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Virgili G, Neill E, Enticott P, Castle D, Rossell SL. A systematic review of visual processing in body dysmorphic disorder (BDD). Psychiatry Res 2024; 339:116013. [PMID: 38924902 DOI: 10.1016/j.psychres.2024.116013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/06/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
To understand the visual preponderance of perceived flaws in appearance in body dysmorphic disorder (BDD), the study of visual processing has been growing. Studies have focused on facial and other basic visual stimuli. The current literature does not provide evidence of consistent behavioural patterns, lacking an overarching body of work describing visual processing in BDD. This systematic review aims to characterise behavioural outcomes of visual processing anomalies and/or deficits in BDD. Articles were collected through online databases MEDLINE and PubMed, and were included if they comprised a clinical BDD group, and were published after 1990. Results indicate that individuals with BDD demonstrate deficits in emotional face processing, a possible overreliance on detail processing, aberrant eye-scanning behaviours, and a tendency to overvalue attractiveness. While findings consistently signal towards visual deficits in BDD, there is lack of clarity as to the type. This inconsistency may be attributed to heterogeneity within BDD samples and differences in experimental design (i.e., stimuli, tasks, conditions). There are difficulties distinguishing between BDD-associated deficits and those associated with OCD or eating disorders. A coherent framework, including sample characterisation and task design will seek to generate clear and consistent behavioural patterns to guide future treatments.
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Affiliation(s)
- Gemma Virgili
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia.
| | - Erica Neill
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Peter Enticott
- Cognitive Neuroscience Unit, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | | | - Susan Lee Rossell
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
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2
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Diaz-Fong JP, Feusner JD. Visual Perceptual Processing Abnormalities in Body Dysmorphic Disorder. Curr Top Behav Neurosci 2024. [PMID: 38691313 DOI: 10.1007/7854_2024_472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Phenomenological observations of individuals with body dysmorphic disorder (BDD), coupled with evidence from neuropsychological, psychophysical, and neuroimaging studies, support a model of aberrant visual perception characterized by deficient global/holistic, enhanced detail/local processing, and selective visual-attentional biases. These features may contribute to the core symptomatology of distorted perception of their appearance, in addition to misinterpretation of others' facial expressions and poor insight regarding their misperceived appearance defects. Insights from visual processing studies can contribute to the development of novel interventions, such as perceptual retraining and non-invasive neuromodulation. However, much remains to be understood about visual perception in BDD. Future research should leverage brain imaging modalities with high temporal resolutions and employ study designs that induce conflicts in multisensory integration, thereby advancing our mechanistic understanding of distorted visual perception observed in BDD.
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Affiliation(s)
- Joel P Diaz-Fong
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jamie D Feusner
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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3
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Hudson M, Chaudhary NI, Nordstrom C. Folie et Société: eroding the body-mind relationship via dysfunctional paternalistic systems. Front Psychol 2024; 15:1324303. [PMID: 38375111 PMCID: PMC10875966 DOI: 10.3389/fpsyg.2024.1324303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/15/2024] [Indexed: 02/21/2024] Open
Abstract
This theoretical perspective examines the proposition of shared complex trauma between a parent and child, arising from blurred relational boundaries and societal oppression, leading to inequality both at home and within the larger paternalistic system of society. Specifically, the focus is on living within a paternalistic, authoritarian system where rules are unjust, demanding obedience and compliance without questioning the behaviors of the authority. Individuals growing up in these circumstances are subject to adverse and emotionally overwhelming experiences, which lead to the creation of emotional memory images (EMIs). The delusion in which the child is caught up becomes a reality for the child as time passes. This phenomenon is recognized in psychiatry as "Folie à deux" (the madness of two or more) at the micro level, and "Folie et Société" (the madness of society) on the macro level. Complex trauma, derived from a child's exposure to multiple adverse events, can erode the mind-body relationship, impacting both mental and physical health. These traumatic experiences in early childhood can manifest as body-focused disorders in adolescents, prevailing throughout adulthood if left unattended. This article provides a theoretical perspective on dealing with the dissociation and chronic stress related to oppressive and authoritarian family systems. The broader implications of this article include highlighting the psychophysiological underpinnings of complex trauma, the relationship of a highly oppressive paternalistic authoritarian system imposed on children and adolescents, and the role of Split-Second Unlearning as a therapeutic intervention to clear EMIs and improve overall health outcomes.
