Disgust domains in the prediction of contamination fear

Neural correlates of emotional response inhibition in obsessive-compulsive disorder: A preliminary study

Failure to inhibit recurrent anxiety-provoking thoughts is a central symptom of obsessive-compulsive disorder (OCD). Neuroimaging studies suggest inhibitory control and disgust processing abnormalities in patients with OCD. However, the emotional modulation of response inhibition deficits in OCD and their neural correlates remain to be elucidated. For this preliminary study we administered an adapted affective response inhibition paradigm, an emotional go/no-go task, during fMRI to characterize the neural systems underlying disgust-related and fear-related inhibition in nine adults with contamination-type OCD compared to ten matched healthy controls. Participants with OCD had significantly greater anterior insula cortex activation when inhibiting responses to both disgusting (bilateral), and fearful (right-sided) images, compared to healthy controls. They also had increased activation in several frontal, temporal, and parietal regions, but there was no evidence of amygdala activation in OCD or healthy participants and no significant between-group differences in performance on the emotion go/no-go task. The anterior insula appears to play a central role in the emotional modulation of response inhibition in contamination-type OCD to both fearful and disgusting images. The insula may serve as a potential treatment target for contamination-type OCD.

Parent Depression and Anger in Peer-Delivered Parent Support Services

Knowledge about parents who seek peer-delivered parent support services in children's mental health is limited. In this prospective study, characteristics of 124 parents who sought peer parent advocate services related to their children's behavioral difficulties are described. This urban sample consisted primarily of low-income mothers of color, 80% of whom were caring for children with clinically significant behavioral problems. Of these parents, 64% endorsed clinically significant levels of depressive symptoms at baseline. Linear mixed effects models were used to examine associations between parent depression and anger expression with working alliances with peer advocates. No independent or combined effects of parent depression or anger expression on working alliance were found. However, adjusting for family demographic factors, caregiver strain and child symptoms, parent depression interacted with anger expression to influence working alliances, primarily around agreement and mutual engagement on goals. Among parents who endorsed clinically significant depressive symptoms, anger expression did not influence working alliance but among non-depressed parents, anger expression was negatively associated with working alliance. Implications for training peer parent advocates to more effectively engage low income parents are discussed.

Symptom Dimensions in Obsessive-Compulsive Disorder and Obsessive Beliefs

BACKGROUND

Obsessive-compulsive disorder (OCD) is a heterogeneous condition with a few major symptom dimensions. These symptom dimensions are thought to have unique clinical and neurobiological correlates. There seems to be a specific relation between OCD symptom dimensions and obsessive beliefs, but the findings are not consistent across studies. There is also a paucity of literature from culturally diverse settings. One of the reasons for the varied findings could be due to the method employed in measuring OCD symptoms.

MATERIALS AND METHODS

In this study, we examined the relation between symptom dimensions and obsessive beliefs using the Dimensional Yale-Brown Obsessive-Compulsive Scale and the Obsessive Beliefs Questionnaire respectively in 75 patients with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition OCD.

RESULTS

Perfectionism predicted both aggressive and symmetry dimensions whereas responsibility beliefs predicted sexual and religious dimensions.

CONCLUSIONS

The findings suggest that certain obsessive beliefs predicted certain OCD symptom dimensions, but results are not entirely consistent with the published literature suggesting the possibility of cross-cultural variations. That the symptom dimensions have unique belief domains support the argument that symptom dimensions could be targeted to reduce the heterogeneity in etiological and treatment studies of OCD. Therapeutic interventions may have to aim at modifying unique belief domains underlying certain symptom dimensions rather than having generic cognitive-behavioral strategies.

Self-Regulation of Anterior Insula with Real-Time fMRI and Its Behavioral Effects in Obsessive-Compulsive Disorder: A Feasibility Study

Introduction

Obsessive-compulsive disorder (OCD) is a common and chronic condition that can have disabling effects throughout the patient's lifespan. Frequent symptoms among OCD patients include fear of contamination and washing compulsions. Several studies have shown a link between contamination fears, disgust over-reactivity, and insula activation in OCD. In concordance with the role of insula in disgust processing, new neural models based on neuroimaging studies suggest that abnormally high activations of insula could be implicated in OCD psychopathology, at least in the subgroup of patients with contamination fears and washing compulsions.

Methods

In the current study, we used a Brain Computer Interface (BCI) based on real-time functional magnetic resonance imaging (rtfMRI) to aid OCD patients to achieve down-regulation of the Blood Oxygenation Level Dependent (BOLD) signal in anterior insula. Our first aim was to investigate whether patients with contamination obsessions and washing compulsions can learn to volitionally decrease (down-regulate) activity in the insula in the presence of disgust/anxiety provoking stimuli. Our second aim was to evaluate the effect of down-regulation on clinical, behavioural and physiological changes pertaining to OCD symptoms. Hence, several pre- and post-training measures were performed, i.e., confronting the patient with a disgust/anxiety inducing real-world object (Ecological Disgust Test), and subjective rating and physiological responses (heart rate, skin conductance level) of disgust towards provoking pictures.

