Demon Face Identity Crisis

A Rarity

Prosopometamorphopsia is a condition where faces generally appear to be distorted, sometimes even demonic. The real face of the person here may appear to be different or petrifying, making it difficult for those suffering from it to decipher distortions from reality!

One should not confuse PMO with prosopagnosia (poor face recognition but without visual distortions). PMO in
this case seems to be an extremely rare condition. People diagnosed with it tend to perceive faces as stretched, out of position or place, abnormally larger or smaller or simply as a droopy face.

“PMO is typically triggered by neurological conditions such as migraines, epilepsy, brain injuries, or lesions in the visual processing areas, particularly in the fusiform gyrus” explains Dr. G M Khan, M.S (General Surgery), D. Orth, M.Ch. (Neurosurgery) from Mumbai. He notes that conditions that serve as triggers like migraines or epilepsy could have genetic components that might suggest an indirect genetic link.

Possible Causes

In 2021, researchers in the Netherlands reviewed 81 cases of PMO. The causes ranged from brain infarction (disrupted blood flow to parts of the brain), haemorrhagic stroke (bleeding into the brain), and any surgery complications or brain tumours or injuries. In around 24% of cases, there were no structural abnormalities found in the brain. Other diagnoses found to be associated were migraine conditions, epilepsy and schizophrenia.
While the distortions take time to happen, perhaps a few seconds. Those who suffer from PMO usually rely heavily on secondary cues such as the person’s voice or clothes.

Dr Khan explains that individuals with PMO also may perceive facial distortions with certain features and facial expressions of the eyes, nose or mouth appear warped, shrunken, enlarged or brutally misplaced. Dr Khan adds, “The experience can vary among individuals, with some seeing grotesque or cartoon-like distortions.”

Psyche Burn

“Prosopometamorphopsia is rare but very distressing,” says Dr. Madhur Rathi, MBBS MD, Consultant Psychiatrist, Noida. He explains that people with PMO tend to resort to forms of social isolation to avoid feelings and moments of discomfort and a heightened fear of being exposed to the very possibility of viewing faces. He opines that a condition like PMO can sadly also lead to loneliness. “The struggle to identify faces usually adds to the cognitive overload and stress levels of patients putting them at a higher risk of anxiety and depression” explains Dr Madhur.

However, he stresses that along with the treatment of neurological triggers and causes, it is imperative to equally address psychological conditions. Adding, “Medications and therapy can help to address clinically significant issues along with counselling and social support.” The treatment options for PMO are focused on managing underlying triggers such as treating migraines, epilepsy or simply helping the patient to relieve stress.

In most cases, people with PMO tend to recover from their condition. However, this may differ from person to person and may either be a full or partial recovery. Other potential aids would be anti-epileptic drugs for epilepsy or perhaps surgery in terms of a brain tumour.

Few in Numbers

Victor’s PMO struggles helped spread awareness about this rare disorder. Fewer than 100 cases have been reported ever since 1904. For the first time, researchers were able to reproduce a digital representation of the warped faces that appear to persons suffering from PMO. Dr Khan, “PMO is a fascinating but rare condition that highlights the complexity of the brain’s visual processing capabilities.”

Sharing that the condition’s rarity makes it challenging to study. He adds, “Awareness and reporting of similar cases are crucial for better understanding and also help in developing treatment strategies.” While PMO may be a nascent area of study, it seeks answers to many facets and layers of the human brain and the specific nature of perception at large!