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4
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Wong WW, Rangaprakash D, Diaz-Fong JP, Rotstein NM, Hellemann GS, Feusner JD. Neural and behavioral effects of modification of visual attention in body dysmorphic disorder. Transl Psychiatry 2022; 12:325. [PMID: 35948537 PMCID: PMC9365821 DOI: 10.1038/s41398-022-02099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022] Open
Abstract
In individuals with body dysmorphic disorder (BDD), perceptual appearance distortions may be related to selective attention biases and aberrant visual scanning, contributing to imbalances in global vs. detailed visual processing. Treatments for the core symptom of perceptual distortions are underexplored in BDD; yet understanding their mechanistic effects on brain function is critical for rational treatment development. This study tested a behavioral strategy of visual-attention modification on visual system brain connectivity and eye behaviors. We acquired fMRI data in 37 unmedicated adults with BDD and 30 healthy controls. Participants viewed their faces naturalistically (naturalistic viewing), and holding their gaze on the image center (modulated viewing), monitored with an eye-tracking camera. We analyzed dynamic effective connectivity and visual fixation duration. Modulated viewing resulted in longer mean visual fixation duration compared to during naturalistic viewing, across groups. Further, modulated viewing resulted in stronger connectivity from occipital to parietal dorsal visual stream regions, also evident during the subsequent naturalistic viewing, compared with the initial naturalistic viewing, in BDD. Longer fixation duration was associated with a trend for stronger connectivity during modulated viewing. Those with more severe BDD symptoms had weaker dorsal visual stream connectivity during naturalistic viewing, and those with more negative appearance evaluations had weaker connectivity during modulated viewing. In sum, holding a constant gaze on a non-concerning area of one's face may confer increased communication in the occipital/parietal dorsal visual stream, facilitating global/holistic visual processing. This effect shows persistence during subsequent naturalistic viewing. Results have implications for perceptual retraining treatment designs.
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Affiliation(s)
- Wan-Wa Wong
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - D Rangaprakash
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Joel P Diaz-Fong
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Natalie M Rotstein
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Gerhard S Hellemann
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jamie D Feusner
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Department of Psychiatry, Division of Neurosciences & Clinical Translation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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5
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Wong WW, Rangaprakash D, Moody TD, Feusner JD. Dynamic Effective Connectivity Patterns During Rapid Face Stimuli Presentation in Body Dysmorphic Disorder. Front Neurosci 2022; 16:890424. [PMID: 35685771 PMCID: PMC9172595 DOI: 10.3389/fnins.2022.890424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Abstract
In individuals with body dysmorphic disorder (BDD), perceptual appearance distortions may be related to imbalances in global vs. local visual processing. Understanding the mechanistic brain effects of potential interventions is crucial for rational treatment development. The dorsal visual stream (DVS) is tuned to rapid image presentation, facilitating global/holistic processing, whereas the ventral visual stream (VVS), responsible for local/detailed processing, reduces activation magnitude with shorter stimulus duration. This study tested a strategy of rapid, short-duration face presentation on visual system connectivity. Thirty-eight unmedicated adults with BDD and 29 healthy controls viewed photographs of their faces for short (125 ms, 250 ms, 500 ms) and long (3000 ms) durations during fMRI scan. Dynamic effective connectivity in DVS and VVS was analyzed. BDD individuals exhibited weaker connectivity from occipital to parietal DVS areas than controls for all stimuli durations. Short compared with long viewing durations (125 ms vs. 3,000 ms and 500 ms vs. 3,000 ms) resulted in significantly weaker VVS connectivity from calcarine cortex to inferior occipital gyri in controls; however, there was only a trend for similar results in BDD. The DVS to VVS ratio, representing a balance between global and local processing, incrementally increased with shorter viewing durations in BDD, although it was not statistically significant. In sum, visual systems in those with BDD are not as responsive as in controls to rapid face presentation. Whether rapid face presentation could reduce connectivity in visual systems responsible for local/detailed processing in BDD may necessitate different parameters or strategies. These results provide mechanistic insights for perceptual retraining treatment designs.