Results

Results of this pilot study, performed in 3 patients (2 females), show that OCD patients can gain self-control of the BOLD activity of insula, albeit to different degrees. In two patients positive changes in behaviour in the EDT were observed following the rtfMRI trainings. Behavioural changes were also confirmed by reductions in the negative valence and in the subjective perception of disgust towards symptom provoking images.

Conclusion

Although preliminary, results of this study confirmed that insula down-regulation is possible in patients suffering from OCD, and that volitional decreases of insula activation could be used for symptom alleviation in this disorder.

Effective behavioural strategies for reducing disgust in contamination-related OCD: A review

Disgust is an understudied but important emotion in various psychological disorders. Over the last decade, increasing evidence suggests that disgust is also present in various subtypes of obsessive-compulsive disorder (OCD), especially in contamination-related OCD (C-OCD). The treatment of choice for C-OCD is exposure with response prevention, originally designed to reduce fear-associated emotions thought to be acquired through Pavlovian conditioning (PC). However, disgust has been proposed to be acquired through evaluative conditioning (EC) and according to the referential model of this form of learning, there are functional differences between PC and EC that need to be considered in the treatment of disgust-related responses. Alternative strategies suggested by EC-based models include counterconditioning (contingent presentation of the CS with a US of opposite valence) and US revaluation (contingent presentation of the US with US of opposite valence). Drawing on the referential model, this paper reviews evidence for the effectiveness of each strategy to identify the most theoretically sound and empirically valid intervention to reduce disgust in C-OCD.

A Bifactor Model of Disgust Proneness

The current research evaluated a bifactor model for the Disgust Emotion Scale (DES) in three samples: N = 1,318 nonclinical participants, N = 152 clinic-referred patients, and N = 352 nonclinical participants. The primary goals were to (a) use bifactor modeling to examine the latent structure of the DES and in turn (b) evaluate whether the DES should be scored as a unidimensional scale or whether subscales should also be interpreted. Results suggested that a bifactor model fit the DES data well and that all DES items were strongly influenced by a general disgust proneness dimension and by five content dimensions. Moreover, model-based reliability analyses suggested that scoring a general disgust dimension is justified despite the confirmed multidimensional structure. However, subscales were found to be unreliable after controlling for the general disgust factor with the potential exception of the Mutilation/Death and Animals subscale. Subsequent analysis also showed that only the general disgust factor robustly predicted an obsessive-compulsive disorder symptom latent factor—a clinical condition closely related to disgust proneness; latent variables representing DES domains displayed weak relations with an obsessive-compulsive disorder factor above and beyond the general disgust factor. Implications for better understanding the structure of DES responses and its use in clinical research are discussed.

Specificity of disgust domains in the prediction of contamination anxiety and avoidance: a multimodal examination

Although core, animal-reminder, and contamination disgust are viewed as distinct "types" of disgust vulnerabilities, the extent to which individual differences in the three disgust domains uniquely predict contamination-related anxiety and avoidance remains unclear. Three studies were conducted to fill this important gap in the literature. Study 1 was conducted to first determine if the three types of disgust could be replicated in a larger and more heterogeneous sample. Confirmatory factor analysis revealed that a bifactor model consisting of a "general disgust" dimension and the three distinct disgust dimensions yielded a better fit than a one-factor model. Structural equation modeling in Study 2 showed that while latent core, animal-reminder, and contamination disgust factors each uniquely predicted a latent "contamination anxiety" factor above and beyond general disgust, only animal-reminder uniquely predicted a latent "non-contamination anxiety" factor above and beyond general disgust. However, Study 3 found that only contamination disgust uniquely predicted behavioral avoidance in a public restroom where contamination concerns are salient. These findings suggest that although the three disgust domains are associated with contamination anxiety and avoidance, individual differences in contamination disgust sensitivity appear to be most uniquely predictive of contamination-related distress. The implications of these findings for the development and maintenance of anxiety-related disorders marked by excessive contamination concerns are discussed.

A Threat-Emotion Profile Approach to Explaining Active Versus Passive Harm in Intergroup Relations

Research on the sociofunctional threat approach illustrates that people have distinct emotional reactions to different forms of threat from outgroups, such that there are distinct threat-emotion profiles. Drawing on emotion-appraisal theory, the present research investigated whether three threat-emotion profiles (obstacle-anger, contamination-disgust, and safety-fear) would be differentially related to active versus passive harm. In two studies, participants were randomly assigned to evaluate different outgroups and completed threat, emotion, and harm measures. Whereas the obstacle-anger profile was more likely to be associated with active, but not passive, harm, contamination-disgust, and safety-fear were more likely to be associated with passive harm. Implications for prejudice and prejudice-reduction are discussed.

