'It's like staring at demons'

Sharrah said the condition came out of the blue one day.

"I just woke up and was sitting on the couch watching TV when my roommate came into the room, and [looking at him] I'm like, 'What am I seeing?'" When his girlfriend walked in, her face looked the same.

According to Sharrah, the faces he would see had their ears, noses, and mouths stretched back with deep grooves in their foreheads, cheeks, and chins.

"I tried to explain to my roommate what I was seeing, and he thought I was nuts," Sharrah said. "Then I went outside and all of the faces of people I saw were distorted and still are."

"It's like staring at demons," he said. "Imagine waking up one morning and suddenly everybody in the world looks like a creature in a horror movie."

After posting about his experience online, someone who taught visually impaired people suggested Sharrah might have PMO, which he was formally diagnosed with last year.

The facial distortions occur only when Sharrah sees people in person, not in photographs or on computer screens. This allowed researchers at Dartmouth College to create a digital representation of what he had been experiencing.

The researchers asked Sharrah to describe the differences between photographs of people's faces and the real-life people who were standing in front of him. They then used image-editing software to modify the pictures based on Sharrah's descriptions and published the images in a case study.

What is PMO?

Researchers suspect that a dysfunction in the brain network that handles facial processing causes PMO. However, no one fully understands what triggers the condition. There have been some PMO cases linked to head trauma, stroke, epilepsy, or migraines.

In Sharrah's case, researchers believe PMO was triggered by either carbon monoxide poisoning, which he had four months before his symptoms started, or a significant head injury he suffered 16 years earlier. In the study, an MRI found a lesion on the left side of Sharrah's brain.

Currently, only 81 cases of PMO have been identified in published literature, according to a review from June 2021. However, Brad Duchaine, a professor of psychological and brain sciences at Dartmouth and a senior author on the case study, said there are likely many more people living with the condition.

According to Duchaine, some patients he's worked with "don't tell anybody or tell very few people about it, because they're afraid of what others are going to think."

Antônio Mello, a doctoral student at Dartmouth and lead author on the case study, said other people have reached out to his lab with PMO symptoms differing significantly from Sharrah's.

Some "have seen face distortions since they remember, since they were a child," Mello said. "For them at least, it's impossible to find a single event that was responsible."

Mello also noted that PMO cases are likely underreported as many doctors aren't aware of the condition and could misdiagnose people with mental health disorders. Some PMO patients have been prescribed medications for schizophrenia or psychosis, which aren't appropriate, he said.

The distortions PMO patients see are different for everyone. Duchaine said he's spoken to people who see drooping faces, one woman who said she sees two faces when she's looking at someone, and another woman who said she sees "witch-like" faces with long noses and pointy ears.

Another case study from 2018 described a 68-year-old woman who developed PMO symptoms following a stroke. While her neurological and eye exams were normal, she said she saw people's left eyes move upwards and to the side when she saw them in person or on television. However, her own face looked normal in a mirror.

Hope for the future

Sharrah said he's found a few ways to cope with his PMO. Living with a roommate and her two children has been helpful, he said, as he's used to having people around and isn't as startled when he sees new faces in public. Sharrah has also found that, for an unknown reason, green light alleviates his symptoms, so he sometimes wears glasses with green-tinted lenses in crowds.

Currently, Sharrah is working with Duchaine and Mello at their lab to test various interventions for PMO symptoms. Their research has replicated the benefit of green lenses for Sharrah's symptoms and found that manipulating colors in lenses has also helped other PMO patients, though the colors may differ. Another potential treatment they've discovered is showing people with PMO completely symmetrical faces, which seems to reduce distortion.

"If that stands up to more testing, perhaps glasses can be made to help people see faces more symmetrically," Mello said.

For his part, Sharrah said he wants to help other people with PMO.

"I came so close to having myself institutionalized," Sharrah said. "If I can help anybody from the trauma that I experienced with it and keep people from being institutionalized and put on drugs because of it, that's my No. 1 goal." (Bendix, NBC News, 3/21; LaMotte, CNN, 3/22)

There's no shortage of clinical technologies available for your service lines, so how do you choose the right one for your organization? This resource library provides overviews of emerging clinical technologies, considerations for investment, keys for investment success, and more.