Psychological Medicine

Original Articles

Abnormalities of object visual processing in body dysmorphic disorder

J. D. Feusnera1 c1, E. Hembachera2, H. Mollera1 and T. D. Moodya3

a1 Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

a2 Department of Psychology, University of California, Davis, CA, USA

a3 Center for Cognitive Neuroscience, University of California, Los Angeles, CA, USA


Background Individuals with body dysmorphic disorder (BDD) may have perceptual distortions for their appearance. Previous studies suggest imbalances in detailed relative to configural/holistic visual processing when viewing faces. No study has investigated the neural correlates of processing non-symptom-related stimuli. The objective of this study was to determine whether individuals with BDD have abnormal patterns of brain activation when viewing non-face/non-body object stimuli.

Method Fourteen medication-free participants with DSM-IV BDD and 14 healthy controls participated. We performed functional magnetic resonance imaging (fMRI) while participants matched photographs of houses that were unaltered, contained only high spatial frequency (HSF, high detail) information or only low spatial frequency (LSF, low detail) information. The primary outcome was group differences in blood oxygen level-dependent (BOLD) signal changes.

Results The BDD group showed lower activity in the parahippocampal gyrus, lingual gyrus and precuneus for LSF images. There were greater activations in medial prefrontal regions for HSF images, although no significant differences when compared to a low-level baseline. Greater symptom severity was associated with lower activity in the dorsal occipital cortex and ventrolateral prefrontal cortex for normal spatial frequency (NSF) and HSF images.

Conclusions Individuals with BDD have abnormal brain activation patterns when viewing objects. Hypoactivity in visual association areas for configural and holistic (low detail) elements and abnormal allocation of prefrontal systems for details are consistent with a model of imbalances in global versus local processing. This may occur not only for appearance but also for general stimuli unrelated to their symptoms.

(Received September 28 2010)

(Revised March 17 2011)

(Accepted March 22 2011)

(Online publication April 18 2011)


c1 Address for correspondence: J. D. Feusner, M.D., 300 UCLA Medical Plaza, Suite 2345, Los Angeles, CA 90095, USA. (Email:


Results presented in part at the 18th European Congress of Psychiatry, Munich, Germany, March 2010.