Self-disgust in mental disorders -- symptom-related or disorder-specific?

BACKGROUND

Dysfunctional disgust experiences occur in a variety of mental disorders. Previous research focused on disgust proneness directed towards stimuli in the external environment. However, self-disgust, the devaluation of one' own physical appearance and personality (personal disgust) as well as one' own behavior (behavioral disgust) has hardly been investigated thus far, although it may play a crucial role in specific psychopathologies.

METHODS

We investigated 112 patients diagnosed with different mental disorders (major depression, schizophrenia, borderline personality disorder (BPD), eating disorders, and spider phobia) and 112 matched mentally healthy individuals. Participants answered the Questionnaire for the Assessment of Self-Disgust (QASD) with two subscales 'personal disgust' and 'behavioral disgust', and the Brief Symptom Inventory (BSI) that provides an overview of patients' psychological problems and their intensity.

RESULTS

Compared to healthy controls self-disgust was elevated in mental disorders. Personal disgust was more pronounced than behavioral disgust in patients, whereas there was no difference in controls. Patients with BPD and eating disorders reported the highest scores on both subscales. Findings also suggest that self-disgust is related to specific psychological problems. In mental disorders psychoticism and hostility were the best predictors for personal disgust, while anxiety and interpersonal sensitivity predicted behavioral disgust. Additionally, we found disorder-specific predictors for personal disgust (e.g., hostility in schizophrenia). Finally, traumatic events during childhood constitute a risk factor for self-disgust.

CONCLUSIONS

The current study provides first evidence for the differential meaning of self-disgust for specific mental disorders and symptoms.

The mediating role of disgust sensitivity and thought-action fusion between religiosity and obsessive compulsive symptoms

Psychological theories of obsessions and compulsions have long recognised that strict religious codes and moral standards might promote thought-action fusion (TAF) appraisals. These appraisals have been implicated in the transformation of normally occurring intrusions into clinically distressing obsessions. Furthermore, increased disgust sensitivity has also been reported to be associated with obsessive compulsive (OC) symptoms. No research, however, has investigated the mediating roles of TAF and disgust sensitivity between religiosity and OC symptoms. This study was composed of 244 undergraduate students who completed measures of OC symptoms, TAF, disgust sensitivity, religiosity and negative effect. Analyses revealed that the relationship between religiosity and OC symptoms was mediated by TAF and disgust sensitivity. More importantly, the mediating role of TAF was not different across OC symptom subtypes, whereas the mediating role of disgust sensitivity showed different patterns across OC symptom subtypes. These findings indicate that the tendency for highly religious Muslims to experience greater OC symptoms is related to their heightened beliefs about disgust sensitivity and the importance of thoughts.

Disgust and fear responding in contamination-based obsessive-compulsive disorder during pictorial exposure

The emotion of disgust has been implicated in the development and maintenance of contamination-based obsessive-compulsive disorder (OCD). In the present study nonclinical participants with high (n=26) and low (n=28) levels of OCD contamination symptoms were exposed to 2 categories of disgust stimuli (blood injury and body waste) across 4 blocks using standardized disgust images. Self-report disgust and fear were recorded, as well as cardiovascular heart rate. In both groups, an initial primary disgust reaction was observed. Self-report disgust and fear, but not heart rate deceleration, was greater in the high symptom group. The high symptom group showed reductions in heart rate deceleration, whereas the low symptom group did not. Significant differences in self-report changes across time were observed between the groups, with fear increasing to a greater extent for high contamination fearful individuals when viewing body waste images. The implications of these findings for theoretical models and clinical treatment of OCD with prominent contamination symptoms are discussed.

Disgust and contamination: a cross-national comparison of ghana and the United States

The emotion of disgust, with feelings of revulsion and behavioral withdrawal, make it a prime emotion to aid in the avoidance of sources of contamination, including sources of potential infectious disease. We tested the theory that living in a region with a historically high prevalence of infectious diseases would promote higher levels of disgust and contamination sensitivity as a protective measure. A sample of undergraduates from Ghana (n = 103, 57 women), a country with a historically high prevalence of infectious diseases, showed significantly higher scores on scales assessing disgust, contamination, and disease susceptibility than a sample of undergraduates from the United States (n = 96, 58 women), a country with lower levels of disease threat. Contamination sensitivity mediated the national differences in disgust. Disgust connoting contamination also produced larger cross-national effect sizes than other types of disgust. Finally, a factor analysis on the Ghanaian responses to one of the disgust scales did not resemble the usual three-factor solution found in West. Taken together, the results were consistent with the hypothesis that a region with a higher prevalence of infectious disease threats would produce greater sensitivity to disgust and contamination than seen in lower disease threat regions. This first study on disgust in Africa showed that disgust sensitivity could differ considerably from that in the West.

