Wei Lin Toh

Regional brain volumes in body dysmorphic disorder compared to controls

Objectives: Body dysmorphic disorder (BDD) is characterized by a preoccupation with a misperceived flaw in appearance, causing significant distress and disability. Neuropsychological research has revealed deficits in executive function and inhibitory control of emotional responses. The few previous structural neuroimaging studies have had inconclusive findings and we aimed to take this field of research forward by contributing high quality structural data. Methods: To investigate regional brain volumes we compared 20 BDD participants and 20 matched controls using high-resolution structural T1-weighted magnetic resonance imaging (MRI). The MRI data was subjected to cortical reconstruction and volumetric segmentation using Freesurfer software. Results: Results showed the right orbitofrontal cortex, bilateral thalamus, left anterior cingulate cortex, hippocampus and amygdala were significantly smaller in the BDD sample compared to controls. The most pronounced differences were in the right orbitofrontal cortex and left anterior cingulate cortex, as these areas were smaller in BDD participants independent of reduced global brain volumes. Duration of illness significantly negatively correlated with right orbitofrontal cortex volumes. Conclusions: This is the largest volumetric neuroimaging study in BDD to date and provides important data on volumetric differences that implicate fronto-limbic circuits.

Attentional biases in body dysmorphic disorder (BDD): Eye-tracking using the emotional Stroop task

OBJECTIVE Body dysmorphic disorder (BDD) is characterised by repetitive behaviours and/or mental acts occurring in response to preoccupations with perceived defects or flaws in physical appearance. This study aimed to examine attentional biases in BDD via the emotional Stroop task with two modifications: i) incorporating an eye-tracking paradigm, and ii) employing an obsessive-compulsive disorder (OCD) control group. METHOD Twenty-one BDD, 19 OCD and 21 HC participants, who were age-, sex-, and IQ-matched, were included. A card version of the emotional Stroop task was employed based on seven 10-word lists: (i) BDD-positive, (ii) BDD-negative, (iii) OCD-checking, (iv) OCD-washing, (v) general positive, (vi) general threat, and (vii) neutral (as baseline). Participants were asked to read aloud words and word colours consecutively, thereby yielding accuracy and latency scores. Eye-tracking parameters were also measured. RESULTS Participants with BDD exhibited significant Stroop interference for BDD-negative words relative to HC participants, as shown by extended colour-naming latencies. In contrast, the OCD group did not exhibit Stroop interference for OCD-related nor general threat words. Only mild eye-tracking anomalies were uncovered in clinical groups. Inspection of individual scanning styles and fixation heat maps however revealed that viewing strategies adopted by clinical groups were generally disorganised, with avoidance of certain disorder-relevant words and considerable visual attention devoted to non-salient card regions. CONCLUSION The operation of attentional biases to negative disorder-specific words was corroborated in BDD. Future replication studies using other paradigms are vital, given potential ambiguities inherent in emotional Stroop task interpretation.

How individuals with body dysmorphic disorder (BDD) process their own face: a quantitative and qualitative investigation based on an eye-tracking paradigm

ABSTRACT Introduction: Body dysmorphic disorder (BDD) is characterised by repetitive behaviours and/or mental acts occurring in response to preoccupations with perceived flaws in physical appearance. Based on an eye-tracking paradigm, this study aimed to examine how individuals with BDD processed their own face. Methods: Participants were 21 BDD patients, 19 obsessive–compulsive disorder patients and 21 healthy controls (HC), who were age-, sex-, and IQ-matched. Stimuli were photographs of participants’ own faces as well as those from the Pictures of Facial Affect battery. Outcome measures were affect recognition accuracy as well as spatial and temporal scanpath parameters. Results: The BDD group exhibited significantly decreased recognition accuracy for their own face relative to the HC group, and this was most pronounced for those who had a key concern centred on their face. Individual qualitative scanpath analysis revealed restricted and extensive scanning behaviours in BDD participants with a facial preoccupation. Persons with severe BDD also exhibited more marked scanpath deficits. Conclusions: Future research should be directed at extending the current work by incorporating neuroimaging techniques, and investigations of eye-tracking focused on affected body parts in BDD. These could yield fruitful therapeutic applications via incorporation with existing treatment approaches.

Facial affect recognition in body dysmorphic disorder versus obsessive-compulsive disorder: An eye-tracking study.

BACKGROUND Body dysmorphic disorder (BDD) is characterised by repetitive behaviours and/or mental acts occurring in response to preoccupations with perceived defects or flaws in physical appearance (American Psychiatric Association, 2013). This study aimed to investigate facial affect recognition in BDD using an integrated eye-tracking paradigm. METHOD Participants were 21 BDD patients, 19 obsessive-compulsive disorder (OCD) patients and 21 healthy controls (HC), who were age-, sex-, and IQ-matched. Stimuli were from the Pictures of Facial Affect (Ekman & Friesen, 1975), and outcome measures were affect recognition accuracy as well as spatial and temporal scanpath parameters. RESULTS Relative to OCD and HC groups, BDD patients demonstrated significantly poorer facial affect perception and an angry recognition bias. An atypical scanning strategy encompassing significantly more blinks, fewer fixations of extended mean durations, higher mean saccade amplitudes, and less visual attention devoted to salient facial features was found. CONCLUSIONS Patients with BDD were substantially impaired in the scanning of faces, and unable to extract affect-related information, likely indicating deficits in basic perceptual operations.

