Effects of visual attention modulation on dynamic effective connectivity and visual fixation during own-face viewing in body dysmorphic disorder

BackgroundIn individuals with body dysmorphic disorder (BDD), selective attention biases and aberrant visual scanning patterns may cause imbalances in global vs. detailed visual processing, contributing to perceptual distortions for appearance. The mechanistic effects of modifying visual attention on brain function in BDD, which may be critical to developing perceptual-based treatments, have not been explored. This study tested the effects of visual-attention modulation on dorsal and ventral visual stream activation and connectivity, and eye behaviors. MethodsWe acquired functional magnetic resonance imaging data in 37 unmedicated adults with BDD and 30 controls. Participants viewed their faces under two conditions: a) unconstrained (naturalistically), and b) holding their gaze on the center of the image (visual-attention modulation), monitored with an eye-tracking camera. We analyzed activation and dynamic effective connectivity in dorsal and ventral visual streams and visual fixation duration. ResultsVisual-attention modulation resulted in longer fixation duration and reduced activation in dorsal and ventral visual streams in both groups compared with naturalistic viewing. Longer fixation duration was associated with greater effective connectivity from V1 to early dorsal visual stream during the second naturalistic viewing, across groups. During naturalistic viewing, there was greater V1 to early dorsal visual stream connectivity after, compared with before, visual-attention modulation. ConclusionsWhen viewing ones face, longer visual fixation may confer greater communication in dorsal visual system, facilitating global/holistic visual processing. The finding that reduction in visual scanning while viewing ones face results in persistent effects during unconstrained viewing has implications for perceptual retraining treatment design for BDD.