Victor Sharrah had always had sharp vision. But one life-altering day in November 2020, he noticed out of the blue that people\u2019s faces around him looked demonic.<\/p>\n\n\n\n
Their ears, noses and mouths were stretched back, and there were deep grooves in their foreheads, cheeks and chins.<\/p>\n\n\n\n
\u201cMy first thought was I woke up in a demon world,\u201d said Sharrah, 59, of Clarksville, Tennessee. \u201cYou can\u2019t imagine how scary it was.\u201d<\/p>\n\n\n\n
Someone he knew taught visually impaired people and suggested he might have prosopometamorphopsia, or PMO. The extremely rare neurological disorder of perception causes faces to appear distorted in shape, size, texture or color. Sharrah felt the symptoms were a match, and he was formally diagnosed last year.<\/p>\n\n\n\n
The distortions appear only when he sees people in person \u2014 not in photographs or through computer screens.<\/p>\n\n\n\n
That gave scientists an opportunity to visualize what the warped faces look like for a person with PMO, something they had never been able to do before. Researchers at Dartmouth College created a digital representation of what Sharrah has been experiencing. The resulting images were published<\/a> Thursday in The Lancet. <\/p>\n\n\n\n To create the visuals, the researchers asked Sharrah to describe the differences between photographs of people\u2019s faces and the real-life people standing in front of him. The researchers then used image-editing software to modify the pictures to match Sharrah\u2019s description.<\/p>\n\n\n\n PMO symptoms often resolve after a few days or weeks, though in some cases they can linger for years. Sharrah said he still sees demonic faces.<\/p>\n\n\n\n There are fewer than 100 published case reports of PMO. Researchers suspect it is caused by dysfunction in the brain network that handles facial processing, though they don\u2019t fully understand what triggers the condition. Some cases have been linked to head trauma, stroke, epilepsy or migraines, but other people have PMO without obvious structural changes in their brains.<\/p>\n\n\n\n The researchers offered two possible triggers for Sharrah\u2019s case. First, he had carbon monoxide poisoning four months before his PMO symptoms started. Second, he endured a significant head injury at age 43: While he was trying to unjam the handle on his trailer, Sharrah fell backward and hit his head on concrete. According to the study, MRI scans showed a lesion on the left side of his brain. <\/p>\n\n\n\n The study\u2019s lead author, Ant\u00f4nio Mello<\/a>, a Ph.D. student who works in Dartmouth’s Social Perception Lab, said other people have reached out the lab with PMO symptoms that differ significantly from Sharrah’s.<\/p>\n\n\n\n Some people “have seen face distortions since they remember, since they were a child,\u201d Mello said. “For them at least, it\u2019s impossible to find a single event that was responsible.”<\/p>\n\n\n\n Researchers even suspect the condition may be underreported.<\/p>\n\n\n\n \u201cWe\u2019re hearing from somebody new every week or two\u201d who describes symptoms consistent with PMO, said Brad Duchaine, a co-author of the study and principal investigator of the Social Perception Lab.<\/p>\n\n\n\n He added that some patients he’s worked with in the lab “don\u2019t tell anybody or tell very few people about it, because they\u2019re afraid of what others are going to think.”<\/p>\n\n\n\n In addition, Mello said, many doctors aren\u2019t aware of PMO and may misdiagnose people with mental health disorders, instead. As a result, some PMO patients have been prescribed medications for schizophrenia or psychosis, which aren\u2019t appropriate for their condition, he said.<\/p>\n\n\n\n A key difference between PMO and psychological disorders, Mello said, is that people with PMO \u201cdon\u2019t think that the world is really distorted \u2014 they just realize that there is something different with their vision.\u201d<\/p>\n\n\n\n While there is some overlap in the symptoms that various PMO patients describe, there is also a good deal of variation, Duchaine said. So the images in the case study may be unique to Sharrah\u2019s experience.<\/p>\n\n\n\n Duchaine said he has spoken to people who see drooping faces, as well as a woman who sees two faces when she looks at someone \u2014 one in front of the other. Another woman he spoke to recently sees \u201cwitch-like\u201d faces with long noses and pointy ears, Duchaine said.<\/p>\n\n\n\n \u201cThe first time it happened, she was on a beach in Jamaica and was looking at two women who were standing in the water. They had this witch-like appearance at one moment, and then they didn\u2019t a while later,\u201d he said.<\/p>\n\n\n\n