and Mental Health: A Roadmap. Biol Psychiatry Cogn Neurosci Neuroimaging 3:501-513
Reggente, Nicco; Moody, Teena D; Morfini, Francesca et al. (2018) Multivariate resting-state functional connectivity predicts response to cognitive behavioral therapy in obsessive-compulsive disorder. Proc Natl Acad Sci U S A 115:2222-2227
Feusner, Jamie; Deshpande, Rangaprakash; Strober, Michael (2017) A translational neuroscience approach to body image disturbance and its remediation in anorexia nervosa. Int J Eat Disord 50:1014-1017
Moody, T D; Morfini, F; Cheng, G et al. (2017) Mechanisms of cognitive-behavioral therapy for obsessive-compulsive disorder involve robust and extensive increases in brain network connectivity. Transl Psychiatry 7:e1230