Disgust sensitivity and anorexia nervosa

Relationship between disgust and orthorexia nervosa and psychometric properties of the Italian Dusseldorf orthorexia scale in a general population sample

BACKGROUND

It remains unclear among clinicians and researchers whether orthorexia nervosa (ON) is a part of the obsessive-compulsive disorder spectrum or eating disorders. Disgust seems to be a shared psychopathological factor in these clinical presentations, indicating a potentially crucial role in ON. On the other hand, numerous psychometric tools have been developed to evaluate ON. The Dusseldorf Orthorexia Scale (DOS) was recently validated in an Italian sample. However, the study's primary limitation was that the scale was only administered to undergraduate university students. This study aimed to investigate the psychometric properties (including factorial structure, reliability, and measurement invariance conditional on sex) of the Italian version of the DOS (I-DOS) on a sample from the general population. Additionally, the study sought to determine the nomological validity of the I-DOS by examining its relationship with disgust sensitivity.

METHODS

A sample of 521 participants took part in this study and completed a battery that assessed ON and disgust sensitivity. To assess the I-DOS structure, reliability, and measurement invariance we respectively conducted confirmatory factor analysis (CFA), computed McDonalds's omega, and performed hierarchical series of multigroup CFAs. Then, we tested the relationship between ON and disgust sensitivity.

RESULTS

CFA confirmed the unifactorial model of I-DOS and it respected the configural, metric, and strict invariance while a partial scalar invariance was achieved. It also showed good reliability with an omega of 0.87. In addition, we found a positive relationship between ON and disgust sensitivity, thus confirming the nomological validity of I-DOS.

CONCLUSIONS

Our findings suggest that the Italian version of the Dusseldorf orthorexia scale (I-DOS) exhibits strong psychometric properties and can be an effective instrument for assessing ON in a general population sample. Notably, the most significant and innovative outcome was the positive correlation between ON and disgust sensitivity. As disgust has been linked to other clinical presentations, this preliminary result could serve as a foundation for future research exploring this phenomenon in greater detail.

Disgust sensitivity and behavioural inhibitory systems in binge eating disorder: associations with eating pathology

Disgust sensitivity refers to how unpleasant a disgusting experience is to an individual and is involved in the development of many psychiatric conditions. Given its link with food ingestion, there is an interest in understanding how an individual's susceptibility to disgust relates to dietary habits. One possible mechanism giving rise to this association is through the effects negative emotions have on high-order cognitive processes, but few studies take this model into account. The aim of this study was to characterize general disgust sensitivity in a clinical binge eating disorder (BED) population, and explore whether disgust sensitivity relates to inhibitory control and eating pathology. Following a case-controlled study design, our results show that: (1) disgust sensitivity and its subscales do not differ between BED and healthy controls, (2) higher disgust sensitivity in BED relates to greater behavioural inhibition, (3) inhibitory control reaction times relate to aspects of eating pathology, and (4) inhibitory control does not mediate relationships between disgust sensitivity and BMI among participants with BED. Understanding the role of disgust sensitivity in BED may allow us to understand how negative emotion systems maintain dysregulated eating behaviours with the potential to inform emotion-regulation treatment approaches. Level of evidence: Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Disgust as a transdiagnostic index of mental illness: A narrative review of clinical populations

Disgust is a basic emotion of rejection, providing an ancestral defensive mechanism against illness. Based on research that documents altered experiences of disgust across several psychopathological conditions, we conducted a narrative review to address the hypothesis that altered disgust may serve as a transdiagnostic index of mental illness. Our synthesis of the literature from past decades suggests that, compared to healthy populations, patients with mental disorders exhibit abnormal processing of disgust in at least one of the analyzed dimensions. We also outline evidence of alterations in brain areas relevant to disgust processing, such as the insula and the interconnected limbic network. Overall, we provide preliminary support for the hypothesis that altered disgust processing may serve as a transdiagnostic index of mental illness.

