Attention to Self-Related Face or Attractive Face? Neural Activation and Oscillation Evidence from Orthognathic Patients.

Attractive faces capture attention. However, the cognitive-behavioral model predicts that individuals with body dysmorphic disorder exhibit a cognitive bias to faces related to their appearance-related self-beliefs. To differentiate between these two mechanisms, we employed electroencephalogram techniques to investigate attentional bias toward faces in orthognathic patients with dento-maxillofacial deformities (DD), who were scheduled to undergo orthognathic surgery to correct these anomalies. We recruited 17 orthognathic patients and 17 controls to complete an oddball task when EEG was recorded. Highly attractive (HA), lowly attractive (LA), and DD faces were used as target stimuli. Waveform analysis revealed that, among controls, HA faces elicited a higher P300 response compared to other faces, a pattern not observed in orthognathic patients. In contrast, time-frequency analysis in the patients showed that DD faces elicited stronger alpha band power initially, and HA faces induced stronger beta band suppression later, a pattern not observed in controls. These findings suggest that attractive faces capture attention in controls. Conversely, orthognathic patients show an initial attentional bias toward DD faces and active attentional suppression of attractive faces, as revealed by neural oscillations in the alpha and beta bands, respectively.