People with anorexia and body dysmorphic disorder have similar brain anomalies

People with anorexia nervosa and with body dysmorphic disorder have similar abnormalities in their brains that affect their ability to process visual information, a new UCLA study reveals.

People with anorexia have such an intense fear of gaining weight that they starve themselves even when they are dangerously thin. Body dysmorphic disorder is a psychiatric condition characterized by an obsessive preoccupation with a perceived flaw in physical appearance.

The researchers found that people with both disorders had abnormal activity in the visual cortex of the brain during the very first instants when the brain processes "global" information, or images as a whole, as opposed to a tiny detail. According to the authors, it could also mean that perceptual retraining may be an effective therapy for both disorders. Perceptual retraining is a behavioral exercise that attempts to help adjust or correct the participant's balance of global and detailed processing. For both of these disorders, participants are encouraged to not focus on details and process objects more globally.

Previous research on body dysmorphic disorder has shown the same type of abnormal activity in the visual cortex, but the UCLA study was the first to link the locations of the abnormal brain activity with time periods beginning as early as one-tenth of a second after an image is viewed.

Understanding that timing is significant, the authors write, because it may help scientists determine whether the problem is in lower-level perception that takes place in the visual cortex, or elsewhere in higher-level brain systems.

The study appears in the current online edition of the peer-reviewed journal Psychological Medicine.

Body dysmorphic disorder (BDD), also known as dysmorphophobia, is an underrecognized yet relatively common and severe mental disorder that occurs around the world. Patients with BDD believe they look ugly or deformed (thinking, for example, that they have a large and 'repulsive' nose, or severely scarred skin), when in reality they look normal. As a result of their appearance concerns, they may stop working and socializing, become housebound, and even commit suicide.

Enrico Morselli, a psychiatrist in Italy, first described BDD more than 100 years ago, noting that "The dysmorphophobic, indeed, is a veritably unhappy individual, who in the midst of his daily affairs, in conversations, while reading, at table, in fact anywhere and at any hour of the day, is suddenly overcome by the fear of some deformity ... (which) may reach a very painful intensity, even to the point of weeping and desperation". Other authors, including Kraepelin and Janet, have described BDD over the past century, referring to it with terms such as 'dermatologic hypochondriasis', Schönheitshypochondrie ('beauty hypochondria'), and Hässlichkeitskümmerer ('one who is worried about being ugly').

The UCLA researchers used functional magnetic resonance imaging, or fMRI, to detect regional abnormalities in visual processing and electroencephalography, or EEG, to assess the timeline for how the brain processes those signals. They compared results for 15 people with anorexia nervosa, 15 people with body dysmorphic disorder and 15 healthy individuals.