Predictive Validity of Explicit and Implicit Threat Overestimation in Contamination Fear

We examined the predictive validity of explicit and implicit measures of threat overestimation in relation to contamination-fear outcomes using structural equation modeling. Undergraduate students high in contamination fear (N = 56) completed explicit measures of contamination threat likelihood and severity, as well as looming vulnerability cognitions, in addition to an implicit measure of danger associations with potential contaminants. Participants also completed measures of contamination-fear symptoms, as well as subjective distress and avoidance during a behavioral avoidance task, and state looming vulnerability cognitions during an exposure task. The latent explicit (but not implicit) threat overestimation variable was a significant and unique predictor of contamination fear symptoms and self-reported affective and cognitive facets of contamination fear. On the contrary, the implicit (but not explicit) latent measure predicted behavioral avoidance (at the level of a trend). Results are discussed in terms of differential predictive validity of implicit versus explicit markers of threat processing and multiple fear response systems.

Giving in to arousal or staying stuck in disgust? Disgust-based mechanisms in sex and sexual dysfunction

Sex and disgust seem like strange bedfellows. The premise of this review is that disgust-based mechanisms nevertheless hold great promise for improving our understanding of sexual behavior, including dysfunctions. Disgust is a defensive emotion that protects the organism from contamination. Accordingly, disgust is focused on the border of the self, with the mouth and vagina being the body parts that show strongest disgust sensitivity. Given the central role of these organs in sexual behavior, together with the fact that bodily products are among the strongest disgust elicitors, the critical question seems not whether disgust may interfere with sex but rather how people succeed in having pleasurable sex at all. We argue that sexual arousal plays a critical role in counteracting disgust-induced avoidance via lowering the threshold for engaging in "disgusting sex." Following this, all mechanisms that interfere with the generation of sexual arousal or enhance the disgusting properties of sexual stimuli may hamper the functional transition from a sex-avoidance into an approach disposition. Since prolonged contact is the most powerful means to reduce disgust, disgust-based mechanisms that counteract sexual approach may give rise to a self-perpetuating cycle in which enhanced sexual disgust becomes a chronic feature.

An experimental analysis of disgust sensitivity and fear of contagion in Spider and Blood Injection Injury Phobia

Disgust sensitivity and concern with contamination have been frequently associated with Spider and Blood-Injection-Injury (BII) Phobias. This study assessed the domain specificity of disgust sensitivity and concern with contamination in 29 Non-Phobic Controls, 25 clinical Spider Phobics, 26 clinical BII Phobics, and 27 persons who met clinical criteria for Spider Phobia and BII Phobia. On self-report measures we found evidence of domain specificity of disgust sensitivity for the Spider and BII Phobia groups. Furthermore, we found that persons with both phobias may be more disgust sensitive than persons with a single phobia. Interestingly, the animal reminder disgust stimulus used in this research was more sensitive to detecting domain specific differences in disgust sensitivity between Phobic groups than was the core disgust stimulus, emphasizing the importance of developing standardized behavioral measures of disgust sensitivity in future research. Lastly, findings from this research suggest that concern with contamination may be more influential in phobic avoidance for persons with Spider Phobia than for persons with BII Phobia. Treatment implications for these findings are discussed.

A multi-modal investigation of the roles of distress tolerance and emotional reactivity in obsessive-compulsive symptoms

Emerging evidence implicates important roles of poor distress tolerance and heightened emotional reactivity in obsessive-compulsive disorder. To date, investigations have relied mostly on self-report measures, and we sought to extend the literature by examining the relationship between OC symptoms and distress tolerance, as well as emotional reactivity, using three laboratory assessments. Nonclinical participants (N=167) viewed emotional films associated with four different negative emotions and also completed mirror tracing and handgrip persistence tasks. Greater obsessions scores were predictive of poorer emotional tolerance for a sad film and shorter persistence on the mirror tracing task. Among men only, obsessions were negatively correlated with persistence on the handgrip task. Associations between increased emotional reactivity and washing symptoms also emerged. These findings provide further evidence for the role of poor distress tolerance in obsessions and suggest heightened emotional reactivity may play a role in compulsive washing.

Disgust: the disease-avoidance emotion and its dysfunctions

This review analyses the accumulating evidence from psychological, psychophysiological, neurobiological and cognitive studies suggesting that the disease-avoidance emotion of disgust is a predominant emotion experienced in a number of psychopathologies. Current evidence suggests that disgust is significantly related to small animal phobias (particularly spider phobia), blood-injection-injury phobia and obsessive-compulsive disorder contamination fears, and these are all disorders that have primary disgust elicitors as a significant component of their psychopathology. Disgust propensity and sensitivity are also significantly associated with measures of a number of other psychopathologies, including eating disorders, sexual dysfunctions, hypochondriasis, height phobia, claustrophobia, separation anxiety, agoraphobia and symptoms of schizophrenia--even though many of these psychopathologies do not share the disease-avoidance functionality that characterizes disgust. There is accumulating evidence that disgust does represent an important vulnerability factor for many of these psychopathologies, but when disgust-relevant psychopathologies do meet the criteria required for clinical diagnosis, they are characterized by significant levels of both disgust and fear/anxiety. Finally, it has been argued that disgust may also facilitate anxiety and distress across a broad range of psychopathologies through its involvement in more complex human emotions such as shame and guilt, and through its effect as a negative affect emotion generating threat-interpretation biases.