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Affiliation(s)
- Wan-wa Wong
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - D. Rangaprakash
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Teena D. Moody
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jamie D. Feusner
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry, Division of Neurosciences & Clinical Translation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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6
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Fradkin SI, Silverstein SM. Resistance to Depth Inversion Illusions: A Biosignature of Psychosis with Potential Utility for Monitoring Positive Symptom Emergence and Remission in Schizophrenia. Biomark Neuropsychiatry 2022. [DOI: 10.1016/j.bionps.2022.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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7
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Borgers T, Kürten M, Kappelhoff A, Enneking V, Möllmann A, Schulte J, Klug M, Leehr EJ, Dohm K, Grotegerd D, Krause P, Zwiky E, Dannlowski U, Buhlmann U, Redlich R. Brain functional correlates of emotional face processing in body dysmorphic disorder. J Psychiatr Res 2022; 147:103-110. [PMID: 35030511 DOI: 10.1016/j.jpsychires.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 12/14/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Abstract
Previous neuroimaging studies in body dysmorphic disorder (BDD) have focused on discordances in visual processing systems. However, little is known about brain functional aberrations in individuals with BDD during emotional face processing. An fMRI paradigm with negative emotional faces was employed in 20 individuals with BDD and 43 mentally healthy controls (HC). We compared functional activity and whole-brain connectivity patterns of the amygdala and the fusiform gyrus (FFG) between both groups. Regression analyses were performed for associations of body dysmorphic symptoms with brain activity and connectivity. Individuals with BDD exhibited higher activity in the left amygdala compared to HC (pFWE = .04) as well as increased functional connectivity of the left amygdala with a network including frontostriatal and temporal regions (pFWE < .05). The FFG revealed increased functional connectivity in individuals with BDD, mapping to brain areas such as the cingulate cortex and temporo-limbic regions (pFWE < .05). In HC, higher levels of body dysmorphic symptoms were associated with higher functional amygdala and FFG activity (pFWE < .05). Individuals with BDD show aberrant functional activity and connectivity patterns within the amygdala and the FFG for negative emotional face processing. Body dysmorphic symptoms in HC are associated with a mild pattern of brain functional alterations, which could emphasize the relevance of a dimensional approach in addition to diagnosis. Treatments for BDD could benefit from targeting visual misperception and evaluation processes upon confrontation with emotional information.
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Affiliation(s)
- Tiana Borgers
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Marla Kürten
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany; Institute of Psychology, University of Münster, Fliednerstrasse 21, 48149, Münster, Germany.
| | - Anna Kappelhoff
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Verena Enneking
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Anne Möllmann
- Institute of Psychology, University of Bremen, Grazer Strasse 2, 28359, Bremen, Germany.
| | - Johanna Schulte
- Institute of Psychology, University of Münster, Fliednerstrasse 21, 48149, Münster, Germany.
| | - Melissa Klug
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Katharina Dohm
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Philine Krause
- Institute of Psychology, University of Halle, Emil Abderhaldenstraße 26, 06108, Halle, Germany.
| | - Esther Zwiky
- Institute of Psychology, University of Halle, Emil Abderhaldenstraße 26, 06108, Halle, Germany.
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Ulrike Buhlmann
- Institute of Psychology, University of Münster, Fliednerstrasse 21, 48149, Münster, Germany.
| | - Ronny Redlich
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany; Institute of Psychology, University of Halle, Emil Abderhaldenstraße 26, 06108, Halle, Germany.
