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Get Past a Distorted Self-Image

Can’t tear yourself away from cataloging your imperfections in front of the mirror? The source of your problem may be a visual processing error in the brain.

Pathological preoccupation with perceived defects in one’s appearance is known as body dysmorphic disorder.

Sufferers often lose the ability to see the entire self that the supposedly defective parts fit into. (Someone with a normal-sized nose can become convinced that it dwarfs the whole face.) Many undergo repeated cosmetic surgeries and struggle to form meaningful personal relationships. The risk of suicide is high.

Until recently, blindness to one’s true facial or body configuration was thought to be psychological. But psychiatrist Jamie D. Feusner, of the University of California-Los Angeles, has recently found that the telltale fixation on details might stem from a problem with big-picture perception.

While looking at blurred photos of their own faces from inside an fMRI machine, those with BDD showed far less activity in brain regions responsible for fitting visual details into composite forms than did healthy controls, Feusner observed.

The reduced responsiveness to the visual gestalt extends beyond faces to inanimate objects. A follow-up study revealed a similar dip in activity in the same brain areas when BDD sufferers viewed images of houses.

“The brains of people with body dysmorphic disorder don’t seem to process the holistic picture well,” says Feusner, who believes the perceptual error underlies the distorted self-image that defines BDD. “Their brains fail to provide a context for the visual details they’re focusing on.” Because the reduced neural responsiveness encompasses images that have nothing to do with appearance, Feusner believes that “BDD may result from a general perceptual deficit.”

But psychiatrist Katharine Phillips, a BDD expert at Brown University (Providence, RI), cautions that the studies still need to be replicated.

“It’s not clear,” she says, “whether the abnormalities contribute to the development of the disorder or result from the disorder.” Nevertheless, she acknowledges, Feusner’s research fits with her own clinical observations.
Both psychiatrists agree that the findings could be a tool in the treatment of BDD.

“The goal,” Feusner says, “is to get BDD patients to say, ‘Hey, I may not be seeing myself accurately because of something that’s happening in my brain – not something that’s an actual reality.’”

See yourself clearly

Those with BDD typically undergo treatment with one or more approaches:

• SSRIs: Antidepressants can ease BDD symptoms, says Feusner, but must be given in larger doses than those typically recommended for depression.
• Cognitive behavioral therapy: Strategies such as exposure therapy can help reduce BDD symptoms over time, says Phillips. Patients can learn to look in the mirror without zeroing in on defects or engaging in negative self-talk.

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