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      The hidden identity of faces: a case of lifelong prosopagnosia

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          Not being able to recognize a person’s face is a highly debilitating condition from which people with developmental prosopagnosia (DP) suffer their entire life. Here we describe the case of J, a 30 year old woman who reports being unable to recognize her parents, her husband, or herself in the mirror.

          Case presentation

          We set out to assess the severity of J’s prosopagnosia using tests with unfamiliar as well as familiar faces and investigated whether impaired configural processing explains her deficit. To assess the specificity of the impairment, we tested J’s performance when evaluating emotions, intentions, and the attractiveness and likability of faces. Detailed testing revealed typical brain activity patterns for faces and normal object recognition skills, and no evidence of any brain injury. However, compared to a group of matched controls, J showed severe deficits in learning new faces, and in recognizing familiar faces when only inner features were available. Her recognition of uncropped faces with blurred features was within the normal range, indicating preserved configural processing when peripheral features are available. J was also unimpaired when evaluating intentions and emotions in faces. In line with healthy controls, J rated more average faces as more attractive. However, she was the only one to rate them as less likable, indicating a preference for more distinctive and easier to recognize faces.


          Taken together, the results illustrate both the severity and the specificity of DP in a single case. While DP is a heterogeneous disorder, an inability to integrate the inner features of the face into a whole might be the best explanation for the difficulties many individuals with prosopagnosia experience.

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          Most cited references 47

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          The distributed human neural system for face perception

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            The many faces of configural processing.

            Adults' expertise in recognizing faces has been attributed to configural processing. We distinguish three types of configural processing: detecting the first-order relations that define faces (i.e. two eyes above a nose and mouth), holistic processing (glueing the features together into a gestalt), and processing second-order relations (i.e. the spacing among features). We provide evidence for their separability based on behavioral marker tasks, their sensitivity to experimental manipulations, and their patterns of development. We note that inversion affects each type of configural processing, not just sensitivity to second-order relations, and we review evidence on whether configural processing is unique to faces.
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              Understanding the recognition of facial identity and facial expression.

              Faces convey a wealth of social signals. A dominant view in face-perception research has been that the recognition of facial identity and facial expression involves separable visual pathways at the functional and neural levels, and data from experimental, neuropsychological, functional imaging and cell-recording studies are commonly interpreted within this framework. However, the existing evidence supports this model less strongly than is often assumed. Alongside this two-pathway framework, other possible models of facial identity and expression recognition, including one that has emerged from principal component analysis techniques, should be considered.

                Author and article information

                +49 521-106-12423 ,
                BMC Psychol
                BMC Psychol
                BMC Psychology
                BioMed Central (London )
                22 January 2019
                22 January 2019
                : 7
                [1 ]ISNI 0000 0001 0944 9128, GRID grid.7491.b, Department of Psychology, , Bielefeld University, ; Bielefeld, Germany
                [2 ]Bethel Epilepsy Center, Mara Hospital, Bielefeld, Germany
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

                Funded by: von Bodelschwinghsche Stiftungen Bethel
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                Case Report
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                © The Author(s) 2019


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