Disgust and Self-Disgust in Eating Disorders: A Systematic Review and Meta-Analysis

Disgust and self-disgust are aversive emotions which are often encountered in people with eating disorders. We conducted a systematic review and meta-analysis of disgust and self-disgust in people with eating disorders using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic review of the literature revealed 52 original research papers. There was substantial heterogeneity regarding the research question and outcomes. However, we found 5 articles on disgust elicited by food images, 10 studies on generic disgust sensitivity, and 4 studies on self-disgust, and we proceeded to a meta-analytic approach on these studies. We found that women with eating disorders have significantly higher momentary disgust feelings in response to food images (1.32; 95% CI 1.05, 1.59), higher generic disgust sensitivity (0.49; 95% CI 0.24, 0.71), and higher self-disgust (1.90; 95% CI 1.51, 2.29) compared with healthy controls. These findings indicate the potential clinical relevance of disgust and self-disgust in the treatment of eating disorders.

Age-related differences in self-reported disgust toward core disgust, sex-related, and food stimuli

INTRODUCTION

While disgust is functional in preventing contagion from pathogens, it also plays a role in various psychopathologies. Disgust responses toward dirt, bodily secretions, certain types of food, and sexual stimuli typically emerge during (early) childhood. However, there is a lack of research on how disgust develops. This cross-sectional study investigated whether there are age-related differences in subjective, self-reported disgust between early and late adolescence and whether there are differences for distinctive types of disgust (core-disgust, sex-related, food-related).

METHODS

Using an online survey, 240 Dutch children (116 female, 124 male) aged 9 through 16 years rated the extent to which they found the different types of stimuli disgusting or not on a VAS scale.

RESULTS AND CONCLUSIONS

The results showed that only the disgust responses to sex-related stimuli decreased with age, whereas disgust toward the other categories did not show any age-related differences. Overall girls reported somewhat higher disgust ratings than boys for sex-related stimuli, but not for the other categories. The present study offers important new angles for future research, which might further disentangle the mechanisms through which the changes occur.

Morphing analysis of facial emotion recognition in anorexia nervosa: association with physical activity

PURPOSE

Anorexia Nervosa (AN) has been linked to emotion processing inefficiencies, social cognition difficulties and emotion dysregulation, but data on Facial Emotion Recognition (FER) are heterogenous and inconclusive. This study aims to explore FER in patients with AN using a dynamic and ecological evaluation, and its relationship with Physical Activity (PA), an important aspect of AN that could impact emotional processing.

METHODS

Sixty-six participants (33 patients with AN and 33 healthy controls) performed a morphed facial emotional recognition task and 49 of them wore an accelerometer during seven days to assess PA. Axis-I disorders and depressive symptoms have been assessed.

RESULTS

No difference was found regarding time to recognize facial emotions. However, patients with AN correctly recognize emotions more frequently than controls. This was specific to disgust, although there was also a tendency for sadness. Among patients, higher depressive scores are associated with a faster and more accurate recognition of disgust, while a higher level of PA is associated to decreased accuracy in recognizing sadness.

CONCLUSION

Patients with AN are capable of recognizing facial emotions as accurately as controls, but could have a higher sensitivity in recognizing negative emotions, especially disgust and sadness. PA has opposite effects and, thus, could be considered as an emotional regulation strategy against negative affect.

LEVEL OF EVIDENCE II

Controlled trial without randomization.

Exploring the role of disgust sensitivity and propensity in selective eating

While disgust is a clinically and theoretically relevant construct for selective eating, limited research has examined how different aspects of disgust relate to selective eating severity in adults. Thus, the present study sought to 1) compare disgust propensity (how easily people are disgusted) and disgust sensitivity (how unpleasant disgust is) across a spectrum of selective eaters, 2) explore the specificity of the associations between disgust sensitivity/propensity and selective eating across selective eating and related phenotypes, and 3) explore whether the relationship between selective eating and disgust is food-specific. Participants were 554 adults recruited on Amazon's Mechanical Turk who completed cross-sectional surveys on study constructs. The sample was recruited to over-represent individuals with high levels of selective eating. Results support that disgust propensity, but not sensitivity, was elevated in the impaired selective eating group compared to non-impaired selective eaters and non-selective eaters. Only the selective eating phenotype was independently associated with both disgust sensitivity and propensity. Correlation results supported that the associations between selective eating and disgust were specific to the disgust elicited by food (i.e., animal protein, fruits, vegetables). Overall, results support that disgust propensity and disgust sensitivity play a role in selective eating. Results imply that disgust sensitivity associated with selective eating appears limited to the food domain and may be more specific to disgust eliciting food itself, rather than signs of food contamination or spoilage.

