The structure of disgust: domain specificity in relation to contamination ideation and excessive washing

The use of fear appeals for pandemic compliance: A systematic review of empirical measurement, fear appeal strategies and effectiveness

Interventions to pandemic outbreaks are often associated with the use of fear-appeal to trigger behavioral change, especially in public health issues. However, no systematic review exists in the literature on the effectiveness of fear appeal strategies in the context of pandemic compliance. This paper aims at providing systematic literature review that answers the following thought-provoking research questions: (1) What is the standard measurement of fear in relation to pandemics in the existing literature? (2) What are the fear appeal strategies used in the empirical literature? (3) How effective are fear appeal strategies in changing behavior toward adopting pandemic preventive measures? A total of 22 studies were selected from 455 potential studies, following a comprehensive literature search and assessment in accordance with the PRISMA guidelines. The findings show that nearly all the available studies on fear measurement used the Likert scale (as the standard approach) with different points of degree and fear appeal strategies such as fear triggers in media channels, print advertisements, and verbal descriptions. Furthermore, most studies conclude that fear appeal is effective in making participants adopt pandemic preventive measures; hence, it is effective for positive behavioral change (the degree of effectiveness depends on gender, population group, etc.), especially when combined with self-efficacy and socio-cultural considerations. Very few studies, however, find an insignificant association, arguably due to the kind and intensity of the fear appeal messages and strategies used.

Obsessive-Compulsive Symptomatology and Disgust Propensity in Disordered Eating Behaviors of Adolescents with Celiac Disease

BACKGROUND

Considering the importance of underlying psychopathological mechanisms that mediate maladaptive eating behaviors in celiac disease (CD) in the determination of cognitive-behavioral therapeutic approaches, we investigated the impact of obsessive-compulsive symptomatology and disgust propensity on disordered eating attitudes (DEA) and poor gluten-free diet (GFD) compliance in adolescents with CD.

METHOD

Adolescents with biopsy-proven CD (n = 148, aged 12-18 years) were compared with age- and sex-matched controls (n = 104) in terms of eating attitudes/behaviors, obsessive-compulsive symptoms, and disgust propensity, as well as depression and anxiety to rule out depression- and anxiety-related covariates. The clinical implications associated with poor GFD compliance were determined using between-subgroup analysis. Multivariate linear regression and multiple logistic regression were used to identify predictors of DEA and GFD noncompliance, respectively.

RESULTS

In adolescents with CD, DEA was remarkably associated with obsessive-compulsive symptom severity and disgust propensity, especially in contamination and core disgust sub-dimensions. Obsessionality and disgust propensity were independent predictors of DEA, of which the obsessive-compulsive symptom severity was the most decisive predictor of DEA. Higher DEA severity and lower body mass index were independent predictors of poor GFD compliance.

CONCLUSION

Higher obsessionality, accompanied by disgust-related evaluative conditioning processes, may contribute to constructing a cognitive network consisting of hypervigilance and catastrophic interpretations towards benign somatic stimulations, food-related preoccupations, and avoidant behaviors in the disordered eating of adolescents with CD. The reciprocal relationship between lifelong GFD and DEA, mediated by obsessionality and disgust propensity, was supported by current findings that could guide clinicians in the management of maladaptive eating behaviors in adolescents with CD.

Obsessive-compulsive disorder-contamination fears, features, and treatment: novel smartphone therapies in light of global mental health and pandemics (COVID-19)

This review aims to shed light on the symptoms of obsessive-compulsive disorder (OCD) with a focus on contamination fears. In addition, we will briefly review the current therapies for OCD and detail what their limitations are. A key focus will be on discussing how smartphone solutions may provide approaches to novel treatments, especially when considering global mental health and the challenges imposed by rural environments and limited resources; as well as restrictions imposed by world-wide pandemics such as COVID-19. In brief, research that questions this review will seek to address include: (1) What are the symptoms of contamination-related OCD? (2) How effective are current OCD therapies and what are their limitations? (3) How can novel technologies help mitigate challenges imposed by global mental health and pandemics/COVID-19.