The association between health anxiety and disgust reactions in a contamination-based behavioral approach task

Existing evidence suggests that disgust is an important affective process related to health anxiety. The present study sought to determine the contribution of health anxiety symptoms in the prediction of disgust and behavioral avoidance in a large, nonclinical sample (N=156). Regression analyses showed that overall health anxiety symptoms predicted disgust on a behavioral approach task independent of gender, negative affect, and fear of contamination. Particularly, health anxiety-related reassurance seeking was found to be uniquely associated with disgust and behavioral avoidance after controlling for the aforementioned covariates. In addition, the interaction between health anxiety and contamination fear was tested, and remained significant when controlling for gender and negative affect. These results suggest that heightened contamination fear is associated with elevated disgust reactions such that high levels of health anxiety leads even those low in contamination fear to be disgusted during a behavioral task. These results are in line with previous research on the role of disgust in health anxiety.

Disgust propensity in obsessive-compulsive disorder: cross-sectional and prospective relationships

BACKGROUND AND OBJECTIVES

Findings from non-clinical samples suggest that disgust propensity is associated with contamination concerns in obsessive-compulsive disorder (OCD). However, studies of clinical samples have yielded conflicting results. We investigated the relationship between disgust propensity and OCD symptoms in a clinical sample and examined whether changes in disgust propensity are associated with changes in OCD symptoms.

METHODS

One hundred and nine OCD participants completed measures of disgust propensity and OCD symptoms. Sixty of these underwent a six-month follow-up assessment.

RESULTS

At the baseline assessment, disgust propensity was associated with all OCD symptom dimensions except hoarding. Changes in overall disgust propensity between baseline and the six-month follow-up assessment were associated with changes in overall self-reported OCD symptoms but not with changes in contamination-based OCD symptoms or changes in interviewer-assessed OCD symptoms.

LIMITATIONS

There was substantial participant attrition between the baseline and follow-up assessments.

CONCLUSIONS

Our study is the first to investigate prospective relationships between disgust propensity and OCD across a six-month interval. Our findings suggest that if there is an association between changes in disgust propensity and changes in contamination-based OCD symptoms its magnitude is likely to be small.

Disgust recognition in obsessive-compulsive disorder: diagnostic comparisons and posttreatment effects

OBJECTIVE

To examine whether disgust recognition deficits are present and specific to obsessive-compulsive disorder (OCD), and the extent to which this deficit, if present, can be reduced in cognitive-behavioural therapy (CBT).

METHOD

Responses to the Pictures of Facial Affect (POFA) were examined in patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosed OCD (n = 20), panic disorder with agoraphobia (PDA; n = 15), and generalized social phobia (GSP; n = 15) and a second, independent OCD sample of treatment responders to CBT (n = 11).

RESULTS

There were significant and statistically large disgust recognition differences between the OCD group and comparison PDA and GSP groups. However, patients with OCD treated with CBT showed disgust recognition scores that were equivalent to the PDA and GSP groups, significantly better than the untreated OCD sample, and equivalent to scores from the original POFA nonaffected standardization sample.

CONCLUSIONS

These results provide support for the presence of disgust recognition impairment in OCD, and provide preliminary evidence that disgust recognition impairments may improve with treatment.

Factor Structure of the Disgust Scale–Revised in an Adolescent Sample

Although recent research with the Disgust Scale–Revised (DS-R) has contributed to current knowledge regarding the structure of disgust, this line of research has exclusively employed adult samples. The current study extended existing research by examining the factor structure of the DS-R in an adolescent sample ( N = 637). Exploratory factor analysis revealed three factors: Contagion, Mortality, and Contact Disgust. Subsequent to removing three items due to inadequate factor loadings, confirmatory factor analysis provided support for the 3-factor model across gender, grade level, and racial subgroups. Tests of item–intercept invariance also revealed no differences in item means across grade level. However, three and four items were associated with differences across race and gender, respectively. Latent factor means were also found to be invariant across racial groups and grade level, but not across gender. Implications of the DS-R factor structure in this adolescent sample and its domains are discussed.