Examining neurocognition in body dysmorphic disorder using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): A comparison with obsessive-compulsive disorder

Body dysmorphic disorder (BDD) is characterised by (i) an excessive preoccupation with an imagined defect in appearance, as well as (ii) repetitive behaviours and/or mental acts that occur in response to the preoccupation. To date, neuropsychological investigations have been limited. This study examined performance on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), tapping into five indices of neurocognition: (i) Immediate Memory, (ii) Visuospatial Construction, (iii) Language, (iv) Attention, and (iv) Delayed Memory. Twenty-one BDD participants were compared with 19 obsessive-compulsive disorder (OCD) participants and 21 healthy controls (HC), who were age-, sex-, and IQ-matched. Results indicated the BDD and OCD groups demonstrated poor overall neuropsychological performance (i.e. total RBANS) as well as deficits on the indices of Immediate Memory and Attention. Further group differences involving the subtests of Story Memory, Digit Span, and Story Recall were detected. Neuropsychological impairment in BDD with indicated similarities in OCD were corroborated. Future research should extend investigations focusing on gist and delayed memory, and aspects of attentional processing.

Reduced cortical thickness in body dysmorphic disorder

Recent neuroimaging studies in body dysmorphic disorder (BDD) have implicated abnormal structure and function of occipito-temporal and fronto-limbic regions in the potential pathophysiology of the disorder. To date, morphometric investigations have yielded inconsistent results, and have suggested that clinical symptoms may mediate structural brain abnormalities in BDD. We measured Grey Matter (GM) cortical thickness in 20 participants with BDD and 20 healthy control participants matched on age, gender, estimated IQ and handedness. We observed cortical thinning in BDD patients compared with healthy control participants within the left middle temporal and left inferior parietal gyrus. No significant relationships between cortical thickness and BDD symptom severity, insight, social anxiety and depression were observed within the BDD group. Thinning within left temporal and left inferior parietal regions supports the involvement of these regions in the pathophysiology of BDD.

What is the future for Schneiderian first-rank symptoms, in the Diagnostic and Statistical Manual of Mental Disorders and otherwise?

Australian & New Zealand Journal of Psychiatry, 50(9) Schneiderian first-rank symptoms (FRS) indicate a clinical presentation where there is significant disturbance in the recognition of oneself as a unique, discrete entity, capable of autonomous action and perception. The first description of FRS was coined by Kurt Schneider (1939), where he later expounded that FRS – characterised by a loss of self coupled with perceived control by external forces – were of key clinical significance in determining a diagnosis of schizophrenia. His aim was to distinguish schizophrenia from other forms of psychoses, especially affective psychoses. The Diagnostic and Statistical Manual of Mental Disorders (DSM) bestowed considerable weighting to FRS in earlier editions in deciding a diagnosis of schizophrenia, but their importance was significantly downgraded in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), with little published evidence justifying the move. This brief report therefore aimed to assess the importance of FRS in distinguishing between non-affective and affective psychoses, an issue garnering only sporadic attention since Mellor (1982). To this end, the 2010 Australian Survey of High Impact Psychosis (SHIP) represents a large-scale epidemiological survey which examined elements of FRS in individuals with a history of psychosis. A complete study description has been published (Morgan et al., 2014). We aimed to examine the lifetime prevalence of FRS in 1825 patients with a primary diagnosis of (1) schizophrenia, (2) schizoaffective disorder, (3) bipolar disorder, (4) depressive psychosis, (5) delusional disorder or (6) psychosisnot otherwise specified. Table 1 shows the prevalence of patients by group endorsing type (A) and number (B) of lifetime FRS. Most FRS appeared especially elevated in schizophrenia and schizoaffective groups, with relatively lower prevalence in remaining groups, except for heightened thought echo in depressive psychosis. Over half of affective psychoses patients endorsed at least one FRS. Comparable proportions of groups endorsed one to six FRS, although it was more likely for schizophrenia and schizoaffective groups to report seven or more FRS. Discriminant function analysis (DFA) was employed to investigate whether the presence of specific FRS could successfully predict group membership. Two significant functions were identified. Function 1, Wilks’ Λ = 0.87, χ2(32, n = 1642) = 219.8, p < 0.001, explained 10.2% of the variance in the model (canonical correlation = 0.32) and maximally separated non-affective (schizophrenia group centroid = 0.15; schizoaffective group centroid = 0.40) and affective (bipolar group centroid = −0.49; depressive group centroid = −0.47) psychoses groups. Function 2, Wilks’ Λ = 0.97, χ2(21, n = 1642) = 43.0, p < 0.005, explained only 1.7% of the variance in the model (canonical correlation = 0.13) and could not effectively discriminate between non-affective (schizophrenia group centroid = −0.10; schizoaffective group centroid = 0.21) and affective (bipolar group centroid = 0.06; depressive group centroid = 0.24) psychoses groups. Function 1 was strongly and positively correlated with running commentary, voices conversing, thought withdrawal/insertion and delusions of passivity, whereas Function 2 was strongly and positively correlated with thought echo. By inference, the shared variance between thought broadcast and delusional perception was perceived as non-discriminant across disorders. Focusing on group membership, the original classification results revealed that only 26.7% of overall cases (schizophrenia = 24.3%; schizoaffective = 39.9%; bipolar = 11.6%; depressive = 21.0%; delusional disorder = 65.2%) were What is the future for Schneiderian first-rank symptoms, in the Diagnostic and Statistical Manual of Mental Disorders and otherwise?