Self-disgust and disgust sensitivity are increased in anorexia nervosa inpatients, but only self-disgust mediates between comorbid and core psychopathology

OBJECTIVE

The possible role of abnormal disgust processing in the development and course of anorexia nervosa (AN) has been emphasized in theoretical models and research. However, disgust toward external stimuli and self-disgust have not yet been investigated together in a clinical sample of AN patients. Therefore, the purpose of the study was to measure these constructs and examine their role in shaping eating pathology in AN patients and healthy controls (HCs), considering comorbid depressive and anxiety psychopathology. The study also aimed at testing the possible mediational roles of both disgust types in the associations between comorbid psychopathology and eating disorders (EDs) characteristics.

METHOD

Altogether, 63 inpatients with AN and 57 HCs partook in the study. Participants completed the Eating Disorder Inventory-3, State-Trait Anxiety Inventory, Beck Depression Inventory-II, Disgust Scale-Revised and Self-Disgust Scale.

RESULTS

AN patients manifested higher self-disgust and disgust sensitivity than HCs. In addition, self-disgust predicted the severity of EDs characteristics and mediated the links of depressive symptoms and trait anxiety with EDs characteristics in both groups.

DISCUSSION

Our findings imply the putative role of self-disgust in the development of EDs psychopathology in HCs and in its maintenance in AN patients.

The revolting body: Self-disgust as a key factor in anorexia nervosa

In this article, we present a theoretical model that points to disgust-induced avoidance as a mechanism that can help explain the persistent and excessive food restriction in individuals with anorexia nervosa (AN). Disgust is characterized by intense negative feelings of revulsion and an overwhelming and irresistible urge to avoid potential disgust elicitors. When eating, or even the prospect of eating, elicits overwhelming feelings of disgust in individuals with AN, this could explain why food restriction persists even when someone is in a state of starvation. Following this model, disgust is elicited by the expected impact of food on the own body ("becoming fat") resulting in body-related self-disgust. We argue that limiting food intake may serve to avoid self-disgust. This implies that when self-disgust remains unchanged after treatment of AN, residual levels of self-disgust after treatment could make individuals vulnerable to relapse.

The Role of Disgust in Eating Disorders

PURPOSE OF REVIEW

In current review, we evaluate the current literature examining the role of disgust in eating disorders (EDs), and provide a theoretical model designed to inform the study and treatment of disgust-based symptoms in EDs.

RECENT FINDINGS

Findings from this review suggest that aberrant disgust-conditioning processes represent promising but understudied mechanisms that may contribute to the risk and maintenance of core eating disorder (ED) psychopathology. In addition, preliminary evidence supports the use of interventions designed to target aversive disgust cues and disrupt maladaptive disgust-based conditioning that may maintain eating pathology. However, experimental studies designed to elucidate the role of disgust and aversive learning processes remain limited. Disgust is a promising risk and maintenance factor in EDs. Future systematic investigation is needed to examine disgust-based processes at a mechanistic level in order to better understand the links between disgust, avoidance behaviors, and EDs. Further investigation of the mechanistic role of disgust in EDs is warranted.

Understanding opposition to human gene editing A role for pathogen disgust sensitivity?

Recent advances in gene editing technology promise much for medical advances and human well-being. However, in parallel domains, there have been objections to the use of such biotechnologies. Moreover, the psychological factors that govern the willingness to use gene editing technology have been underexplored to date. In this registered report, we sought to test whether pathogen disgust sensitivity is linked with opposition to gene editing. U.K.-based adult participants (N = 347) were recruited to this study. Gene editing attitudes reflected two largely distinct latent factors concerning enhancing human traits and treating medical disorders. In contrast to prediction, pathogen disgust sensitivity was related to greater support for gene editing in both of these domains. This result suggests that gene editing, at least in the current study, is not viewed as pathogenic, or that the perceived benefits of gene editing outweigh any perceived pathogen risk.