Interoception and Obsessive-Compulsive Disorder: A Review of Current Evidence and Future Directions

Disrupted interoceptive processes are present in a range of psychiatric conditions, and there is a small but growing body of research on the role of interoception in obsessive-compulsive disorder (OCD). In this review, we outline dimensions of interoception and review current literature on the processing of internal bodily sensations within OCD. Investigations in OCD utilizing objective measures of interoception are limited and results mixed, however, the subjective experience of internal bodily sensations appears to be atypical and relate to specific patterns of symptom dimensions. Further, neuroimaging investigations suggest that interoception is related to core features of OCD, particularly sensory phenomena and disgust. Interoception is discussed in the context of treatment by presenting an overview of existing interventions and suggesting how modifications aimed at better targeting interoceptive processes could serve to optimize outcomes. Interoception represents a promising direction for multi-method research in OCD, which we expect, will prove useful for improving current interventions and identifying new treatment targets.

Pre-pandemic disgust proneness predicts increased coronavirus anxiety and safety behaviors: Evidence for a diathesis-stress model

Although health anxiety and corresponding safety behaviors can facilitate disease transmission avoidance, they can be maladaptive in excess, including during the coronavirus pandemic. Disgust proneness (i.e., tendency to experience and be sensitive to disgust) is one factor that may predict elevated coronavirus anxiety and safety behaviors during the pandemic, given the role of disgust in avoiding disease transmission. The present study examined the relations between pre-pandemic disgust proneness and coronavirus anxiety and safety behaviors in community adults who completed a 2016 study and were re-contacted on 4/1/2020 (N = 360). Interactions between pre-pandemic disgust proneness and current perceived stress were tested to examine a diathesis-stress model of the role of disgust proneness in anxiety response to the pandemic. Increased pre-pandemic disgust proneness predicted increased coronavirus anxiety and safety behaviors, controlling for number of COVID-19 cases by state. Consistent with a diathesis-stress model, current perceived stress moderated this effect, such that highest coronavirus anxiety and safety behaviors were reported by those with high disgust proneness and high stress. Trait disgust proneness may be a vulnerability factor for anxiety responses to the coronavirus pandemic, particularly among individuals experiencing high stress. Assessing disgust proneness and current stress may facilitate targeted anxiety intervention during the pandemic.

Development and psychometric evaluation of the colostomy disgust scale in patients with colostomy

OBJECTIVE

To establish and validate the Colostomy Disgust Scale (CDS) for assessing disgust in colostomy patients.

DESIGN

Triphasic, cross-sectional psychometric study.

SETTING

A total of 423 patients with colostomy (222 first samples and 201 s samples) were recruited from a tertiary hospital between January 2015 and April 2016.

METHODS

Three phases were undertaken: (a) item generation, (b) item selection and (c) evaluation and validation. The evaluation and validation of the CDS were performed through feasibility and initial item analysis, exploratory factor analysis, confirmatory factor analysis and internal consistency.

RESULTS

Following item generation and item selection, a 22-item CDS was generated. Principal axis factoring indicated a two-factor solution for the proposed CDS model, which was also verified by confirmatory factor analysis. Moreover, the proposed CDS had a high internal consistency.

CONCLUSION

The CDS is a self-report instrument with initial evidence for its validity and reliability. It is a promising tool to identify the triggers of disgust in colostomy contexts, which can be of great importance for promoting the mental health of colostomy patients.

Is Heightened Disgust Propensity Truly a Risk Factor for Contamination-Related Obsessive-Compulsive Disorder?

Disgust propensity (DP) has been conceptualized as a stable personality trait that confers risk for contamination-related OCD (C-OCD). However, the extent to which DP leads to the subsequent development of C-OCD is unclear. In fact, the presence of C-OCD might lead to an increase in DP rather than the inverse. The present study was aimed to test this hypothesis in a large clinical sample of OCD patients (≥ 21 years of age) with (C-OCD; n = 56) and without (NC-OCD; n = 103) contamination-related symptoms that completed measures of OCD symptoms, depression, anxiety, and DP. DP was assessed twice, in reference to the present situation (T1) and to when the participant was 18 years old (T0). The two groups did not significantly differ in DP at T0. However, C-OCD participants reported higher DP scores than NC-OCD at T1. Furthermore, the T1 vs T0 difference in DP was significant only in the C-OCD group. Subsequent analyses also showed that T1 DP levels, but not T0 levels, significantly predicted contamination-related symptoms. Despite study limitations, these findings question the role of DP as a risk factor for C-OCD.

