New Research May Help Those Afraid of Own Looks

[Nagishkaw 510]

When Christian Jahn, a 37-year-old graduate student, was 13, he wouldn't leave the house without wearing a heavy Arctic jacket. In Southern California, that was enough to set him apart. But Christian was obsessed with what he deemed an even more troubling physical anomaly: He was terrified of his own face.

Over the next 15 years, Jahn almost flunked out of college, then dropped out of law school – all because of a fixation on physical flaws. Then he caught an episode of "Oprah" about obsessive compulsive disorder. A little more online research yielded another related illness: body dysmorphic disorder (BDD). Suddenly, Jahn's mysterious and life-altering condition had a name.

At the time, there were few resources available for sufferers, and little was known about the cause of BDD. Now, thanks to a group of researchers at the David Geffen School of Medicine, UCLA, Christian and millions of others are getting answers. A study by the group, published in this month's Archives of General Psychiatry, has made significant progress in understanding how BDD works in the brain.

The UCLA team, led by Dr. Jamie Feusner, compared patients with BDD to a healthy control group. Participants underwent MRI tests while looking at photos of two faces – their own and that of an actor.

Researchers evaluated how brain activity changed when they altered the images, first to show highly detailed characteristics, like moles and hairs, and then only a general face shape. BDD patients exhibited abnormal brain activity in regions associated with visual processing, leading the team to conclude that they were unable to correctly process visual input. A healthy person perceives a face in full context – minor details and overall shape. BDD sufferers can only see the details, making them vulnerable to fixating on a single "imperfection."

That's the primary symptom of BDD, which afflicts 1 to 2 percent of the American population. Patients notice, and then obsess over, a perceived imperfection that's either minor or doesn't exist at all, like a skin blemish, disfigured nose or oversize stomach. They'll hide or cover mirrors, pick at skin and hair, and conceal their imagined flaws under baggy clothing and excessive makeup.

But BDD is hardly a disease of vanity. Those with it can become severely depressed, reclusive, obsessive and suicidal. Patients also suffer from obsessive compulsive disorder or an eating disorder. They're twice as likely to commit suicide as patients with serious depression; 80 percent of them often suffer from suicidal thoughts.

Despite its prevalence and life-threatening psychological effects, medical science has yet to determine how the brain might contribute to BDD. This study will help change that, Feusner said.

"We're closer to creating a treatment that will directly target a specific area of brain function," he said. "Rather than improving how someone functions with the disorder, we'll actually change the perceptions they're coping with."

Feusner is cautiously optimistic. He plans to follow this study with research on unaffected family members and teenagers suffering from the first onset of BDD. Most important is to determine whether altered visual perception is the cause of BDD or the consequence of some other malfunction or disorder.

"The question remains, how does BDD fit into OCD or eating disorders?" Feusner said. "There's similar brain activity going on, but what specific processes do they share?"

BDD was recognized by the American Psychiatric Association in 1987, but doctors and psychiatrists still have trouble detecting the illness. In one study on 17 patients with BDD, a panel of psychiatrists diagnosed none and only detected symptoms in five. Shame and secrecy often impair medical care, as patients tend to avoid social contact and rarely seek help – especially men. That may explain why BDD is often wrongly considered a women's illness.

Right now, treatment is confined to antidepressant medication and ongoing psychotherapy. The approaches can be successful at helping a patient manage the disorder, but they aren't a cure. This latest study will help researchers move toward targeting specific brain regions, either through medication or behavioral therapy, which has proved effective at rewiring the brain.

At first, Jahn's treatment followed the usual course – he participated in group therapy for a year – until he took a leap and joined the Army. He spent 11 months overseas, trained as a paratrooper and confronted anxiety head-on in war zones. Now discharged, Jahn is pursuing a master's degree in rehabilitation counseling. He hopes to help other BDD sufferers.

Despite his success, symptoms remain – Jahn's just learned to deal with them. "I'm more self-aware, more aware of BDD symptoms, [and] more skilled in coping with the thoughts and feelings," he said. "I choose to act, despite the feelings."

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