TMS Visual Modulation in Body Dysmorphic Disorder (EMPAC-BDD)

Inclusion Criteria: Body dysmorphic disorder: Inclusion: males or females ages 18-40 meet Diagnostic and Statistical Manual (DSM-5) criteria for Body Dysmorphic Disorder have a Body Dysmorphic Disorder version of the Yale-Brown Obsessive-Compulsive Disorder Scale (BDD-YBOCS) score of ≥20 primary appearance concerns of the face or head area medication naïve or medication free for at least 8 weeks prior to enrollment Subclinical body dysmorphic disorder: males or females ages 18-40 have a score on the Dysmorphic Concern Questionnaire of ≥8 (1 standard deviation [STD] above population norms) primary appearance concerns of the face or head area medication naïve or medication free for at least 8 weeks prior to enrollment Exclusion Criteria: Body dysmorphic disorder: concurrent major Axis I disorders including substance use disorders, aside from anxiety disorders or depressive disorders as these comorbidities are very common and the sample would otherwise be non-representative; however, BDD must be the primary diagnosis. lifetime: bipolar disorder or psychotic disorder psychotropic medications, aside from a short half-life sedative/hypnotic for insomnia, or a short half-life benzodiazepine as needed for anxiety but not exceeding a frequency of 3 doses in one week and not to be taken on the days of the training or MRI scan current cognitive-behavioral therapy Subclinical body dysmorphic disorder: Exclusion: meet full DSM-5 criteria for body dysmorphic disorder current Axis I disorders including substance use disorders lifetime: bipolar disorder or psychotic disorder psychotropic medications, aside from a short half-life sedative/hypnotic for insomnia, or a short half-life benzodiazepine as needed for anxiety but not exceeding a frequency of 3 doses in one week and not to be taken on the days of the training or MRI scan current cognitive-behavioral therapy Exclusion criteria for all participants: Neurological disorder Pregnancy Current major medical disorders that may affect cerebral metabolism such as diabetes or thyroid disorders Current risk of suicide with a plan and intent Ferromagnetic metal implantations or devices (electronic implants or devices, infusion pumps, aneurysm clips, metal fragments or foreign bodies, metal prostheses, joints, rods or plates) Visual acuity worse than 20/35 for each eye as determined by Snellen close vision acuity chart (vision will be tested with corrective lenses if participant uses them).