Face and Object Perception in Body Dysmorphic Disorder versus Obsessive-Compulsive Disorder: The Mooney Faces Task

OBJECTIVES Body dysmorphic disorder (BDD) is characterized by repetitive behaviors and/or mental acts occurring in response to preoccupations with perceived defects or flaws in physical appearance. There are some similarities, but also important differences, between BDD and obsessive-compulsive disorder (OCD), not just in terms of core clinical symptoms, but possibly in the domain of perception. This study compared the nature and extent of perceptual anomalies in BDD versus OCD and health controls (HC), using a modified Mooney task. METHODS We included 21 BDD, 19 OCD, and 21 HC participants, who were age-, sex-, and IQ-matched. A set of 40 Mooney faces and 40 Mooney objects arranged in three configurations (i.e., upright, inverted, or scrambled) were presented under brief (i.e., 500 ms) free-viewing conditions. Participants were asked to decide whether each image represented a human face, an object, or neither in a forced-choice paradigm. RESULTS The BDD group showed significantly reduced face and object inversion effects relative to the other two groups. This was accounted for by BDD participants being significantly more accurate in identifying inverted Mooney faces and objects than the other participants. CONCLUSIONS These data were interpreted as reflecting an overreliance on independent components at the expense of holistic (configural) processing in BDD. (JINS, 2017, 23, 471-480).

Insight in body dysmorphic disorder (BDD) relative to obsessive-compulsive disorder (OCD) and psychotic disorders: Revisiting this issue in light of DSM-5

INTRODUCTION In DSM-5, body dysmorphic disorder (BDD) was reclassified under the obsessive-compulsive and related disorders (OCRDs), but little is known about the nature of BDD beliefs. This study aimed to compare level of insight in BDD and consider related implications for DSM-5 classification. METHOD Participants were 27 BDD, 19 obsessive-compulsive disorder (OCD), and 20 psychosis (SZ) participants as well as 42 non-clinical controls (NC), who completed the Brown Assessment of Beliefs Scale (BABS) and Peters Delusions Inventory (PDI). RESULTS For total (and most individual) BABS items, BDD and SZ participants scored significantly higher than OCD and NC participants. On the PDI, there were significant group differences in number of questions endorsed, with clinical groups scoring significantly higher than the NC group on dimensions of distress and preoccupation, but not conviction. CONCLUSION These findings suggest appearance-related concerns in BDD somewhat resemble delusions seen in psychosis (and not OCD), and convey important nosological and therapeutic implications.

F83. INVESTIGATING THE RELATIONSHIP BETWEEN NEGATIVE SYMPTOM PROFILE AND COGNITIVE FUNCTION IN SCHIZOPHRENIA

Abstract Background Negative symptoms are core to schizophrenia. Understanding the complex way specific symptom profiles may affect cognition independent of a diagnosis of schizophrenia per se will allow for an improved understanding of the disorder, and specific subtypes as well as potential treatment targets therein. Methods The neurocognitive profiles of 132 patients with schizophrenia/schizoaffective disorder and 189 healthy controls were examined using the MATRICS Consensus Cognitive Battery. Patients were grouped as either having a negative symptom profile or no negative symptoms using the PANSS. Healthy controls were grouped as high or low schizotypy on the negative symptom analogue subscale from the O-LIFE. Results There was a significant effect of negative symptom profile on the processing speed domain, the participants with negative symptoms performed significantly worse than those with no negative symptoms, after controlling for premorbid IQ, F(1,129)=4.30, p<0.05. The same relationship with speed of processing was found when investigating high vs low schizotypal aspects of negative symptoms in an equivalent analysis of healthy controls, with those scoring highly on negative symptoms performing significantly worse, after premorbid IQ was controlled for, F(1,186)=6.24, p<0.05. Discussion The processing speed domain seems significantly impacted by negative symptom profile in both schizophrenia patients and healthy controls. The speed of processing deficits does not seem to be presenting a bottom up influence on higher order cognitive tasks, as no group differences were observed on reasoning and problem solving tasks. In conclusion, these findings indicate that the negative symptom cluster contributes to this specific cognitive impairment independently of the disorder.