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8
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Brain activation and connectivity in anorexia nervosa and body dysmorphic disorder when viewing bodies: relationships to clinical symptoms and perception of appearance. Brain Imaging Behav 2021; 15:1235-1252. [PMID: 32875486 DOI: 10.1007/s11682-020-00323-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are characterized by distorted perception of appearance, yet no studies have directly compared the neurobiology associated with body perception. We compared AN and BDD in brain activation and connectivity in relevant networks when viewing images of others' bodies and tested their relationships with clinical symptoms and subjective appearance evaluations. We acquired fMRI data from 64 unmedicated females (20 weight-restored AN, 23 BDD, 21 controls) during a matching task using unaltered or spatial-frequency filtered photos of others' bodies. Using general linear model and independent components analyses we compared brain activation and connectivity in visual, striatal, and parietal networks and performed univariate and partial least squares multivariate analyses to investigate relationships with clinical symptoms and appearance evaluations. AN and BDD showed partially overlapping patterns of hyperconnectivity in the dorsal visual network and hypoconnectivity in parietal network compared with controls. BDD, but not AN, demonstrated hypoactivity in dorsal visual and parietal networks compared to controls. Further, there were significant activity and connectivity differences between AN and BDD in both networks. In both groups, activity and/or connectivity were associated with symptom severity and appearance ratings of others' bodies. Thus, AN and BDD demonstrate both distinct and partially-overlapping aberrant neural phenotypes involved in body processing and visually encoding global features. Nevertheless, in each disorder, aberrant activity and connectivity show relationships to clinically relevant symptoms and subjective perception. These results have implications for understanding distinct and shared pathophysiology underlying perceptual distortions of appearance and may inform future novel treatment strategies.
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9
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Maier MJ, Haeussinger FB, Hautzinger M, Fallgatter AJ, Ehlis AC. Excessive bodybuilding as pathology? A first neurophysiological classification. World J Biol Psychiatry 2019; 20:626-636. [PMID: 29057722 DOI: 10.1080/15622975.2017.1395070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objectives: Excessive bodybuilding as a pathological syndrome has been classified based on two different theories: bodybuilding as dependency or as muscle dysmorphic disorder (MDD). This study is a first attempt to find psychophysiological data supporting one of these classifications.Methods: Twenty-four participants (bodybuilders vs healthy controls) were presented with pictures of bodies, exercise equipment or general reward stimuli in a control or experimental condition, and were measured with functional near-infrared spectroscopy (fNIRS). Higher activation in the dorsolateral prefrontal cortex (DLPFC) and the orbitofrontal cortex (OFC) while watching bodies and training equipment in the experimental condition (muscular bodies and bodybuilding-typical equipment) would be an indicator for the addiction theory. Higher activation in motion-related areas would be an indicator for the MDD theory.Results: We found no task-related differences between the groups in the DLPFC and OFC, but a significantly higher activation in bodybuilders in the primary somatosensory cortex (PSC) and left-hemispheric supplementary motor area (SMA) while watching body pictures (across conditions) as compared to the control group.Conclusions: These neurophysiological results could be interpreted as a first evidence for the MDD theory of excessive bodybuilding.
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Affiliation(s)
- Moritz Julian Maier
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Graduate School of Neural and Behavioral Sciences, University Tuebingen, Tuebingen, Germany
| | | | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Andreas Jochen Fallgatter
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Centre for Integrative Neuroscience (CIN), Cluster of Excellence, University of Tuebingen, Tuebingen, Germany.,LEAD Graduate School and Research Network, University of Tuebingen, Tuebingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,LEAD Graduate School and Research Network, University of Tuebingen, Tuebingen, Germany
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10
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Zhang B, Wang F, Dong HM, Jiang XW, Wei SN, Chang M, Yin ZY, Yang N, Zuo XN, Tang YQ, Xu K. Surface-based regional homogeneity in bipolar disorder: A resting-state fMRI study. Psychiatry Res 2019; 278:199-204. [PMID: 31220786 DOI: 10.1016/j.psychres.2019.05.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 12/11/2022]
Abstract
Surface-based, two-dimensional regional homogeneity (2dReHo) was used in the current study to compare local functional synchronization of spontaneous neuronal activity between patients with bipolar disorder (BD) and healthy controls (HC), rather than volume-based, three-dimensional regional homogeneity (3dReHo) methods that have been previously described. Seventy-one BD patients and 113 HC participated in structural and resting-state fMRI scans. Participants ranged in age from 12 to 54 years. All subjects were rated with the Young Mania Rating Scale and the Hamilton Depression Rating Scale. BD patients showed reduced surface-based ReHo across the cortical surface, both at the global level and in the left ventral visual stream (VVS). Additionally, ReHo value across the cortical surface showed a significant negative correlation with age in both groups at the global level. Abnormal activity in the left VVS cortex may contribute to the pathogenesis of BD. Therefore, surface-based ReHo may be a useful index to explore the pathophysiology of BD.
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Affiliation(s)
- Bo Zhang
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, Liaoning 110001, PR China
| | - Fei Wang
- Department of Radiology and Psychiatry, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, Liaoning 110001, PR China
| | - Hao-Ming Dong
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, PR China
| | - Xiao-Wei Jiang
- Department of Radiology and Psychiatry, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, Liaoning 110001, PR China
| | - Sheng-Nan Wei
- Department of Radiology and Psychiatry, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, Liaoning 110001, PR China
| | - Miao Chang
- Department of Radiology and Psychiatry, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, Liaoning 110001, PR China
| | - Zhi-Yang Yin
- Department of Radiology and Psychiatry, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, Liaoning 110001, PR China
| | - Ning Yang
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, PR China
| | - Xi-Nian Zuo
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, PR China; Key Laboratory of Behavioral Science and Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, PR China
| | - Yan-Qing Tang
- Department of Radiology and Psychiatry, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, Liaoning 110001, PR China
| | - Ke Xu
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, Liaoning 110001, PR China.
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11
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Reggente N, Moody TD, Morfini F, Sheen C, Rissman J, O'Neill J, Feusner JD. Multivariate resting-state functional connectivity predicts response to cognitive behavioral therapy in obsessive-compulsive disorder. Proc Natl Acad Sci U S A 2018; 115:2222-2227. [PMID: 29440404 PMCID: PMC5834692 DOI: 10.1073/pnas.1716686115] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cognitive behavioral therapy (CBT) is an effective treatment for many with obsessive-compulsive disorder (OCD). However, response varies considerably among individuals. Attaining a means to predict an individual's potential response would permit clinicians to more prudently allocate resources for this often stressful and time-consuming treatment. We collected resting-state functional magnetic resonance imaging from adults with OCD before and after 4 weeks of intensive daily CBT. We leveraged machine learning with cross-validation to assess the power of functional connectivity (FC) patterns to predict individual posttreatment OCD symptom severity. Pretreatment FC patterns within the default mode network and visual network significantly predicted posttreatment OCD severity, explaining up to 67% of the variance. These networks were stronger predictors than pretreatment clinical scores. Results have clinical implications for developing personalized medicine approaches to identifying individual OCD patients who will maximally benefit from intensive CBT.
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Affiliation(s)
- Nicco Reggente
- Department of Psychology, University of California, Los Angeles, CA 90095;
| | - Teena D Moody
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Francesca Morfini
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Courtney Sheen
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Jesse Rissman
- Department of Psychology, University of California, Los Angeles, CA 90095
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Joseph O'Neill
- Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
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12
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The neurobiology of body dysmorphic disorder: A systematic review and theoretical model. Neurosci Biobehav Rev 2017; 83:83-96. [DOI: 10.1016/j.neubiorev.2017.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/27/2017] [Accepted: 10/02/2017] [Indexed: 12/12/2022]
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13
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Beilharz F, Castle DJ, Grace S, Rossell SL. A systematic review of visual processing and associated treatments in body dysmorphic disorder. Acta Psychiatr Scand 2017; 136:16-36. [PMID: 28190269 DOI: 10.1111/acps.12705] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recent advances in body dysmorphic disorder (BDD) have explored abnormal visual processing, yet it is unclear how this relates to treatment. The aim of this study was to summarize our current understanding of visual processing in BDD and review associated treatments. METHOD The literature was collected through PsycInfo and PubMed. Visual processing articles were included if written in English after 1970, had a specific BDD group compared to healthy controls and were not case studies. Due to the lack of research regarding treatments associated with visual processing, case studies were included. RESULTS A number of visual processing abnormalities are present in BDD, including face recognition, emotion identification, aesthetics, object recognition and gestalt processing. Differences to healthy controls include a dominance of detailed local processing over global processing and associated changes in brain activation in visual regions. Perceptual mirror retraining and some forms of self-exposure have demonstrated improved treatment outcomes, but have not been examined in isolation from broader treatments. CONCLUSION Despite these abnormalities in perception, particularly concerning face and emotion recognition, few BDD treatments attempt to specifically remediate this. The development of a novel visual training programme which addresses these widespread abnormalities may provide an effective treatment modality.