A tasting experiment comparing food and nutritional supplement in anorexia nervosa

Anorexia nervosa (AN) is a severe psychiatric disorder leading to life-threatening emaciation. Weight restoration is crucial in treatment but few data are available on how to achieve it. Nutritional supplements are needed in treatment but patients' preferences about natural versus medical foods and their gustatory/hedonic perception are unclear. We aimed to measure disgust and reward-based eating in AN and to assess psychological, interoceptive awareness-related, behavioral, and hedonic aspects comparing natural versus medical food. Thirty-three inpatients with AN and 39 healthy controls (HCs) were recruited and received 50 ml of either apricot juice or nutritional liquid supplement with apricot flavor on two consecutive days. Disgust, reward-based eating, and eating psychopathology were evaluated. Visual Analogue Scales measuring anxiety, hunger, confusion about internal states, need for over-exercise, restraint, and satiety were completed before and after the experiment. Disgust and hedonic responses were measured after the experiment. Patients with AN reported preserved disgust sensitivity and higher reward-based eating drive. When compared to HCs, inpatients with AN reported higher scores on anxiety, hunger, confusion about internal states, urge to over-exercise, urge to eating restraint, and satiety before and after the tasting experiment. The supplement slightly increased patients' anxiety with HCs reporting the same trend. Still, patients reported more food-related disgust after the supplement but their overall hedonic evaluation was similar for both conditions. Also, anxiety, confusion about internal states, and urge to over-exercise and restraint did not significantly increase after consuming either food. Therefore, if we take into account patients' level of heightened satiety and suppressed hunger, supplements could be helpful for patients with severe AN since greater energy intakes could be provided with only small volumes of food and little changes of eating concerns.

Improving emotion recognition in anorexia nervosa: An experimental proof-of-concept study

OBJECTIVE

Previous research has found increasing evidence for difficulties in emotion recognition ability (ERA) and social cognition in anorexia nervosa (AN), and recent models consider these factors to contribute to the development and maintenance of the disorder. However, there is a lack of experimental studies testing this hypothesis. Therefore, the present proof-of-concept study examined whether ERA can be improved by a single session of a computerized training in AN, and whether this has short-term effects on eating disorder symptoms.

METHOD

Forty inpatients (22.20 ± 7.15 years) with AN were randomly assigned to receive a single session of computerized training of ERA (TERA) or a sham training (training the recognition of different types of clouds). ERA, self-reported eating disorder symptoms, and body mass index (BMI) were assessed within 3 days before and after training.

RESULTS

After training, both groups showed improved ERA, reduced self-reported eating disorder symptoms, and an increased BMI. As compared to patients in the control group, patients who received TERA showed greater improvements in ERA and self-reported eating disorder symptoms.

DISCUSSION

ERA can be effectively trained in patients with AN. Moreover, short-term improvements in self-reported eating disorder symptoms provide tentative support for the hypothesis that difficulties in ERA contribute to the maintenance of AN, and that specific trainings of ERA hold promise as an additional component in AN treatment. Future studies are needed to replicate these findings in larger samples, and to investigate long-term effects and transfer into real-world settings.

Disgust and fear: common emotions between eating and phobic disorders

Eating disorders (ED) are prevalent mental illnesses composed mainly of anorexia nervosa, bulimia nervosa and binge eating disorders. Anxiety disorders are another set of mental illnesses, with phobic disorder (PD) being the most prevalent disorder. ED and PD are highly comorbid. The aim of this study is to assess, in 131 individuals attending an outpatient clinic for different health issues, the level of fear related to situations generating avoidance such as in social anxiety and specific phobias according to the fear questionnaire (FQ), the level of disgust according to the disgust scale (DS-R) and the vulnerability towards ED according to the SCOFF scale to demonstrate that high levels of both fear and disgust increase the vulnerability towards ED. The study demonstrated that the level of disgust increased when fear increases (r = 0.377, p < 0.001 for the first part of the FQ; r = 0.225, p = 0.01 for the second part of the FQ). Moreover, individuals with vulnerability towards having an ED presented a higher level of disgust than individuals without this vulnerability (p = 0.009). Furthermore, individuals with vulnerability towards ED have a higher level of anxiety related to PD subtypes (p = 0.008 for agoraphobia; p = 0.001 for injection/blood phobia) as well as to social anxiety (p = 0.01), independently from having a depressive or another anxiety disorder. In the multivariate analysis, a history of psychiatric consultation has been the only significantly different parameter between individuals with or without vulnerability towards ED (p = 0.0439). Accordingly, fear and disgust are negative emotions that seem to be clinically associated which better explains the comorbidity of ED with PD. LEVEL OF EVIDENCE: Level III. Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.