Erroneously Disgusted: fMRI Study Supports Disgust-Related Neural Reuse in Obsessive-Compulsive Disorder (OCD)

Objective: fMRI scans of patients with obsessive-compulsive disorder (OCD) consistently show a hyperactivity of the insular cortex, a region responsible for disgust-processing, when confronted with symptom-triggering stimuli. This asks for an investigation of the role of disgust and the insula in OCD patients.

Methods: Seventeen inpatients with OCD and 17 healthy controls (HC) underwent fMRI scanning. Whole-brain contrasts were calculated for “Disgust vs. Neutral” for both groups, plus an analysis of variance (ANOVA) to assess the interaction between group and condition. Additionally, the emotional dimensions of valence and arousal, along with the ability to cope, were assessed by picture ratings.

Results: The picture ratings confirmed the patients’ heightened sensitivity to disgust with higher values for arousal and inability to cope, but not for valence. fMRI scans revealed no hyperactivity of the insula in patients compared to controls for the condition “Disgust vs. Neutral,” indicating no basic hypersensitivity to disgusting stimuli. Increased activity in the precuneus in controls for this condition might correspond to the downregulation of arousal.

Conclusions: The absent differences in neural activity of the insula in patients compared to controls for the disgust-condition, but heightened activity for symptom-provoking conditions, suggests that the illness is due to an erroneous recruitment of the insula cortex for OCD-stimuli. The finding is interpreted within the framework of the neural reuse hypothesis.

Different Disgust Domains Specifically Relate to Mental and Contact Contamination Fear in Obsessive-Compulsive Disorder: Evidence From a Path Analytic Model in an Italian Clinical Sample

Both contact contamination (CC) and mental contamination (MC) fears-which combined represent the most common manifestation of obsessive-compulsive disorder (OCD)-have been widely associated with disgust propensity. However, extant research explored this relationship using measures assessing only pathogen-related disgust, not taking into account the potential role played by sexual and moral disgust, despite literature about MC suggesting that this might be particularly relevant. In Study 1, the psychometric properties of the Italian version of the Three Domains of Disgust Scale (TDDS) were assessed in a large Italian community sample. Exploratory and confirmatory factor analyses confirmed the three-factor structure of the TDDS. The scale also showed good internal consistency and construct validity. In Study 2, the differential patterns of relationships between CC and MC and the three disgust domains were explored in an Italian clinical OCD sample using a path analytic approach. The TDDS-Pathogen subscale was a unique predictor of CC while the TDDS-Sexual subscale was a unique predictor of MC, after controlling for anxiety and depression. Surprisingly, the TDDS-Moral subscale was not a predictor of either domain of contamination fear. Limitations and clinical implications are discussed.

Disgust assessment: Factorial structure and psychometric properties of the French version of the Disgust Propension and Sensibility Scale Revised-12

The present study examined the internal and external validity of the French version of the 12-item Disgust Propensity and Sensitivity Scale-Revised (DPSS-12) in a nonclinical sample from the general population. Two hundred and eighty-two participants completed the DPSSf-12 questionnaire as well as the Anxiety Sensitivity Index (ASI), Anxiety Trait (STAI B), Obsessional Belief Questionnaire 44 items (OBQ 44), Obsessive Compulsive Inventory-Revised (OCI-R) and Positive and Negative Affect Schedule (PANAS). Confirmatory Factor Analysis supported a 2-factor structure after two sensitivity items were removed. The 10-item scale showed good internal consistency, construct validity and test-retest reliability. These adequate psychometric properties make the DPSSf-10 appropriate for use by researchers and practitioners.

Changes in Problematic Anger, Shame, and Disgust in Anxious and Depressed Adults Undergoing Treatment for Emotion Dysregulation

Emotion dysregulation, the pervasive difficulty managing negative emotions, is a core problem across mood and anxiety disorders. Anger, shame, and disgust are particularly problematic emotions, impacting both disorder severity and treatment outcome. We previously found that a 16-week dialectical behavior therapy skills training group (DBT-ST) was superior to an activities-based support group (ASG) in decreasing emotion dysregulation in 44 adults with high emotion dysregulation who met diagnostic criteria for an anxiety or depressive disorder. We presently examine these participants' changes in anger, shame, disgust, and distress using self-reports collected over 6 months during and after treatment. Hierarchical linear modeling analyses show that DBT-ST was superior to ASG in decreasing anger suppression (d = 0.93) and distress (d = 1.04). Both conditions significantly reduced shame, disgust propensity, and disgust sensitivity, but neither was superior for these outcomes. The treatments did not significantly reduce anger expression. Mediation analyses suggest that condition indirectly influenced 4-month anger suppression, shame, and distress through its effect on 2-month emotion dysregulation. These findings suggest that DBT-ST is efficacious for certain problematic emotions and distress in depressed and anxious adults and that common factors may account for some, but not all, of its benefits.

