Effects of theta burst stimulation on neural connectivity and visual perception following attention modification of own-face viewing in body dysmorphic disorder
- 1Centre for Addiction and Mental Health
Abstract
BackgroundIndividuals with body dysmorphic disorder (BDD) misperceive defects in their appearance. Evidence suggests that visual processing abnormalities may underlie this core symptom. Previous studies testing perceptual and attentional interventions and non-invasive neuromodulation suggest these abnormalities may be modifiable, but their combined effects on neural connectivity and perceptual processing remain unclear.
MethodsUnmedicated participants with BDD or subclinical BDD received one session each of intermittent and continuous theta burst stimulation (TBS) targeting the lateral parietal cortex, combined with a visual attention modification paradigm during functional magnetic resonance imaging, in a crossover design. Dynamic effective connectivity within dorsal and ventral visual stream pathways was calculated, and global visual processing biases were assessed using the face inversion effect before and after each session.
ResultsThe analytic sample comprised 38 participants (60.5% female). Intermittent TBS increased connectivity in higher-level dorsal pathways during naturalistic viewing following attention modification ({beta} = 0.079, p = .008), whereas continuous TBS reduced connectivity in lower-level dorsal pathways ({beta} = -0.118, p < .001) and increased connectivity in ventral pathways (higher: {beta} = 0.239, p < .001; lower: {beta} = 0.079, p = .014). These changes were accompanied by differential effects on global visual processing.
ConclusionsCombined neuromodulation and visual attention modification modulate visual system connectivity and perceptual processing in individuals with BDD symptoms. These findings support a mechanistic link between dorsal-ventral stream dynamics and perceptual biases. Integrating neuromodulation with perceptual retraining may represent a viable approach for targeting distorted appearance perception.
ClinicalTrials.gov: NCT05607121
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BibTeX
@misc{diazfong2026effects,
title = {{Effects of theta burst stimulation on neural connectivity and visual perception following attention modification of own-face viewing in body dysmorphic disorder}},
author = {J. P. Diaz-Fong and H. J. Peel and K. Zhang and J. Qian and M. Lewis and W.-W. Wong and A. F. Leuchter and R. Tadayonnejad and D. Voineskos and G. Konstantinou and E. Lam and D. M. Blumberger and J. D. Feusner},
howpublished = {medRxiv},
year = {2026},
month = may,
doi = {10.64898/2026.05.25.26354053},
url = {https://www.medrxiv.org/content/10.64898/2026.05.25.26354053v2},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Effects of theta burst stimulation on neural connectivity and visual perception following attention modification of own-face viewing in body dysmorphic disorder
AU - J. P. Diaz-Fong
AU - H. J. Peel
AU - K. Zhang
AU - J. Qian
AU - M. Lewis
AU - W.-W. Wong
AU - A. F. Leuchter
AU - R. Tadayonnejad
AU - D. Voineskos
AU - G. Konstantinou
AU - E. Lam
AU - D. M. Blumberger
AU - J. D. Feusner
PY - 2026
DA - 2026/05/25
PB - medRxiv
DO - 10.64898/2026.05.25.26354053
UR - https://www.medrxiv.org/content/10.64898/2026.05.25.26354053v2
AB - BackgroundIndividuals with body dysmorphic disorder (BDD) misperceive defects in their appearance. Evidence suggests that visual processing abnormalities may underlie this core symptom. Previous studies testing perceptual and attentional interventions and non-invasive neuromodulation suggest these abnormalities may be modifiable, but their combined effects on neural connectivity and perceptual processing remain unclear. MethodsUnmedicated participants with BDD or subclinical BDD received one session each of intermittent and continuous theta burst stimulation (TBS) targeting the lateral parietal cortex, combined with a visual attention modification paradigm during functional magnetic resonance imaging, in a crossover design. Dynamic effective connectivity within dorsal and ventral visual stream pathways was calculated, and global visual processing biases were assessed using the face inversion effect before and after each session. ResultsThe analytic sample comprised 38 participants (60.5% female). Intermittent TBS increased connectivity in higher-level dorsal pathways during naturalistic viewing following attention modification ({beta} = 0.079, p = .008), whereas continuous TBS reduced connectivity in lower-level dorsal pathways ({beta} = -0.118, p < .001) and increased connectivity in ventral pathways (higher: {beta} = 0.239, p < .001; lower: {beta} = 0.079, p = .014). These changes were accompanied by differential effects on global visual processing. ConclusionsCombined neuromodulation and visual attention modification modulate visual system connectivity and perceptual processing in individuals with BDD symptoms. These findings support a mechanistic link between dorsal-ventral stream dynamics and perceptual biases. Integrating neuromodulation with perceptual retraining may represent a viable approach for targeting distorted appearance perception. ClinicalTrials.gov: NCT05607121
ER -