Linking Pavlovian Disgust Conditioning and Eating Disorder Symptoms: An Analogue Study

Although the experience of disgust is commonly endorsed among women with eating disorders, it remains unclear how to best model this emotion in relation to disordered eating. The present study sought to identify potential disgust conditioning abnormalities that may underlie the development of eating disorder symptoms. Individuals high and low in eating disorder symptoms (HED, n = 19; LED, n = 18) completed a Pavlovian conditioning procedure in which one neutral food item (conditioned stimulus; CS+) was followed by disgusting videos of individuals vomiting (unconditioned stimulus; US) and another neutral food item (CS-) was not reinforced with the disgusting video. Following this acquisition procedure, there was an extinction procedure in which both CSs were presented unreinforced. The results showed that ratings of disgust, fear, and willingness to eat the CS+ and CS- did not significantly vary as a function of the conditioning phase for the LED group. However, the HED group rated the CS+ as significantly more disgusting and fear inducing than the CS- after the acquisition phase and this pattern persisted after extinction. These conditioning effects were also observed to be significantly larger for disgust compared to fear. The HED group also reported being significantly less willing to eat the CS+ compared to the CS- after the acquisition phase and this pattern also persisted after extinction. In the full sample, only discriminant disgust responding after acquisition was associated with the amount of calorie consumption over the 24-hour period after conditioning. These findings suggest that eating disorder symptoms may result from a heightened proneness to associate disgusting outcomes with otherwise neutral food items. This pattern of disgust learning may reinforce food avoidance in eating disorders and appears to be difficult to fully unlearn.

Food-Specific Inhibitory Control Mediates the Effect of Disgust Sensitivity on Body Mass Index

Disgust is an emotion that drives food avoidance. People vary in their responses to disgust, which is captured by their disgust sensitivity. Disgust sensitivity is clinically significant because it can influence eating behaviors, and indirectly people's body mass index (BMI). Inhibitory control can also influence BMI through the role that such reflective abilities play in governing food intake. In this study, we relied on neural models of disgust to suggest that disgust and inhibitory control are intertwined, and that inhibitory control facilitates the translation of disgust sensitivity into BMI. Mediation analyses applied to 46 subjects, including 29 normal body weight [BMI = 18.34 kg/m² (SD = 1.58)] and 17 overweight/obese [BMI = 26.03 kg/m² (SD = 2.58)] subjects, were used to test the hypothesis. Subjects completed the Chinese version of the Disgust Scale-Revised, and an inhibition control test (Food-Specific Stop-Signal Task). There were negative correlations between the disgust sensitivity score (DS) and body mass index (BMI), and between DS and stop-signal reaction time (SSRT). Moreover, BMI was positively correlated with SSRT. The mediation model results showed that disgust sensitivity was associated with BMI and that this relationship was mediated via inhibition control. There was no significant effect of DS on BMI, while the effect of SSRT on BMI was significant. This suggested that the effect of disgust sensitivity on BMI was fully mediated through food-specific inhibitory control. This supports our hypothesis that BMI is affected by disgust sensitivity and that this relationship is mediated by inhibition control. These findings reveal a key mechanism that underlies disgust sensitivity-BMI association and point to future research and potential interventions aimed at food intake management.

Dysfunction of the to in Anorexia and Bulimia Nervosa: A fMRI

Brain reward dysfunction in eating disorders has been widely reported. However, whether the neural correlates of hedonic and motivational experiences related to food cues are differentially affected in anorexia nervosa of restrictive type (ANr), bulimia nervosa (BN), and healthy control (HC) participants remains unknown. Here, 39 women (14 ANr, 13 BN, and 12 HC) underwent fMRI while smelling food or non-food odors in hunger and satiety states during liking and wanting tasks. ANr and BN patients reported less desire to eat odor-cued food and odor-cued high energy-density food (EDF), respectively. ANr patients exhibited lower ventral tegmental area (VTA) activation than BN patients to food odors when rating their desire to eat, suggesting altered incentive salience attribution to food odors. Compared with HC participants, BN patients exhibited decreased activation of the caudate nucleus to food odors in the hunger state during the wanting task. Both patient groups also showed reduced activation of the anterior ventral pallidum and insula in response to high EDF odors in the hunger state during the wanting task. These findings indicate that brain activation within the food reward-regulating circuit differentiates the three groups. ANr patients further exhibited lower activation of the precuneus than other participants, suggesting a possible role of body image distortion in ANr. Our study highlights that food odors are relevant sensory probes to gain better insight into the dysfunction of the mesolimbic and striatal circuitry involved in food reward processing in patients with EDs.

