Feusner Jamie D, Moody Teena, Hembacher Emily, Townsend Jennifer, McKinley Malin, Moller Hayley, Bookheimer Susan
Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA.
Arch Gen Psychiatry. 2010 Feb;67(2):197-205. doi: 10.1001/archgenpsychiatry.2009.190.
Body dysmorphic disorder (BDD) is a psychiatric disorder in which individuals are preoccupied with perceived defects in their appearance, often related to their face. Little is known about its pathophysiology, although early research provides evidence of abnormal visual processing.
To determine whether patients with BDD have abnormal patterns of brain activation when visually processing their own face with high, low, or normal spatial resolution.
Case-control study.
A university hospital.
Seventeen right-handed medication-free subjects with BDD and 16 matched healthy control subjects. Intervention Functional magnetic resonance imaging while viewing photographs of face stimuli. Stimuli were neutral-expression photographs of the patient's own face and a familiar face (control stimuli) that were unaltered, altered to include only high spatial frequency (fine spatial resolution), or altered to include only low spatial frequency (low spatial resolution).
Blood oxygen level-dependent signal changes in the BDD and control groups during each stimulus type.
Subjects with BDD showed relative hyperactivity in the left orbitofrontal cortex and bilateral head of the caudate for the unaltered own-face vs familiar-face condition. They showed relative hypoactivity in the left occipital cortex for the low spatial frequency faces. Differences in activity in frontostriatal systems but not visual cortex covaried with aversiveness ratings of the faces. Severity of BDD symptoms correlated with activity in frontostriatal systems and visual cortex.
These results suggest abnormalities in visual processing and frontostriatal systems in BDD. Hypoactivation in the occipital cortex for low spatial frequency faces may indicate either primary visual system abnormalities for configural face elements or top-down modulation of visual processing. Frontostriatal hyperactivity may be associated both with aversion and with symptoms of obsessive thoughts and compulsive behaviors.
躯体变形障碍（BDD）是一种精神疾病，患者过度关注自己外貌中被察觉到的缺陷，这些缺陷通常与面部有关。尽管早期研究提供了视觉处理异常的证据，但其病理生理学仍知之甚少。
确定BDD患者在以高、低或正常空间分辨率视觉处理自己的面部时，是否存在大脑激活模式异常。
病例对照研究。
一家大学医院。
17名右手利、未服用药物的BDD患者和16名匹配的健康对照者。干预措施：在观看面部刺激照片时进行功能磁共振成像。刺激物为患者自己面部的中性表情照片和一张熟悉面孔（对照刺激物）的照片，这些照片未作改变、仅改变为包含高空间频率（精细空间分辨率）或仅改变为包含低空间频率（低空间分辨率）。
BDD组和对照组在每种刺激类型下血氧水平依赖信号的变化。
与熟悉面孔条件相比，BDD患者在未改变的自己面部条件下，左侧眶额皮质和双侧尾状核头部表现出相对活跃。对于低空间频率面孔，他们在左侧枕叶皮质表现出相对不活跃。额纹状体系统而非视觉皮质的活动差异与面孔的厌恶评分相关。BDD症状的严重程度与额纹状体系统和视觉皮质的活动相关。
这些结果表明BDD患者在视觉处理和额纹状体系统存在异常。枕叶皮质对低空间频率面孔的激活不足可能表明构型面部元素的初级视觉系统异常或视觉处理的自上而下调节。额纹状体过度活跃可能与厌恶以及强迫观念和强迫行为的症状有关。
