Exogenous Modulation of Visual Perception And Connectivity in Body Dysmorphic Disorder (EMPAC-BDD)

项目总结 躯体变形障碍(BDD)患者错误地认为他们外表的某些方面很明显 有缺陷或有缺陷，尽管这些在其他人看来是不明显的或微不足道的。被判有罪 毁容和丑陋，他们通常有贫乏的洞察力或妄想的信念，强迫性的思想和 强迫行为、焦虑和抑郁。这些导致了功能上的巨大困难， 抑郁、自杀企图(25%)和精神科住院(50%)。尽管如此，关于 神经生物学和很少的治疗研究已经进行过。这突显出迫切需要 研究，以确定新的干预目标的基础上全面了解 病理生理机制。先前的研究已经发现了可能有助于 知觉扭曲，包括视觉处理系统中的显著异常。这些都有助于 减少全局/整体处理和增强局部/详细处理的模式，归因于 知觉中的“自下而上”和“自上而下”干扰。之前使用心理物理测试的实验， 新的行为视觉调制技术和功能磁共振成像(FMRI) 研究了负责全局和局部处理的大脑视觉系统，发现早期证据表明 它们可以在BDD中修改。这项研究将测试是否可以使用非侵入性技术实现进一步的修改 重复经颅磁刺激(TMS)的神经调节。这种调制可能是必要的 为了增强行为调节的效果，并诱导必要的功能变化 在BDD患者的知觉体验方面取得临床上有意义的改善。建议数 实验将确定兴奋性和抑制性TMS是否分别增强和抑制 行为视觉调节策略对大脑连通性和大脑整体视觉加工的影响 心理物理任务。这将在临床型BDD患者和亚临床型BDD患者身上进行测试。 研究结果将有助于建立异常视觉信息加工的综合机制模型 隐藏在对外表的误解这一核心症状领域之下。此外，结果将对 神经调节与新型知觉再训练未来组合的发展与优化 治疗。

PROJECT SUMMARY Individuals with body dysmorphic disorder (BDD) misperceive aspects of their appearance to be conspicuously flawed or defective, despite these being unnoticeable or appearing miniscule to others. With convictions of disfigurement and ugliness, they 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. Previous research has 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. Previous experiments using psychophysical tests, novel behavioral visual modulation techniques, and functional magnetic resonance imaging (fMRI) have probed the brain’s visual systems responsible for global and local processing and found early evidence that they may be modifiable in BDD. This study will test if further modification could be achieved using noninvasive neuromodulation with repetitive transcranial magnetic stimulation (TMS). Such modulation may be necessary to enhance the effects of behavioral modulation and induce the magnitude of functional changes necessary to achieve clinically meaningful improvements in perceptual experiences in those with BDD. The proposed experiment will determine whether excitatory and inhibitory TMS enhances and inhibits, respectively, the effects of a behavioral visual modulation strategy on brain connectivity and on global visual processing on a psychophysical task. This will be tested in individuals with clinical BDD and in individuals with subclinical BDD. Results will contribute to a comprehensive mechanistic model of abnormal visual information processing underlying the core symptom domain of misperceptions of appearance. Further, results will be critical for the development and optimization of future combinations of neuromodulation and novel perceptual retraining treatments.