The effects of cognitive reappraisal on conditioned disgust in contamination-based OCD: An analogue study

Experimental research has shown that conditioned disgust is resistant to extinction, which may account for the slower habituation to disgust relative to fear in contamination-based obsessive-compulsive disorder (OCD). However, few studies have examined the efficacy of interventions that may attenuate conditioned disgust responses. Studies of cognitive reappraisal have demonstrated that reinterpreting a stimulus can alter emotional responding. This technique is based on cognitive theories which suggest that anxiety disorders arise from biased cognitions; therefore, changing a person's thoughts will elicit durable changes in emotional responses. Given the demonstrated effectiveness of cognitive reappraisal, the present study examined whether cognitive reappraisal would attenuate conditioned disgust responses. We conditioned participants high in contamination fear (n=55) using images of neutral food items (conditioned stimuli; CS) paired with videos of individuals vomiting (unconditioned stimuli; US) while we obtained subjective disgust reports. After conditioning, half of the participants were randomly assigned to cognitive reappraisal training aimed at decreasing their emotional response to the US and CS, while the other half received no such training. The findings showed that cognitive reappraisal participants demonstrated a reduction in learned disgust across sessions and further benefited from extinction. These findings suggest that cognitive reappraisal may be an effective strategy for attenuating learned disgust.

Does the measure matter? On the association between disgust proneness and OCD symptoms

Although some studies suggest that the association between disgust proneness (DP) and obsessive-compulsive symptoms (OCS) is specific to the contamination subtype, others suggest that DP is associated with OCS more broadly. To examine if the discrepant findings may partially reflect differences in self-report measures used, this investigation employed structural equation modeling to examine the association between DP and OCS in three samples that completed different combinations of measures of DP, OCS, and anxiety/negative affect. In Study 1 (n=626), the path from DP to contamination-based OCS was significantly stronger than the path from DP to non-contamination OCS when controlling for anxiety sensitivity. In Study 2 (n=403), the results showed that the path from DP to contamination-based OCS did not significantly differ from the path from DP to non-contamination OCS when controlling for negative affect. Lastly, Study 3 (n=296) showed that the path from DP to contamination-based OCS was significantly weaker than the path from DP to non-contamination OCS. These findings highlight that the self-report measures employed is an important moderator when making inferences about the association between DP and contamination-based OCS and non-contamination OCS.

The effect of disgust-related side-effects on symptoms of depression and anxiety in people treated for cancer: a moderated mediation model

As maladaptive disgust responses are linked to mental health problems, and cancer patients may experience heightened disgust as a result of treatments they receive, we explored the associations between disgust-related side-effects and symptoms of depression and anxiety in people treated for cancer. One hundred and thirty two (83 women, M age = 57.48 years) participants answered questions about their treatments, side-effects, disgust responding, and mental health. Experiencing bowel and/or bladder problems, sickness and/or nausea (referred to here as "core" disgust-related side-effects) was significantly related to greater symptoms of depression and borderline increased anxiety. Further, these links were explained by a moderated mediation model, whereby the effects of core disgust side-effects on depression and anxiety were mediated by (physical and behavioural) self-directed disgust, and disgust propensity moderated the effect of core disgust side-effects on self-disgust. These findings stress the importance of emotional responses, like disgust, in psychological adaptation to the side-effects of cancer treatments.

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.