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Affiliation(s)
- F Beilharz
- Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Vic., Australia
| | - D J Castle
- Department of Psychiatry, St Vincent's Hospital, Melbourne, Vic., Australia.,Psychiatry, Faculty of Medicine, University of Melbourne, Melbourne, Vic., Australia
| | - S Grace
- Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Vic., Australia
| | - S L Rossell
- Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Vic., Australia.,Department of Psychiatry, St Vincent's Hospital, Melbourne, Vic., Australia.,Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Monash University Central Clinical School, Melbourne, Vic., Australia
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Moody T, Shen VW, Hutcheson NL, Henretty JR, Sheen CL, Strober M, Feusner JD. Appearance evaluation of others' faces and bodies in anorexia nervosa and body dysmorphic disorder. Int J Eat Disord 2017; 50:127-138. [PMID: 27566987 PMCID: PMC5345932 DOI: 10.1002/eat.22604] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/22/2016] [Accepted: 07/24/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Individuals with anorexia nervosa (AN) and body dysmorphic disorder (BDD) exhibit distorted perception and negative evaluations of their own appearance; however, little is known about how they perceive others' appearance, and whether or not the conditions share perceptual distortions. METHOD Thirty participants with BDD, 22 with AN, now weight-restored, and 39 healthy comparison participants (HC) rated photographs of others' faces and bodies on attractiveness, how overweight or underweight they were, and how much photographs triggered thoughts of their own appearance. We compared responses among groups by stimulus type and by level-of-detail (spatial frequency). RESULTS Compared to HCs, AN and BDD had lower attractiveness ratings for others' bodies and faces for high-detail and low-detail images, rated bodies as more overweight, and were more triggered to think of their own appearance for faces and bodies. In AN, symptom severity was associated with greater triggering of thoughts of own appearance and higher endorsement of overweight ratings for bodies. In BDD, symptom severity was associated with greater triggering of thoughts of own appearance for bodies and higher overweight ratings for low-detail images. BDD was more triggered to think of own facial appearance than AN. DISCUSSION AN and BDD show similar behavioral phenotypes of negative appearance evaluations for others' faces and bodies, and have thoughts of their own appearance triggered even for images outside of their primary appearance concerns, suggesting a more complex cross-disorder body-image phenotype than previously assumed. Future treatment strategies may benefit from addressing how these individuals evaluate others in addition to themselves. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:127-138).
