A case report published on March 24, 2024 in The Lancet is helping researchers gain new insights into a poorly understood neurological disorder. The case is that of Victor Sharrah, a 58-year-old man who complained about seeing “demonic” faces for nearly three years. Everything else he views appears normal.
What makes Sharrah’s case special is that faces in photographs or on a computer screen remain normal — he only sees the demonic features when looking at a real face.
In his own words, “Every face I see that’s not on a screen looks evil, twisted and demented.”
There is a real disorder that causes people to see faces as demonic appearances. This haunting condition is called prosopometamorphopsia (PMO) and Sharrah’s case provided investigators, a team at Dartmouth led by Brad Duchaine, a unique opportunity to see the world through a PMO patient’s eyes for the first time.
We Don’t Know a Lot About PMO
With fewer than 100 reported cases in medical literature, PMO is an exceedingly rare disorder. People afflicted with PMO experience an unsettling visual defect that is specific to faces.
These individuals perceive a variety of facial distortions; for example, a general widening of the face, sinister grins, enlarged noses, pronounced eyebrows, and deep forehead lines. Faces can also appear to be discolored, exhibit a course texture, or have features out of place.
The images can certainly be disquieting, especially those who see their own face distorted in the mirror. But people with PMO do not experience other neurological symptoms, such as hallucinations or delusions. Nonetheless, they can be misdiagnosed with disorders like schizophrenia.
Until now, we could only guess at the horror PMO patients experience. But with Sharrah coming forward, experts could change that.
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The Demons that PMO Patients See
Duchaine asked Sharrah to compare an in-person face to a photo of the distorted face. Then, using image-editing software, the researchers modified the photo according to the specifications Sharrah described. The modified image that materialized on the computer screen could easily be interpreted as demonic, although some would say the faces resemble a mischievous elf or the pointy-eared Vulcans in Star Trek.
In some cases of PMO, the symptoms resolve on their own — sometimes within a few days, but for others it could take years. A better understanding of the causes of PMO could lead to better treatment.
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How can you Develop the Rare Disorder?
Sharrah reported that he sustained a serious head injury about 12 years prior to the onset of his PMO. He also had a history of bipolar disorder as well as post-traumatic stress disorder, and possible exposure to carbon monoxide four months prior to his PMO. MRI scans performed on Sharrah located a probable arachnoid cyst in his brain. It is unclear which, if any, of these pre-existing circumstances led to the development of PMO.
In others, PMO has been reported to occur following some type of brain injury, either a blow to the head, tumor, or infection. Cases of PMO following epileptic seizures or stroke have also been reported.
How the brain constructs facial features is complex and involves multiple regions, which partly explains the variety of distortions experienced by those with PMO. Different wavelengths of light can produce changes in perception.
When Sharrah was advised to view his own face under different colors of light, he found that green light largely helped his symptoms. Remarkably, by wearing green-tinted sunglasses, Sharrah could see faces as normal once again.
As the condition can be misdiagnosed, Duchaine believes PMO may be more common than reported. He has set up a website to help recruit individuals who believe they suffer from PMO in hopes of gaining a better understanding of the disorder.
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