The Three Domains of Disgust Scale

This investigation examined the measurement properties of the Three Domains of Disgust Scale (TDDS). Principal components analysis in Study 1 ( n = 206) revealed three factors of Pathogen, Sexual, and Moral Disgust that demonstrated excellent reliability, including test–retest over 12 weeks. Confirmatory factor analyses in Study 2 ( n = 406) supported the three factors. Supportive evidence for the validity of the Pathogen and Sexual Disgust subscales was found in Study 1 and Study 2 with strong associations with disgust/contamination and weak associations with negative affect. However, the validity of the Moral Disgust subscale was limited. Study 3 ( n = 200) showed that the TDDS subscales differentially related to personality traits. Study 4 ( n = 47) provided evidence for the validity of the TDDS subscales in relation to multiple indices of disgust/contamination aversion in a select sample. Study 5 ( n = 70) further highlighted limitations of the Moral Disgust subscale given the lack of a theoretically consistent association with moral attitudes. Lastly, Study 6 ( n = 178) showed that responses on the Moral Disgust scale were more intense when anger was the response option compared with when disgust was the response option. The implications of these findings for the assessment of disgust are discussed.

Disgust proneness and obsessive-compulsive symptoms in a clinical sample: structural differentiation from negative affect

Although a growing body of research has revealed robust associations between disgust and obsessive-compulsive disorder (OCD) symptoms, there remains a paucity of research examining the specificity of this association in clinical samples. The present study employed structural equation modeling to differentiate disgust from negative affect in the prediction of OCD symptoms in a clinical sample (n=153). Results indicate that disgust and negative affect latent factors were independently related to OCD symptoms. However, when both variables were simultaneously modeled as predictors, latent disgust remained significantly associated with OCD symptoms, whereas the association between latent negative affect and OCD symptoms became nonsignificant. Multiple statistical tests of mediation converged in support of disgust as a significant intervening variable between negative affect and OCD symptoms. The implications of these findings for further delineating the role of individual differences in disgust proneness in the development of OCD are discussed.

Specificity of disgust vulnerability in the distinction and treatment of OCD

A growing body of research has implicated disgust as a potential risk factor for the development and maintenance of obsessive-compulsive disorder (OCD). The first aim of the present study was to determine whether related, yet distinct, disgust vulnerabilities are endorsed more strongly by individuals with OCD than by those with another anxiety disorder. The second aim was to examine the unique contributions of changes in disgust to symptom improvement observed with exposure-based treatment for OCD. In study 1, individuals with OCD, generalized anxiety disorder (GAD), and nonclinical controls (NCCs) completed a measure of disgust propensity and disgust sensitivity. Compared to NCCs and individuals with GAD, those with OCD more strongly endorsed disgust propensity. However, individuals with OCD did not significantly differ from individuals with GAD in disgust sensitivity, although both groups reported significantly higher disgust sensitivity levels compared to NCCs. Study 2 comprised mediation analyses of symptom improvement among individuals with OCD and revealed that decreases in disgust propensity over time mediated improvement in OCD symptoms, even after controlling for improvements in negative affect. The implications of these findings for conceptualizing the role of disgust in the nature and treatment of OCD are discussed.

Poor Control Strengthens the Association Between Sensation Seeking and Disgust Reactions

Perception of risk to a stimulus associated with negative affect may depend on the level of emotional arousal it elicits. Sensation seeking is associated with a decreased level of arousal to risk stimuli. Individuals high in sensation seeking may require greater emotional arousal in order to induce harm avoidance. Poor control increases the salience of emotional cues, which may increase the magnitude of emotion associated with risk stimuli. In the present study, we found that, as sensation seeking decreased, high levels of poor control increased the likelihood of experiencing an emesis perception following disgust. The results support a harm avoidance system tied to emotions elicited from immediate threat that is potentiated by poor control.

Unique affective and cognitive processes in contamination appraisals: Implications for contamination fear

A large body of evidence suggests an important role of disgust in contamination fear (CF). A separate line of research implicates various cognitive mechanisms in contamination fear, including obsessive beliefs, memory biases, and delayed attentional disengagement from threat. This study is an initial attempt to integrate these two lines of research and examines whether disgust and delayed attention disengagement from threat explain unique or overlapping processes within CF. Non-clinical undergraduate students (N = 108) completed a spatial cueing task, which provided measures of delayed disengagement from frightening and disgusting cues, and a self-report measure of disgust propensity (DP). Participants also completed a chain of contagion task, in which they provided contamination appraisals of an object as a function of degrees of removal from an initial contaminant. Results demonstrated that DP predicted greater initial contamination appraisals, but a sharper decline in estimations across further degrees of removal from the contaminant. Delayed disengagement from disgust cues uniquely predicted sustained elevations in contamination estimations across further degrees of removal from the contaminant. These results suggest that DP and delayed disengagement from disgust cues explain unique and complimentary processes in contamination appraisals, which suggests the utility of incorporating the disparate affective and cognitive lines of research on CF.

