Neural basis of distorted self-face recognition in social anxiety disorder

Background The observer perspective causes patients with social anxiety disorder (SAD) to excessively inspect their performance and appearance. This study aimed to investigate the neural basis of distorted self-face recognition in non-social situations in patients with SAD. Methods Twenty patients with SAD and 20 age- and gender-matched healthy controls participated in this fMRI study. Data were acquired while participants performed a Composite Face Evaluation Task, during which they had to press a button indicating how much they liked a series of self-faces, attractively transformed self-faces, and attractive others’ faces. Results Patients had a tendency to show more favorable responses to the self-face and unfavorable responses to the others’ faces compared with controls, but the two groups’ responses to the attractively transformed self-faces did not differ. Significant group differences in regional activity were observed in the middle frontal and supramarginal gyri in the self-face condition (patients < controls); the inferior frontal gyrus in the attractively transformed self-face condition (patients > controls); and the middle frontal, supramarginal, and angular gyri in the attractive others’ face condition (patients > controls). Most fronto-parietal activities during observation of the self-face were negatively correlated with preference scores in patients but not in controls. Conclusion Patients with SAD have a positive point of view of their own face and experience self-relevance for the attractively transformed self-faces. This distorted cognition may be based on dysfunctions in the frontal and inferior parietal regions. The abnormal engagement of the fronto-parietal attentional network during processing face stimuli in non-social situations may be linked to distorted self-recognition in SAD.