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Affiliation(s)
- Teena Moody
- Department of Psychiatry and Biobehavioral Sciences, The University of California Los Angeles, Los Angeles, CA
| | - Vivian W. Shen
- Department of Psychiatry and Biobehavioral Sciences, The University of California Los Angeles, Los Angeles, CA
| | - Nathan L. Hutcheson
- Department of Psychiatry and Biobehavioral Sciences, The University of California Los Angeles, Los Angeles, CA
| | | | - Courtney L Sheen
- Department of Psychiatry and Biobehavioral Sciences, The University of California Los Angeles, Los Angeles, CA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, The University of California Los Angeles, Los Angeles, CA
| | - Jamie D. Feusner
- Department of Psychiatry and Biobehavioral Sciences, The University of California Los Angeles, Los Angeles, CA
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15
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Silverstein SM, Elliott CM, Feusner JD, Keane BP, Mikkilineni D, Hansen N, Hartmann A, Wilhelm S. Comparison of visual perceptual organization in schizophrenia and body dysmorphic disorder. Psychiatry Res 2015; 229:426-33. [PMID: 26184989 PMCID: PMC4546849 DOI: 10.1016/j.psychres.2015.05.107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 05/05/2015] [Accepted: 05/17/2015] [Indexed: 02/04/2023]
Abstract
People with schizophrenia are impaired at organizing potentially ambiguous visual information into well-formed shape and object representations. This perceptual organization (PO) impairment has not been found in other psychiatric disorders. However, recent data on body dysmorphic disorder (BDD), suggest that BDD may also be characterized by reduced PO. Similarities between these groups could have implications for understanding the RDoC dimension of visual perception in psychopathology, and for modeling symptom formation across these two conditions. We compared patients with SCZ (n=24) to those with BDD (n=20), as well as control groups of obsessive-compulsive disorder (OCD) patients (n=20) and healthy controls (n=20), on two measures of PO that have been reliably associated with schizophrenia-related performance impairment. On both the contour integration and Ebbinghaus illusion tests, only the SCZ group demonstrated abnormal performance relative to controls; the BDD group performed similarly to the OCD and CON groups. In addition, on both tasks, the SCZ group performed more abnormally than the BDD group. Overall, these data suggest that PO reductions observed in SCZ are not present in BDD. Visual processing impairments in BDD may arise instead from other perceptual disturbances or attentional biases related to emotional factors.
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Affiliation(s)
- Steven M. Silverstein
- Department of Psychiatry and University Behavioral Health Care, Rutgers University, Piscataway, New Jersey, USA,Corresponding author: Steven M. Silverstein, Ph.D. Rutgers University Behavioral Health Care, 151 Centennial Avenue, Piscataway, NJ 08854, USA. Tel.: +1-732-235-5149.
| | - Corinna M. Elliott
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Jamie D. Feusner
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA
| | - Brian P. Keane
- Department of Psychiatry and University Behavioral Health Care, Rutgers University, Piscataway, New Jersey, USA
| | - Deepthi Mikkilineni
- Department of Psychiatry and University Behavioral Health Care, Rutgers University, Piscataway, New Jersey, USA
| | - Natasha Hansen
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Andrea Hartmann
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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16
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Rossell SL, Harrison BJ, Castle D. Can understanding the neurobiology of body dysmorphic disorder (BDD) inform treatment? Australas Psychiatry 2015; 23:361-4. [PMID: 26129816 DOI: 10.1177/1039856215591327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We aim to provide a clinically focused review of the neurobiological literature in body dysmorphic disorder (BDD), with a focus on structural and functional neuroimaging. CONCLUSIONS There has been a recent influx of studies examining the underlying neurobiology of BDD using structural and functional neuroimaging methods. Despite obvious symptom similarities with obsessive-compulsive disorder (OCD), no study to date has directly compared the two groups using neuroimaging techniques. Studies have established that there are limbic and visual cortex abnormalities in BDD, in contrast to fronto-striatal differences in OCD. Such data suggests affect or visual training maybe useful in BDD.
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Affiliation(s)
- Susan L Rossell
- Professor, Deputy Director Brain and Psychological Sciences Research Centre, Swinburne University, Melbourne, VIC, and; Adjunct Professor, Psychiatry, St. Vincent's Hospital, Melbourne and Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Ben J Harrison
- A/Professor, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - David Castle
- Professor, Chair of Psychiatry, St. Vincent's Hospital Melbourne and The University of Melbourne, Melbourne, VIC, Adjunct Professor, Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
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17
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Madsen SK, Zai A, Pirnia T, Arienzo D, Zhan L, Moody TD, Thompson PM, Feusner JD. Cortical thickness and brain volumetric analysis in body dysmorphic disorder. Psychiatry Res 2015; 232:115-22. [PMID: 25797401 PMCID: PMC4404218 DOI: 10.1016/j.pscychresns.2015.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/11/2014] [Accepted: 02/08/2015] [Indexed: 01/29/2023]
Abstract
Individuals with body dysmorphic disorder (BDD) suffer from preoccupations with perceived defects in physical appearance, causing severe distress and disability. Although BDD affects 1-2% of the population, the neurobiology is not understood. Discrepant results in previous volumetric studies may be due to small sample sizes, and no study has investigated cortical thickness in BDD. The current study is the largest neuroimaging analysis of BDD. Participants included 49 medication-free, right-handed individuals with DSM-IV BDD and 44 healthy controls matched by age, sex, and education. Using high-resolution T1-weighted magnetic resonance imaging, we computed vertex-wise gray matter (GM) thickness on the cortical surface and GM volume using voxel-based morphometry. We also computed volumes in cortical and subcortical regions of interest. In addition to group comparisons, we investigated associations with symptom severity, insight, and anxiety within the BDD group. In BDD, greater anxiety was significantly associated with thinner GM in the left superior temporal cortex and greater GM volume in the right caudate nucleus. There were no significant differences in cortical thickness, GM volume, or volumes in regions of interest between BDD and control subjects. Subtle associations with clinical symptoms may characterize brain morphometric patterns in BDD, rather than large group differences in brain structure.
