Seeing "changes" that aren't there: facial and object discrimination in body dysmorphic disorder.

Cognitive-behavioral models of body dysmorphic disorder (BDD) suggest the disorder is characterized by several interpretive, attentional, and perceptual biases that contribute to its maintenance or even development. In addition, the role of aesthetic sensitivity has been discussed in BDD. However, previous research examining the ability to identify subtle changes in facial features and geometrical objects has produced mixed results. The purpose of the current study was to further evaluate facial and object discrimination among individuals with BDD (n=35), individuals with a dermatological condition (n=35), and mentally healthy control participants (n=35) using a facial and object discrimination paradigm assessing the sensitivity for changes in symmetry, color, and size. Overall, the groups did not differ with respect to their performance in detecting actual changes in facial or object images. However, there was a significant group difference when they were presented with a series of unchanged facial but not object images: the BDD group rated identical facial images significantly more often as being changed, relative to individuals without BDD. The current results are discussed in light of the existing literature on facial and object discrimination in BDD.

Abnormally high degree connectivity of the orbitofrontal cortex in obsessive-compulsive disorder.

IMPORTANCE: Neurobiological models of obsessive-compulsive disorder (OCD) predict hyperactivity in brain circuits involving the orbitofrontal cortex and the basal ganglia, but it is unclear whether these areas are also characterized by altered brain network properties. OBJECTIVES: To determine regions of abnormal degree connectivity in patients with OCD and to investigate whether connectivity measures are affected by antidepressant medication in OCD. DESIGN: Case-control cross-sectional study using resting-state functional magnetic resonance imaging and a data-driven, model-free method to test for alterations in the degree of whole-brain, distant, and local connectivity in unmedicated patients with OCD compared with healthy controls. SETTING: Outpatient clinic for OCD. PARTICIPANTS: Twenty-three patients with OCD (12 women, 11 men) receiving no medication, 23 patients with OCD (14 women, 9 men) treated with antidepressant medication, and 2 equally sized control samples matched for age, sex, handedness, educational level, and IQ. MAIN OUTCOME MEASURES: Statistical parametric maps testing the degree of distant and local functional connectivity of each voxel (hub analysis at voxel level) and OCD symptom severity. RESULTS: Unmedicated patients with OCD showed greater distant connectivity in the orbitofrontal cortex and subthalamic nucleus and greater local connectivity in the orbitofrontal cortex and the putamen. Furthermore, distant connectivity of the orbitofrontal cortex and the putamen positively correlated with global OCD symptom severity. Medicated patients with OCD showed reduced local connectivity of the ventral striatum compared with the unmedicated patients. CONCLUSIONS AND RELEVANCE: Consistent with neurobiological models of OCD, the orbitofrontal cortex and the basal ganglia are hyperconnected in unmedicated patients. The finding of distant connectivity alterations of the orbitofrontal cortex and the basal ganglia represents initial evidence of greater connections with distant cortical areas outside of corticostriatal circuitry. Furthermore, these data suggest that antidepressant medication may reduce connectivity within corticobasal ganglia-thalamo-cortical circuits in OCD.

Modifying emotion recognition deficits in body dysmorphic disorder: an experimental investigation.

BACKGROUND: Individuals with body dysmorphic disorder (BDD) are characterized by excessive concerns about perceived defects or flaws in their appearance, most commonly, facial features. Previous research has shown that BDD sufferers, relative to mentally healthy controls, are characterized by emotion recognition deficits (particularly a bias to misinterpret neutral facial expressions in a negative way). It remains an open question though whether these deficits can be modified through specific training programs. METHODS: To address this question, we evaluated emotion recognition among individuals with BDD (n = 34), individuals with a dermatological condition (n = 34), and mentally healthy control participants (n = 34) before and after a single-session emotion recognition training program. RESULTS: As expected, BDD participants were overall significantly worse in identifying neutral expressions, relative to the other groups, whereas no difference was obtained between the dermatology and control groups. Further, with respect to neutral and scared expressions, BDD participants improved significantly more in the training condition, relative to the nontraining condition. CONCLUSION: There is initial evidence that deficits in recognizing neutral and scared expressions can be normalized through a specific training program when evaluated immediately after the training session. It needs to be addressed in future research whether emotion recognition training programs can diminish these deficits on the long term, and how improved emotion recognition might be related to BDD's symptom reduction such as decreased avoidance behaviors in social situations.