From one day to the next, individuals start to see distorted faces. Prosopometamorphopsia (PMO) is still of unknown origin, but, for the first time, scientists have managed to recreate what a patient with the condition sees. Victor Sharrah believed he lived a normal day, until he said good morning to the friend with whom he shares an apartment. What he saw was not his friend, but a demon, with pointy ears, gigantic eyes and a wide mouth that stretched across his entire face.
“I thought I woke up in a horror movie,” said Sharrah, who lives in Clarksville, Tennessee (USA).
Trying to remain calm, he took the dog for a walk, but all the people he saw on the street had equally strange and distorted faces.
“I started to get really nervous,” said the 59-year-old. He even considered checking himself into “a psychiatric unit.” However, Sharrah had not “gone crazy” as he believed.
Victor Sharrah suffers from an extremely rare visual condition, which appears from one day to the next, causing people to see distorted faces for days and even years: prosopometamorphopsia (PMO).
Many people are afraid to mention their symptoms because “they worry that others will think the distortions are a sign of a psychiatric disorder,” says Brad Duchaine, professor of psychology and brain sciences at Dartmouth University and co-author of a study on the topic. . “It’s a problem that people often don’t understand.”
Doctors often confuse PMO with mental health problems such as schizophrenia or psychosis. And while there is overlap in some symptoms, a big difference is that PMO patients “don’t think the world is distorted, they realize there’s something different about their vision,” says Antônio Mello, a cognitive psychologist and neuroscientist at Dartmouth and another co-author of the study published in the scientific journal The Lancet.
In the study, for the first time, with Sharrah’s help, scientists were able to recreate in 2D images what patients see when they look at faces.
What is Prosopometamorphopsia (PMO)?
Prosopometamorphopsia, or PMO, is an extremely rare visual condition, with fewer than 100 cases cited since 1904. Patients report a huge variety of facial distortions. While Sharrah, the patient in this study, sees extremely stretched features with deep grooves on her face, others may see changes that cause the features to change position or size.
Therefore, for people with this condition, faces appear distorted in various ways. While Sharrah sees demons, some see elves, Mello explains.
For some patients, half of the face disappears. For others, the faces are purple or green, or constantly moving. Sometimes the condition only lasts a few days. But more than three years after that terrifying morning in November 2020, Sharrah still sees “demons.”
Sharrah’s case is very rare
Unlike other people with PMO, when Sharrah sees faces on flat screens, they appear normal. This allowed Mello and the other researchers to create the first 2D images that give an idea of how people with PMO see faces.
To create the images, researchers asked Sharrah to compare how she saw faces with photos of those same people appearing on a computer screen. Thus, it was possible to detail and describe the distortions.
For other patients suffering from PMO, the faces in photos also appear distorted. Sharrah said life with PMO is “far more traumatic than the images created can convey.”
“What people don’t understand when they see these images is that, in real life, that face is moving, gesturing and talking,” he adds.
The images are “helpful for people to understand the types of distortions people might see,” says Jason Barton, a neurologist at the University of British Columbia in Canada who was not involved in the study.
The exact cause of prosopometamorphopsia remains unknown. Neurologist Jason Barton considers PMO a “symptom, not a disorder”, therefore, it could have several causes, according to an article published in Science News.
In most of the cases Barton studied, “something happens in the brain that correlates with the onset of this abnormal experience.”
Sharrah has a brain injury from an accident he suffered while working as a truck driver in 2007.
But in Mello’s opinion, however, this is not related to PMO, because the MRI scans showed that the lesion is in Sharrah’s hippocampus, a part of the brain “not associated with the face processing network.”
Only 81 cases of PMO have been reported to date in the scientific literature. But Mello said more than 70 patients have contacted his lab in the past three years.
Life after diagnosis
The frightening nature of the illness means it is often misdiagnosed as schizophrenia or psychosis.
Sharrah only found out about PMO after posting her experience in an online support group for people with bipolar disorder. For him, it was a great relief. “It meant I wasn’t psychotic,” he says.
The man, who has perfect vision, had glasses made with a green tint that reduces the severity of distortions. Red makes them “more intense,” he explains. In addition to color, depth perception appears to play an important role. Although Sharrah doesn’t see facial distortions on flat screens, they started to appear when researchers had him wear virtual reality glasses.
Sharrah said she has adapted well to her strange new world. More than three years after his diagnosis, he no longer wears his green-tinted glasses. “I’ve gotten a little used to it,” he says, adding that in crowded places like supermarkets, the crowd of demons around you can still be quite “scary.”
Because patients suffering from PMO know that what they are seeing is not real, many face a difficult decision: Is it worth telling people how grotesque they look, at the risk of appearing crazy?
Some choose silence. Mello told the story of a man who never told his wife that her face, for many years, seemed distorted to him.
Sharrah says she shares her experience so that other people with PMO can avoid a false diagnosis and being “hospitalized for psychosis.”
“That way, they know what’s going on and don’t go through the trauma that I went through.”
lr/le (AFP, Dartmouth, The Lancet, Science News)
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