Visual processing in anorexia nervosa and body dysmorphic disorder: Similarities, differences, and future research directions

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.

Body-part compatibility effects are modulated by the tendency for women to experience negative social comparative emotions and the body-type of the model

“…Therefore, there may be something inherent in the proneness to experience comparative emotions that modulates basic neuro-cognitive mechanisms. Additionally, this finding is supported by recent evidence highlighting individuals with psychological disorders that involve a focus on the body (i.e., anorexia nervosa; body dysmorphic disorder) have higher sensitivity when processing body-related stimuli [49,50]–in particular when exposed to the body of another individual [51]. The current study highlights how the self-other matching or body-part resonance may be another cognitive process that is differentially experienced across individuals, based on higher-level emotional dispositions.…”

Anorexia nervosa and body dysmorphic disorder are associated with abnormalities in processing visual information

“…The results of this study suggest the possibility that a general visual processing phenotype may operate in psychiatric disorders that involve distortion of one’s appearance and are accompanied by emotional distress and related self-esteem concerns (Madsen et al 2013). The phenotype may explain the peculiar, increased attention given to miniscule defects seen on the skin (in BDD), or areas of perceived cellulite, or “fat,” on thighs and stomach (in AN), and the inability to process these perceptions contextually, i.e., to see them as inconsequential relative to the body as a whole (Madsen et al 2013).…”

“…The phenotype may explain the peculiar, increased attention given to miniscule defects seen on the skin (in BDD), or areas of perceived cellulite, or “fat,” on thighs and stomach (in AN), and the inability to process these perceptions contextually, i.e., to see them as inconsequential relative to the body as a whole (Madsen et al 2013). The finding in the BDD group that greater degree of activation for high detail stimuli is associated with lower face attractiveness ratings supports this interpretation; enhanced detail processing may lead to a greater likelihood of flaw detection, and hence lower perception of attractiveness.…”

Trastorno dismórfico corporal: aspectos clínicos, dimensiones nosológicas y controversias con la anorexia nerviosa

“…En contraste, en el TDC prevalece la concentración en defectos erró-neamente percibidos de su apariencia física, más comúnmente del rostro, con un patrón caracterizado por sobre-atención al detalle (procesamiento cognitivo reducido de características generales) de la auto-imagen (ej. corporalidad general en AN, rasgos faciales en TDC) 18 .…”