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Affiliation(s)
- Sarah K. Madsen
- Imaging Genetics Center, Institute for Neuroimaging & Informatics, Department of Neurology, University of Southern California, Marina del Rey, CA, USA, Departments of Neurology, Psychiatry, Radiology, Pediatrics, Engineering, & Ophthalmology, University of Southern California, Los Angles, CA, USA,Corresponding author: Imaging Genetics Center, Laboratory of Neuro Imaging, Institute of Neuroimaging and Informatics, Keck School of Medicine of USC, 2001 North Soto Street – Room 102, Los Angeles, CA 90033, USA. Tel.: +1 323-44-BRAIN (323-442-7246).
| | - Alex Zai
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Tara Pirnia
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Donatello Arienzo
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angles, CA, USA
| | - Liang Zhan
- Imaging Genetics Center, Institute for Neuroimaging & Informatics, Department of Neurology, University of Southern California, Marina del Rey, CA, USA, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Teena D. Moody
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angles, CA, USA
| | - Paul M. Thompson
- Imaging Genetics Center, Institute for Neuroimaging & Informatics, Department of Neurology, University of Southern California, Marina del Rey, CA, USA, Departments of Neurology, Psychiatry, Radiology, Pediatrics, Engineering, & Ophthalmology, University of Southern California, Los Angles, CA, USA, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angles, CA, USA
| | - Jamie D. Feusner
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angles, CA, USA
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18
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Visual processing in anorexia nervosa and body dysmorphic disorder: similarities, differences, and future research directions. J Psychiatr Res 2013; 47:1483-91. [PMID: 23810196 PMCID: PMC3786585 DOI: 10.1016/j.jpsychires.2013.06.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 06/04/2013] [Accepted: 06/06/2013] [Indexed: 12/11/2022]
Abstract
Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are psychiatric disorders that involve distortion of the experience of one's physical appearance. In AN, individuals believe that they are overweight, perceive their body as "fat," and are preoccupied with maintaining a low body weight. In BDD, individuals are preoccupied with misperceived defects in physical appearance, most often of the face. Distorted visual perception may contribute to these cardinal symptoms, and may be a common underlying phenotype. This review surveys the current literature on visual processing in AN and BDD, addressing lower- to higher-order stages of visual information processing and perception. We focus on peer-reviewed studies of AN and BDD that address ophthalmologic abnormalities, basic neural processing of visual input, integration of visual input with other systems, neuropsychological tests of visual processing, and representations of whole percepts (such as images of faces, bodies, and other objects). The literature suggests a pattern in both groups of over-attention to detail, reduced processing of global features, and a tendency to focus on symptom-specific details in their own images (body parts in AN, facial features in BDD), with cognitive strategy at least partially mediating the abnormalities. Visuospatial abnormalities were also evident when viewing images of others and for non-appearance related stimuli. Unfortunately no study has directly compared AN and BDD, and most studies were not designed to disentangle disease-related emotional responses from lower-order visual processing. We make recommendations for future studies to improve the understanding of visual processing abnormalities in AN and BDD.
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