The source effect as a natural function of disgust in interpersonal context and its impairment in mental disorders

Disgust affects interpersonal relationships and regulates hygienic, sexual and distance behaviour. Its intensity in the interpersonal context depends on the character of the relationship. Strangers normally evoke more disgust than intimates (known as the source effect). General disgust sensitivity is increased in various mental diseases. It is unclear how disgust in the interpersonal context is affected and whether the source effect is preserved. 460 inpatients with mental disorders and 463 healthy subjects answered a newly developed Questionnaire (DIRQ) that covers disgust in the interpersonal context on content categories (hygiene, physical proximity, sexuality) and on source categories (self, partner, parent, stranger). Mental disorders were diagnosed with structured interviews. Healthy controls exhibited a pronounced source effect, with strangers evoking more disgust than intimates. In patients, this source effect was reduced (Cohen's d = 0.3), especially for sexual disgust, while general disgust sensitivity was increased (d = 0.5). High disgust in patients was best predicted by a history of sexual abuse and by the presence of post-traumatic stress disorder. In conclusion, mentally impaired patients show increased and trauma-associated disgust sensitivity. Their downregulation of sexual disgust in intimate relationships is hindered, which may have a boundary protective function but might also fuel difficulties engaging in relationships or intimacy.

Negative body image: Relationships with heightened disgust propensity, disgust sensitivity, and self-directed disgust

Consistent with the view that disgust might be involved in persistent body dissatisfaction, there is preliminary evidence showing a positive correlation between measures of negative body image and indices of both trait disgust and self-directed disgust. In two correlational studies among undergraduates (N = 577 and N = 346, respectively) we aimed at replicating and extending these findings by testing a series of critical relationships, which follow from our hypotheses that 1) trait disgust propensity would increase the risk of developing a negative body image by increasing the likelihood of feeling self-disgust, and 2) trait disgust sensitivity would heighten the impact of self-disgust on the development of persistent negative body appraisals. Replicating previous research, both studies showed that negative body image was positively related to self-disgust, disgust propensity and disgust sensitivity. Mediation analyses showed that, in line with our model, self-disgust partly accounted for the association between disgust propensity and negative body image. Although disgust sensitivity showed an independent relationship with body image, disgust sensitivity did not moderate the association between self-disgust and negative body image. All in all, findings are consistent with the view that self-disgust-induced avoidance may contribute to persistent negative body appraisals.

Altered processing of rewarding and aversive basic taste stimuli in symptomatic women with anorexia nervosa and bulimia nervosa: An fMRI study

Functional magnetic resonance imaging (fMRI) studies have displayed a dysregulation in the way in which the brain processes pleasant taste stimuli in patients with anorexia nervosa (AN) and bulimia nervosa (BN). However, exactly how the brain processes disgusting basic taste stimuli has never been investigated, even though disgust plays a role in food intake modulation and AN and BN patients exhibit high disgust sensitivity. Therefore, we investigated the activation of brain areas following the administration of pleasant and aversive basic taste stimuli in symptomatic AN and BN patients compared to healthy subjects. Twenty underweight AN women, 20 symptomatic BN women and 20 healthy women underwent fMRI while tasting 0.292 M sucrose solution (sweet taste), 0.5 mM quinine hydrochloride solution (bitter taste) and water as a reference taste. In symptomatic AN and BN patients the pleasant sweet stimulus induced a higher activation in several brain areas than that induced by the aversive bitter taste. The opposite occurred in healthy controls. Moreover, compared to healthy controls, AN patients showed a decreased response to the bitter stimulus in the right amygdala and left anterior cingulate cortex, while BN patients showed a decreased response to the bitter stimulus in the right amygdala and left insula. These results show an altered processing of rewarding and aversive taste stimuli in ED patients, which may be relevant for understanding the pathophysiology of AN and BN.