The Mediating Roles of Disgust Sensitivity and Danger Expectancy in Relation to Hand Washing Behaviour

Background: Recent interest in the role of vulnerability factors in obsessional washing has suggested that disgust sensitivity, danger expectancy and health anxiety may be of interest. Aims: This study explores the differential impact of these factors on both behavioural and cognitive measures of washing behaviour and is based on a replication of the Jones and Menzies (1997) experiment, during which participants immersed their hands in a noxious compound while rating themselves on a range of measures: the time they subsequently took to wash their hands was measured and danger expectancies were found to be the best predictor of this. Method: The present study added measures of disgust sensitivity and health anxiety to this experimental methodology while removing factors they found to be of little import to compulsive washing. Thirty non-clinical participants took part. Results: Results confirmed that disgust sensitivity was related to the behavioural measure of washing time, but that this relationship was almost entirely mediated by the danger expectancy concerning judgements of severity of consequent disease. However, a different pattern emerged when the outcome measure was questionnaire based: danger expectancy was not at all related to this. Disgust sensitivity mediated the relationship between health anxiety and scores on a questionnaire measure of washing compulsions. Interestingly, these scores were not related to the behavioural measure of washing time. Conclusions: The implications of these relationships to the further development of subtypes of Obsessive Compulsive Disorder (OCD) are discussed.

Disgust vulnerability and symptoms of contamination-based OCD: descriptive tests of incremental specificity

The present investigation examines the incremental association between disgust propensity and sensitivity and contamination-based obsessive-compulsive disorder (OCD) symptoms. Structural equation modeling in Study 1 indicated that general disgust was related to contamination fear even when controlling for negative affect in a nonclinical sample. Evidence was also found for a model in which the effect of negative affect on contamination fear is mediated by general disgust. Study 1 also showed that both disgust sensitivity and disgust propensity uniquely predicted contamination fear when controlling for negative affect. Growth curve analyses in Study 2 indicated that higher baseline contamination fear is associated with less reduction in contamination fear over a 6-week period as disgust sensitivity increases even when controlling for negative affect. Lastly, disgust propensity was associated with concurrent levels of excessive washing symptoms among patients with OCD in Study 3 when controlling for depression. Implications of these findings from nonclinical, analogue, and clinical samples for future research on the specificity of disgust-related vulnerabilities in the etiology of contamination concerns in OCD are discussed.

Disgust Propensity as a Predictor of Intrusive Cognitions Following a Distressing Film

Although extant research examining predictors of development of Posttraumatic Stress Disorder (PTSD) have focused primarily on fear and anxiety, recent research suggests that a range of different emotional reactions may occur in response to traumatic events. For example, specific aspects of traumatic exposure frequently include either experiencing or witnessing events that may elicit disgust, including injury, death, or sexual assault (e.g., Dalgleish and Power in Behav Res Ther Spec Issue Festschrift Spec Issue John Teasdale 42(9):1069–1088, 2004); McNally in J Anxiety Disord 16(5):561–566, 2002). However, no published research has specifically examined the role of disgust propensity in the development and maintenance of PTSD. Thus, the aim of the present study was to evaluate the relationship between disgust propensity and intrusive symptoms. To this end, 30 undergraduates without symptoms of PTSD were recruited to participate in a distressing film paradigm (for a review of this paradigm see Holmes and Bourne in Acta Psychol 127(3):553–566, 2008). Anxiety, depression, and trait disgust scores were entered hierarchically into a regression equation to predict the number of intrusions during a post-film thought monitoring period. Results indicated that disgust propensity predicted intrusions independent of anxiety and depression. Although still preliminary, results suggest that disgust propensity may be one factor that predicts frequency of intrusive memories after witnessing injury or bodily harm.

Perception bias of disgust in ambiguous facial expressions in obsessive-compulsive disorder

Impaired recognition of facial expressions of disgust has been suggested for patients with obsessive-compulsive disorder (OCD). This study aimed to compare the perception of negative emotions by OCD patients and controls using both non-ambiguous and ambiguous facial expressions. Forty-one OCD patients and thirty-seven controls performed the computerised emotion perception task. There were no differences between OCD patients and controls in the frequency of correct identification of non-ambiguous facial expressions. However, OCD patients were more likely to perceive disgust and less likely to perceive anger in response to ambiguous facial expressions when controlling for covariates. In OCD patients, a higher cleaning dimension was associated with a lower perception of anger and a higher perception of disgust when presented with ambiguous facial expressions. The domains of core disgust and contamination-based disgust domains of disgust sensitivity were positively correlated with the perception of ambiguous facial expressions as disgust, as well as cleaning symptom dimension scores. Our findings suggest that OCD patients, particularly those with higher washing/contamination symptoms, are more likely to perceive disgust in ambiguous facial expressions.

