Demon-Like Faces: How a Rare Condition Alters Perception

Dr. Rameez Shaikh
3 min readMar 24, 2024

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The disorder known as prosopometamorphopsia (PMO) can lead to unsettling distortions in the facial features of others, making them appear horrifying with drooped, enlarged, diminished, misplaced, or unnaturally stretched characteristics. Photo courtesy of A. Mello et al.

Prosopometamorphopsia, also known as prosopometamorphosis, is a rare neurological condition characterized by distorted perception of faces. People with this condition may see faces as warped, misshapen, or transformed in some way, even though the actual faces are normal. This can lead to significant social and emotional challenges as facial recognition is crucial for human interaction.

Prevalence:

Prosopometamorphopsia is a relatively uncommon condition, and its exact prevalence is not well-established due to its rarity. However, it is believed to occur in a small percentage of individuals with certain neurological disorders or brain injuries.

Causes:

The exact causes of prosopometamorphopsia are not fully understood. It is often associated with neurological conditions such as:

  • Traumatic brain injury (TBI)
  • Stroke
  • Epilepsy
  • Brain tumors
  • Neurodegenerative diseases like Alzheimer’s and Parkinson’s

Research suggests that damage or dysfunction in areas of the brain responsible for processing facial information, such as the fusiform face area (FFA) and the occipital face area (OFA), may contribute to the development of prosopometamorphopsia.

Symptoms:

The primary symptom of prosopometamorphopsia is the distorted perception of faces. Individuals with this condition may describe seeing faces as:

  • Stretched or elongated
  • Shrunk or compressed
  • Twisted or asymmetrical
  • Blurred or fragmented

These visual distortions are specific to faces and do not typically affect the perception of other objects or visual stimuli.

Examples:

  • A patient with prosopometamorphopsia may describe their friend’s face as appearing elongated or stretched, despite no actual changes in the friend’s facial features.
  • In a clinical setting, a neuropsychologist may use specialized tests and assessments to diagnose prosopometamorphopsia based on the patient’s reports of distorted facial perception and neuroimaging findings indicating brain abnormalities.

Treatment:

Treatment for prosopometamorphopsia depends on the underlying cause and may include:

  1. Medication: In some cases, medications such as anti-seizure drugs or medications to improve cognitive function may be prescribed.
  2. Vision Therapy: Visual rehabilitation techniques, including perceptual training and eye exercises, may help improve facial recognition and reduce distortions.
  3. Cognitive Behavioral Therapy (CBT): CBT can be beneficial for coping with the emotional and social challenges associated with prosopometamorphopsia.
  4. Neurosurgical Interventions: In rare cases where prosopometamorphopsia is caused by a brain tumor or structural abnormality, surgery may be considered.

Latest Scientific Research:

Recent studies have focused on understanding the neural mechanisms underlying prosopometamorphopsia using advanced neuroimaging techniques such as functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI). These studies aim to identify specific brain regions and neural pathways involved in facial processing and to elucidate how damage or dysfunction in these areas leads to distorted perception.

One study published in the Journal of Neuroscience utilized fMRI to investigate the neural correlates of prosopometamorphopsia in patients with TBI. The findings suggested aberrant activation patterns in the FFA and OFA, highlighting the role of these brain regions in normal facial perception.

Another research article in Neurology examined the efficacy of transcranial magnetic stimulation (TMS) in improving facial recognition deficits, including prosopometamorphopsia, in patients with stroke-induced brain damage. The study reported promising results in terms of enhanced facial perception following TMS treatment.

Overall, ongoing research efforts continue to advance our understanding of prosopometamorphopsia and contribute to the development of more effective diagnostic and therapeutic strategies for this challenging condition.

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Dr. Rameez Shaikh
Dr. Rameez Shaikh

Written by Dr. Rameez Shaikh

Consultant Psychiatrist, Psychotherapist and Sexologist at Mind & Mood Clinic, Nagpur

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