Validating the Italian Version of the Disgust and Propensity Scale-Revised

The aim of this work is to evaluate the factor structure and psychometric properties of the Italian version of the Disgust Propensity and Sensitivity Scale-Revised (DPSS-R, 16 items) in two samples taken from the general population. In the first study, 285 participants completed the DPSS-R questionnaire through a web-based survey. Exploratory factor analysis for ordinal Likert-type data supported the existence of four underlying factors, reflecting self-focused disgust, disgust propensity, somatic anxiety and disgust sensitivity. In the second study, an independent sample of 293 participants was enrolled as a test set to validate the factor structure obtained in the exploratory phase. The factor solution was confirmed, but showed quite highly correlated latent factors. We fitted the model and tested whether or not the bifactor structure was better than the previous one (four correlated factors). Actually, we had evidence supporting the presence of a general factor, providing a measure of disgust susceptibility, along with the four specific factors previously defined. This result could be useful also from the clinical perspective since the DPSS-R questionnaire will be used in clinical context, where underlying factors may be related to different and specific psychopathological profiles. Finally, we examined and visualized the interrelationships among the four DPSS-R factors and the external scales (Anxiety Sensitivity, Disgust Scale and Padua) using a graphical model approach.

Anorexia nervosa, depression and suicidal thoughts among Chinese adolescents: a national school-based cross-sectional study

Background

Although there is much literature on adolescent suicide, combined effects of depression and anorexia nervosa on suicide were rarely investigated. The aims of this study are to examine the association between anorexia nervosa and suicidal thoughts and explore the interaction between anorexia nervosa and depression.

Methods

This is a cross-sectional study, in the study, a sample of 8,746 Chinese adolescents was selected by multistage stratified method in 2012/2013 from 20 middle schools in 7 provinces across China Mainland. Multilevel logistic model was introduced to explore association between anorexia nervosa and suicidal thoughts. And subgroup analyses were conducted on participants with or without depression.

Results

Multilevel logistic model revealed that demographic variables, including academic achievement, were not the predictive risk factors of suicidal thoughts. Those who suffered from worse severity of perceived anorexia nervosa were at increased risk of thinking about suicide. The interaction between depression and anorexia nervosa was significant, however, subgroup analyses showed that the associations were significant only among the adolescents without depression.

Conclusions

Our results indicate that all levels of anorexia nervosa serve as predictable indicators of suicidal thoughts in Chinese adolescents, and the effects of anorexia nervosa are modified by depression status.

Food-Induced Emotional Resonance Improves Emotion Recognition

The effect of food substances on emotional states has been widely investigated, showing, for example, that eating chocolate is able to reduce negative mood. Here, for the first time, we have shown that the consumption of specific food substances is not only able to induce particular emotional states, but more importantly, to facilitate recognition of corresponding emotional facial expressions in others. Participants were asked to perform an emotion recognition task before and after eating either a piece of chocolate or a small amount of fish sauce-which we expected to induce happiness or disgust, respectively. Our results showed that being in a specific emotional state improves recognition of the corresponding emotional facial expression. Indeed, eating chocolate improved recognition of happy faces, while disgusted expressions were more readily recognized after eating fish sauce. In line with the embodied account of emotion understanding, we suggest that people are better at inferring the emotional state of others when their own emotional state resonates with the observed one.

Anorexia nervosa, emotional go/no-go, and the distinct effect of testosterone

OBJECTIVE

Behavioral disinhibition in the context of negative emotion (e.g., disgust, fear, etc.) may promote the core psychopathology of anorexia nervosa (AN). Affective models of AN position a number of clinical behaviors as functioning to reduce negative affect. Gonadal hormone dysregulation, in particular testosterone, likely plays some role in this process.

METHOD

Adolescent and young adult AN (n = 32) and healthy control (HC; n = 20) participants completed an emotional go/no-go task--a valenced measure of behavioral disinhibition--and had blood drawn to assess gonadal steroid hormone concentrations.

RESULTS

Analyses indicated that patients with AN committed significantly more commission errors, which measures the tendency to respond to nontarget stimuli. This effect was qualified by the valence of the stimulus; the higher relative level of error was true for disgust and happy stimuli, but not neutral stimuli. Hormone analyses revealed a testosterone by group interaction. Testosterone was associated with decreased commission errors for patients with AN, but had no discernible relationship with task outcome for HCs. These effects were not confounded by weight, pubertal status, or self-reported anxiety or depression.

DISCUSSION

These findings suggest patients with AN have difficulty inhibiting behavior in the context of emotional stimuli, and that this disinhibition is negatively related to levels of circulating androgens.