Neural Circuitry of Interoception: New Insights into Anxiety and Obsessive-Compulsive Disorders

Over the past century, much research has investigated how the brain processes signals from the body (interoception) and how this processing may be disturbed in patients with psychiatric disorders. In this paper, I discuss the literature examining the relationship between interoceptive awareness and emotional and cognitive processes, and review the evidence suggesting that anxiety and obsessive-compulsive disorder (OCD) are characterized by abnormal interoception. A network of cortical and subcortical brain regions centered on the insula has repeatedly been implicated in interoception and is abnormal in anxiety and OCD. The investigation of interoception provides a framework for understanding behavioral and neural mechanisms of anxiety and OCD, although additional research is needed to directly link insula functioning to aberrant interoception in these disorders. Future work targeting interoception may be useful for the development of novel treatments.

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.

Emotion processing in words: a test of the neural re-use hypothesis using surface and intracranial EEG

This study investigates the spatiotemporal brain dynamics of emotional information processing during reading using a combination of surface and intracranial electroencephalography (EEG). Two different theoretical views were opposed. According to the standard psycholinguistic perspective, emotional responses to words are generated within the reading network itself subsequent to semantic activation. According to the neural re-use perspective, brain regions that are involved in processing emotional information contained in other stimuli (faces, pictures, smells) might be in charge of the processing of emotional information in words as well. We focused on a specific emotion-disgust-which has a clear locus in the brain, the anterior insula. Surface EEG showed differences between disgust and neutral words as early as 200 ms. Source localization suggested a cortical generator of the emotion effect in the left anterior insula. These findings were corroborated through the intracranial recordings of two epileptic patients with depth electrodes in insular and orbitofrontal areas. Both electrodes showed effects of disgust in reading as early as 200 ms. The early emotion effect in a brain region (insula) that responds to specific emotions in a variety of situations and stimuli clearly challenges classic sequential theories of reading in favor of the neural re-use perspective.

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.

Can theory be embedded in visual interventions to promote self-management? A proposed model and worked example

Nurses are increasingly involved in a range of strategies to encourage patient behaviours that improve self-management. If nurses are to be involved in, or indeed lead, the development of such interventions then processes that enhance the likelihood that they will lead to evidence that is both robust and usable in practice are required. Although behavioural interventions have been predominantly based on written text or the spoken word increasing numbers are now drawing on visual media to communicate their message, despite only a growing evidence base to support it. The use of such media in health interventions is likely to increase due to technological advances enabling easier and cheaper production, and an increasing social preference for visual forms of communication. However, the development of such media is often highly pragmatic and developed intuitively rather than with theory and evidence informing their content and form. Such a process may be at best inefficient and at worst potentially harmful. This paper performs two functions. Firstly, it discusses and argues why visual based interventions may be a powerful media for behaviour change; and secondly, it proposes a model, developed from the MRC Framework for the Development and Evaluation of Complex Interventions, to guide the creation of theory informed visual interventions. It employs a case study of the development of an intervention to motivate involvement in a lifestyle intervention among people with increased cardiovascular risk. In doing this we argue for a step-wise model which includes: (1) the identification of a theoretical basis and associated concepts; (2) the development of visual narrative to establish structure; (3) the visual rendering of narrative and concepts; and (4) the assessment of interpretation and impact among the intended patient group. We go on to discuss the theoretical and methodological limitations of the model.

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.

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 trait modulates frontal-posterior coupling as a function of disgust domain

Following the two-stage model of disgust, 'core disgust' (e.g. elicited by rotten food) is extended to stimuli that remind us of our animal nature 'AR disgust' (e.g. mutilations, animalistic instincts). There is ample evidence that core and AR represent distinct domains of disgust elicitors. Moreover, people show large differences in their tendency to respond with disgust to potential disgust elicitors (propensity), as well as in their appraisal of experiencing disgust (sensitivity). Thus these traits may be important moderators of people's response patterns. Here, we aimed to find brain mechanisms associated with these distinct disgust domains and traits, as well as the interaction between them. The right ventrolateral occipitotemporal cortex, which preferentially responded to visual AR, was functionally coupled to the middle cingulate cortex (MCC), thalamus and prefrontal cortex (medial, dorsolateral), as a function of disgust domain. Coupling with the anterior part of MCC was modulated by disgust 'propensity', which was strongest during AR. Coupling with anterior insula and ventral premotor cortex was weaker, but relied fully on this domain-trait interaction. Disgust 'sensitivity' modulated left anterior insula activity irrespective of domain, and did not affect functional connectivity. Thus a frontal-posterior network that interacts with disgust 'propensity' dissects AR and core disgust.

