TMS Visual Modulation in Body Dysmorphic Disorder

The goal of this observational study is to test the effects of a type of noninvasive brain stimulation called transcranial magnetic stimulation (TMS) on visual processing in adults with body dysmorphic disorder symptoms when combined with modifying visual attention.The main goals are to understand, in people with body dysmorphic disorder and people with subclinical body dysmorphic disorder:The effects of excitatory and inhibitory TMS stimulation of parietal brain regions when done right before visual attention modulation on brain functional connections.The effects of excitatory and inhibitory TMS stimulation of parietal brain regions when done right before visual attention modulation on global/holistic visual perception.Participants will receive one type of TMS (excitatory or inhibitory) followed immediately by an fMRI brain scan during which they will view images of their faces. On the second day, they will do the same, but receive either the excitatory or inhibitory TMS stimulation that they did not receive on the first day.

Inclusion Criteria:Body dysmorphic disorder:Inclusion:males or femalesages 18-40meet Diagnostic and Statistical Manual (DSM-5) criteria for Body Dysmorphic Disorderhave a Body Dysmorphic Disorder version of the Yale-Brown Obsessive-Compulsive Disorder Scale (BDD-YBOCS) score of ≥20primary appearance concerns of the face or head areamedication naïve or medication free for at least 8 weeks prior to enrollmentSubclinical body dysmorphic disorder:males or femalesages 18-40have a score on the Dysmorphic Concern Questionnaire of ≥8 (1 standard deviation [STD] above population norms)primary appearance concerns of the face or head areamedication naïve or medication free for at least 8 weeks prior to enrollmentExclusion Criteria:Body dysmorphic disorder:concurrent major Axis I disorders including substance use disorders, aside from anxiety disorders or depressive disorders as these comorbidities are very common and the sample would otherwise be non-representative; however, BDD must be the primary diagnosis.lifetime: bipolar disorder or psychotic disorderpsychotropic medications, aside from a short half-life sedative/hypnotic for insomnia, or a short half-life benzodiazepine as needed for anxiety but not exceeding a frequency of 3 doses in one week and not to be taken on the days of the training or MRI scancurrent cognitive-behavioral therapySubclinical body dysmorphic disorder:Exclusion:meet full DSM-5 criteria for body dysmorphic disordercurrent Axis I disorders including substance use disorderslifetime: bipolar disorder or psychotic disorderpsychotropic medications, aside from a short half-life sedative/hypnotic for insomnia, or a short half-life benzodiazepine as needed for anxiety but not exceeding a frequency of 3 doses in one week and not to be taken on the days of the training or MRI scancurrent cognitive-behavioral therapyExclusion criteria for all participants:Neurological disorderPregnancyCurrent major medical disorders that may affect cerebral metabolism such as diabetes or thyroid disordersCurrent risk of suicide with a plan and intentFerromagnetic metal implantations or devices (electronic implants or devices, infusion pumps, aneurysm clips, metal fragments or foreign bodies, metal prostheses, joints, rods or plates)Visual acuity worse than 20/35 for each eye as determined by Snellen close vision acuity chart (vision will be tested with corrective lenses if participant uses them).