The relationship between obsessive beliefs and symptom dimensions in obsessive-compulsive disorder

Research findings on the specific relationships between beliefs and OCD symptoms have been inconsistent, yet the existing studies vary in their approach to measuring the highly heterogeneous symptoms of this disorder. The Dimensional Obsessive-Compulsive Scale (DOCS) is a new measure that allows for the assessment of OCD symptom dimensions, rather than types of obsessions and compulsions per se. The present study examined the relationship between OCD symptom dimensions and dysfunctional (obsessive) beliefs believed to underlie these symptom dimensions using a large clinical sample of treatment-seeking adults with OCD. Results revealed that certain obsessive beliefs predicted certain OCD symptom dimensions in a manner consistent with cognitive-behavioral conceptual models. Specifically, contamination symptoms were predicted by responsibility/threat estimation beliefs, symmetry symptoms were predicted by perfectionism/certainty beliefs, unacceptable thoughts were predicted by importance/control of thoughts beliefs and symptoms related to being responsible for harm were predicted by responsibility/threat estimation beliefs. Implications for cognitive conceptualizations of OCD symptom dimensions are discussed.

Cognitive bias to symptom and obsessive belief threat cues in obsessive-compulsive disorder

The current study examined the extent to which patients with obsessive compulsive disorder (OCD) demonstrate cognitive biases to OCD symptom or inflated responsibility threat cues. Participants with either primary contamination-washing or doubting/harming-checking OCD, non-OCD anxiety disorders, and student controls completed a primed lexical decision task. Following either neutral or OCD-threat priming conditions, participants made lexical decisions regarding different sets of word stimuli: nonwords, OCD symptoms, OCD inflated responsibility, and depression. Following the OCD primes, the primary contamination-washing symptom subgroup showed increased interference on OCD symptom words compared with the harming symptom and student groups. The primary contamination-washing subgroup also showed increased interference on responsibility words compared with the harming, non-OCD anxious and student groups. However, subsidiary analyses comparing patients with contamination obsessions with and without associated fears of harming others through the spreading of contaminants, demonstrated that it was the latter group that evidenced cognitive biases to responsibility threat cues. These results are considered in relation to cognitive models of OCD.

Incremental specificity of disgust propensity and sensitivity in the prediction of health anxiety dimensions

The present study sought to determine the incremental specificity of disgust propensity and sensitivity in the prediction of symptoms of health anxiety in a large nonclinical sample (N=498). Exploratory factor analysis identified Illness Likelihood, Illness Severity, and Body Vigilance as dimensions of health anxiety symptoms that significantly correlated with disgust propensity and sensitivity. Negative affect and the fear of contamination were also significantly correlated with the three health anxiety symptom dimensions. Regression analyses did show that disgust propensity and sensitivity predicted overall health anxiety symptoms independent of negative affect and fear of contamination. However, the unique association between disgust propensity and sensitivity and symptoms of health anxiety was specific to the Body Vigilance dimension. These findings suggest that disgust propensity and sensitivity may be a unique vulnerability for the vigilance for bodily sensations/changes aspect of health anxiety but not necessarily other (perceived probability/severity of having a serious illness) aspects of health anxiety. The clinical and research implications of these findings for conceptualizing disgust propensity and sensitivity as a vulnerability for excessive health anxiety are discussed.

Disgust sensitivity and emotion regulation potentiate the effect of disgust propensity on spider fear, blood-injection-injury fear, and contamination fear

Research consistently reveals a relation between disgust and specific anxiety concerns, but research has only begun to investigate possible mechanisms by which this relation occurs. The current study tested whether disgust sensitivity (DS; a specific difficulty regulating disgust) and general emotion dysregulation (GED; non-emotion-specific regulation difficulties) moderated the relation between disgust propensity (DP) and spider fear, blood-injection-injury (BII) fear, and contamination fear. A total of 594 undergraduate students completed verbal-report measures of DP, DS, GED, negative affectivity, and spider, BII, and contamination fears. Results suggest that GED potentiates the ability of DP to predict spider and contamination fears, but not BII fears. DS potentiates the ability of DP to predict BII fears, but not spider or contamination fears. These data suggest that GED and DS are possible mechanisms that strengthen the influence of DP on spider, BII, and contamination fears. The present study demonstrates the utility of incorporating emotion regulation into the theory of disgust in certain anxiety disorders.

Disgust and Obsessive Beliefs in Contamination-related OCD

A large body of evidence suggests that disgust is an important affective process underlying contamination fear. An independent line of research demonstrates that obsessive beliefs, particularly overestimations of threat, are also an important cognitive process underlying contamination fear. The present study attempts to integrate these two lines of research by testing whether obsessive beliefs potentiate the influence of disgust propensity on contamination fear. The interaction between disgust propensity and obsessive beliefs was tested in two large non-clinical samples (N = 252 in Study 1; N = 308 in Study 2) using two different self-report measures of contamination fear. Regression analyses supported the hypotheses in both samples. The interaction remained significant when controlling for negative affect. The results are hypothesized to suggest that contamination fear results, at least partly, from obsessive beliefs about the contamination-based appraisals that accompany heightened disgust responding. These results complement previous affective-driven explanations of the role of disgust in contamination fear by suggesting cognitive factors that similarly potentiate disgust's role in contamination fear.