Disgust proneness and associated neural substrates in obesity

Defects in experiencing disgust may contribute to obesity by allowing for the overconsumption of food. However, the relationship of disgust proneness and its associated neural locus has yet to be explored in the context of obesity. Thirty-three participants (17 obese, 16 lean) completed the Disgust Propensity and Sensitivity Scale-Revised and a functional magnetic resonance imaging paradigm where images from 4 categories (food, contaminates, contaminated food or fixation) were randomly presented. Independent two-sample t-tests revealed significantly lower levels of Disgust Sensitivity for the obese group (mean score = 14.7) compared with the lean group (mean score = 17.6, P = 0.026). The obese group had less activation in the right insula than the lean group when viewing contaminated food images. Multiple regression with interaction analysis revealed one left insula region where the association of Disgust Sensitivity scores with activation differed by group when viewing contaminated food images. These interaction effects were driven by the negative correlation of Disgust Sensitivity scores with beta values extracted from the left insula in the obese group (r = -0.59) compared with a positive correlation in the lean group (r = 0.65). Given these body mass index-dependent differences in Disgust Sensitivity and neural responsiveness to disgusting food images, it is likely that altered Disgust Sensitivity may contribute to obesity.

Anorexia nervosa and its relation to depression, anxiety, alexithymia and emotional processing deficits

PURPOSE

Psychopathological changes and dysfunction in emotion processing have been described for anorexia nervosa (AN). Yet, findings are applicable to adult patients only. Furthermore, potential for discriminative power in clinical practice in relation to clinical parameters has to be discussed. The aim of this study was to investigate psychopathology and emotional face processing in adolescent female patients with AN.

METHODS

In a sample of 15 adolescent female patients with AN (16.2 years, SD ± 1.26) and 15 age and sex matched controls we assessed alexithymia, depression, anxiety and empathy in addition to emotion labelling and social information processing.

RESULTS

AN patients had significantly higher alexithymia, higher levels of depression, and state and trait anxiety compared to controls. There was a trend for a lower ability to recognize disgust. Happiness as a positive emotion was recognized better. All facial expressions were recognized significantly faster by AN patients. Associations of pathological eating behaviour and trait anxiety were seen.

CONCLUSION

In accordance with the stress reduction hypothesis, typical psychopathology of alexithymia, anxiety and depression is prevalent in female adolescent AN patients. It is present detached from physical stability. Pathogenesis of AN is multifactorial and already fully present in adolescence. An additional reinforcement process can be discussed. For clinical practice, those parameters might have a better potential for early prognostic factors related to AN than physical parameters and possible implication for intervention is given.

Neurocircuitry of limbic dysfunction in anorexia nervosa

Anorexia Nervosa (AN) is a serious psychiatric condition marked by firmly entrenched and maladaptive behaviors and beliefs about body, weight and food, as well as high rates of psychiatric comorbidity. The neural roots of AN are now beginning to emerge, and appear to be related to dysfunctional, primarily limbic, circuits driving pathological thoughts and behaviors. As a result, the significant physical symptoms of AN are increasingly being understood at least partially as a result of abnormal or dysregulated emotional processing. This paper reviews the nature of limbic dysfunction in AN, and how structural and functional imaging has implicated distinct emotional and perceptual neural circuits driving AN symptoms. We propose that top-down and bottom-up influences converge on key limbic modulatory structures, such as the subcallosal cingulate and insula, whose normal functioning is critical to affective regulation and emotional homeostasis. Dysfunctional activity in these structures, as is seen in AN, may lead to emotional processing deficits and psychiatric symptoms, which then drive maladaptive behaviors. Modulating limbic dysregulation may therefore be a potential treatment strategy in some AN patients.

A comparison of risk factors for women seeking labiaplasty compared to those not seeking labiaplasty

Little is known about the factors associated with the desire for labiaplasty. We compared 55 women seeking labiaplasty with 70 women in a comparison group who were not seeking labiaplasty. Measures administered included the Perception of Appearance and Competency Related Teasing Scale, Childhood Trauma Questionnaire, Disgust Scale Revised, and the Genital Appearance Satisfaction scale with open-ended questions about their genitalia. Approximately a third of the labiaplasty group recalled specific negative comments in the past towards their labia, a proportion significantly greater than the three per cent in the comparison group. Participants reporting genital teasing also showed higher Genital Appearance Satisfaction scores than those who were not teased. However, women seeking labiaplasty were, compared to the comparison group, no more likely to have a history of neglect or abuse during childhood. There was no difference between the groups on disgust sensitivity or the perception of being teased in the past about their competence or appearance in general.