Perceptual Abnormalities and Their Malleability in BDD

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

146 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-12-01

Study Completion Date

2026-06-01

Brief Summary

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A core symptom of body dysmorphic disorder (BDD) is perceptual distortions for appearance, which contributes to poor insight and delusionality, limits engagement in treatment, and puts individuals at risk for relapse. Results from this study will provide a comprehensive mechanistic model of brain, behavioral, and emotional contributors to abnormal perceptual processing, as well as how malleable it is with visual modulation techniques. This will lay the groundwork for next-step translational perceptual retraining approaches.

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Detailed Description

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Individuals with body dysmorphic disorder (BDD) misperceive specific aspects of one's own appearance to be conspicuously flawed or defective, despite these being unnoticeable or appearing minuscule to others. With convictions of disfigurement and ugliness, individuals with BDD typically have poor insight or delusional beliefs, obsessive thoughts and compulsive behaviors, anxiety, and depression. These result in significant difficulties in functioning, depression, suicide attempts (25%), and psychiatric hospitalization (50%). Despite this, relatively few studies of the neurobiology, and few treatment studies, have been conducted. This underscores a critical need for research to identify novel targets for intervention based on a comprehensive understanding of the pathophysiological mechanisms. Neuropsychological, behavioral, and neurobiological research by investigators have uncovered mechanisms that may contribute to perceptual distortions, including prominent abnormalities in visual processing systems. These have contributed to a model of diminished global/holistic processing and enhanced local/detailed processing, attributed to "bottom-up" and "top-down" disturbances in perception. Using psychophysical experiments and novel visual modulation techniques, investigators have probed the brain's visual systems responsible for global and local processing and found early evidence that they may be modifiable in BDD. These techniques include a "top-down" attentional modulation and a "bottom-up" perceptual modulation strategy. Abnormal eye gaze and emotional arousal when viewing faces may further contribute to abnormal perception. Whether these brain and behavior abnormalities are directly linked to abnormal perception remains to be understood. Accordingly, this study will determine a) if abnormalities in neural activation and connectivity in BDD when viewing one's own appearance are directly associated with abnormalities in perceptual functioning; and b) if changes in neural activation and connectivity from these visual modulation strategies are linked to changes in perceptual functioning, thus representing potential biomarkers. Investigators will also determine how attentional systems, eye gaze behaviors and emotional arousal interact with brain functioning in visual systems, and with global and local perceptual functioning. Investigators will enroll participants with BDD, with subclinical BDD, and healthy controls who will undergo functional magnetic resonance imaging while viewing photographs of own, and others' faces. Investigators will obtain measures of global and local visual processing, emotional arousal while participants view own face, and eye gaze behaviors using eye tracking. To understand the malleability of global/local perception, and the neural mechanisms of these changes, investigators will determine whether repeated visual modulation using top-down and bottom-up strategies results in alterations of perceptual functioning and brain activity/connectivity, and relationships between them. Results will provide a comprehensive mechanistic model of abnormal visual information processing underlying the core symptom domain of misperceptions of appearance. This will lay the groundwork for next-step translational approaches.

Conditions

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Body Dysmorphic Disorder

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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attention modulation

Group Type EXPERIMENTAL

attentional modulation

Intervention Type BEHAVIORAL

Attentional instructions when viewing faces will be given

perceptual modulation

Group Type EXPERIMENTAL

perceptual modulation

Intervention Type OTHER

Faces will be presented of varying durations

naturalistic viewing

Group Type EXPERIMENTAL

naturalistic viewing

Intervention Type OTHER

Faces will be viewed without specific instructions

Interventions

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attentional modulation

Attentional instructions when viewing faces will be given

Intervention Type BEHAVIORAL

perceptual modulation

Faces will be presented of varying durations

Intervention Type OTHER

naturalistic viewing

Faces will be viewed without specific instructions

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Body dysmorphic disorder: Inclusion:

* males or females
* ages 18-40
* meet Diagnostic and Statistical Manual-5 (DSM-5) criteria for Body Dysmorphic Disorder
* have a Body Dysmorphic Disorder version of the Yale-Brown Obsessive-Compulsive Disorder Scale (BDD-YBOCS) score of ≥20
* primary appearance concerns of the face or head area
* medication naïve or medication free for at least 8 weeks prior to enrollment

Subclinical body dysmorphic disorder: Inclusion:

* males or females
* ages 18-40
* have a score on the Dysmorphic Concern Questionnaire of ≥8 \[1 standard deviation (STD) above population norms\] - primary appearance concerns of the face or head area
* medication naïve or medication free for at least 8 weeks prior to enrollment

Healthy controls: Inclusion

* Healthy males and females from any racial or ethnic background - ages 18-40
* have a score on the Dysmorphic Concern Questionnaire of \<8

Exclusion Criteria

Body dysmorphic disorder: Exclusion

* concurrent major Axis I disorders including substance use disorders, aside from anxiety disorders or depressive disorders, as these comorbidities are very common and the sample would otherwise be non-representative; however BDD must be the primary diagnosis.
* lifetime: bipolar disorder or psychotic disorder.
* psychotropic medications, aside from a short half-life sedative/hypnotic for insomnia, or a short half-life benzodiazepine as needed for anxiety but not exceeding a frequency of 3 doses in one week and not to be taken on the days of the training or MRI scan
* current cognitive-behavioral therapy

Exclusion:

Subclinical body dysmorphic disorder: Exclusion

* meet full DSM-5 criteria for Body Dysmorphic Disorder
* current Axis I disorders including substance use disorders
* lifetime: bipolar disorder or psychotic disorder
* psychotropic medications, aside from a short half-life sedative/hypnotic for insomnia, or a short half-life benzodiazepine as needed for anxiety but not exceeding a frequency of 3 doses in one week and not to be taken on the days of the training or MRI scan
* current cognitive-behavioral therapy

Healthy Controls: Exclusion

* Any current Axis I disorder
* lifetime: bipolar disorder or psychotic disorder
* Psychiatric medication

All participants: Exclusion

* Neurological disorder
* Pregnancy
* Current major medical disorders that may affect cerebral metabolism such as diabetes or thyroid disorders - Current risk of suicide with a plan and intent
* Ferromagnetic metal implantations or devices (electronic implants or devices, infusion pumps, aneurysm clips, metal fragments or foreign bodies, metal prostheses, joints, rods or plates)
* Visual acuity worse than 20/35 for each eye as determined by Snellen close vision acuity chart (vision will be tested with corrective lenses if participant uses them).

Minimum Eligible Age

18 Years

Maximum Eligible Age

40 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes