This article was published by Fairfax (The Age, Sydney Morning Herald) on 29th December 2013 and was written about my brain imaging research.

Full article by John Elder via The Age website

A new imaging technique has uncovered a weak link in the brains of people who obsessively believe themselves to be ugly, a condition known as body dysmorphic disorder.

People with the disorder believe that a facial feature, usually their nose or mouth, is horribly disfigured, when in fact it is normal.

Dr Ben Buchanan brain psychologist

The Melbourne researcher who made the discovery says cosmetic surgeons should screen for the disorder, and refuse to carry out procedures on sufferers because they won’t be happy with or even perceive there to any improvement.

”About 14 per cent of people getting plastic surgery have been diagnosed with [the disorder] … and yet it’s known they will be left wholly dissatisfied with the surgery. They shouldn’t be getting it in the first place,” says Dr Ben Buchanan, who conducted the research as a PhD candidate at Monash University, and this month published his findings in the prestigious journal Psychological Medicine.

Dr Buchanan says the disorder is five times more prevalent than anorexia, and causes higher levels of psychological impairment – and the true number of sufferers seeking ”unnecessary surgery” isn’t known. Research into the condition is hampered by the shyness of sufferers who don’t seek help.

”They don’t want to talk to anyone about their feelings … they see themselves as unbearably ugly or disfigured, and they’re too embarrassed to talk about it.”

Dr Buchanan’s research – the biggest neuro-imaging study of body dysmorphic disorder in the world – involved 40 patients referred by local specialists, many of them working out of St Vincent’s Hospital. Using an MRI machine, and a new neuro-imaging technique called diffusion tensor imaging, Dr Buchanan found there was a weak connection between the amygdala, the brain’s emotion centre, and the orbitofrontal cortex, the rational part of the brain that helps regulate and calm down emotional arousal.

“When … sufferers become emotionally distressed about their looks, they find it very difficult to wind down because the emotional and rational parts of their brain aren’t communicating effectively,” says Dr Buchanan.

Where previous neuro-imaging showed only parts of the brain lit up by activity, diffusion tensor imaging tracks and evaluates how different parts of the brain talk to one another. ”The imaging can measure the strength of the nerve fibres between the different areas,” says Buchanan. ”If the connection is weak, information is not getting through or is composed in some way that is deficient.”

Buchanan says sufferers of the disorder have significant problems with social functioning or going to work. ”They will skip days at work because they are feeling particularly ugly. Or they will avoid going to parties because they are scared of being judged.”

He says the false beliefs are so strong they would be ”highly resistant” to a surgeon saying no to their demands for a procedure. ”This should be a red flag to surgeons that a patient in fact suffers BDD,” he says. ”The other dead giveaway is if people have unrealsitic expectations that their entire life will be changed. Expectations that are too high would be a warning sign.”

Buchanan’s research also found that cognitive behaviour therapy may be the most effective mechanism to reduce symptoms.

The Australian Society of Plastic Surgeons didn’t respond to questions before The Sunday Age went to print.