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.

Changes in disgust correspond with changes in symptoms of contamination-based OCD: a prospective examination of specificity

Although several studies have implicated disgust in contamination-based obsessive-compulsive disorder (OCD), there remains a paucity of research examining this relationship prospectively. To address this gap in the literature, undergraduate students (n=177) participated in a 12-week prospective study for which they completed measures of contamination-based OCD symptoms, disgust, and negative affect. Change in disgust levels over the 12-week period predicted change in symptoms of contamination-based OCD, even when controlling for age, gender, and change in negative affect. However, this association was driven by change in the perceived negative impact of experiencing disgust (disgust sensitivity) rather than change in the intensity that disgust is generally experienced (disgust propensity). Subsequent analyses also revealed that change in disgust sensitivity fully mediated the association between change in disgust propensity and change in symptoms of contamination-based OCD. The implications of these findings for further delineating the causal role of disgust-related vulnerabilities in contamination-based OCD are discussed.

Is disgust associated with psychopathology? Emerging research in the anxiety disorders

Recent evidence indicates that the propensity towards experiencing disgust may contribute to the development and maintenance of some anxiety disorders. This article summarizes the empirical evidence with emphasis on illuminating potential mediators, moderators, and mechanisms of the disgust-anxiety disorder association that may inform the development of an integrative conceptual model. Early research using neuroimaging methods suggest that disgust processing is associated with activation of the insula. This research has the potential to facilitate progress in developing an empirically informed psychobiological theory on the causal role of disgust in the anxiety disorders.

Differential habituation of fear and disgust during repeated exposure to threat-relevant stimuli in contamination-based OCD: an analogue study

In the present study, participants (N=20) displaying marked contamination concerns were provided 30 min of repeated in vivo exposure to threat-relevant stimuli (cleaning a 'dirty' bed pan), during which time their fear and disgust levels were repeatedly assessed. Results indicated that repeated exposure led to a significant decline in fear but not disgust. The observed decline in fear remained significant after accounting for changes in disgust and vice versa. Although initial disgust was higher than initial fear ratings, differences between the two slopes were not statistically significant. Baseline trait anxiety and global disgust sensitivity levels prior to exposure did not moderate the level of fear or disgust activation during exposure. However, sensitivity specifically related to core and contamination disgust was marginally associated with fear and disgust parameters during outcome. There was also evidence that less fear decline during repeated exposure was associated with higher disgust ratings after the exposure was completed. Theoretical and clinical implications of the present findings for the treatment of contamination concerns in obsessive-compulsive disorder are discussed.

Behavioral avoidance and self-reported fainting symptoms in blood/injury fearful individuals: an experimental test of disgust domain specificity

This study examined the specificity of disgust in predicting avoidance in blood/injury (BI) phobia. Participants high (n=38) and low (n=46) in BI fear completed measures of disgust across multiple domains and severity of BI-related fear. They then completed three randomly presented behavioral avoidance tasks (BATs) that consisted of exposure to a 15'' severed deer leg (BI task), a live spider (spider task), and a 'contaminated' cookie (cookie task). Fainting symptoms associated with each BAT were recorded as well. When controlling for gender and BI fear group membership, mutilation disgust contributed unique variance to avoidance on the BI task and animal disgust contributed unique variance to avoidance on the spider task. None of the disgust domains contributed unique variance to avoidance on the cookie task. For the high BI fear group, self-reported fainting symptoms were more pronounced during the BI and spider BAT than during the cookie BAT. Although mutilation disgust was significantly associated with self-reported fainting symptoms on the BI task among the high BI fear group, this relationship became nonsignificant when controlling for BI-related fear severity. Implications of the domain specificity of disgust and its relevance for understanding fainting responses in BI phobia are discussed.

Disgust sensitivity as a predictor of obsessive-compulsive contamination symptoms and associated cognitions

Disgust sensitivity has been hypothesized to play a key role in the etiology and maintenance of several anxiety disorders. The association between disgust sensitivity, trait anxiety, and washing and contamination-related concerns was tested using two different measures of obsessive-compulsive contamination fears using linear structural modeling. Two different models were tested, one where trait anxiety mediated the relationship between disgust sensitivity and contamination fear, and a second model unmediated by trait anxiety. A total of 740 undergraduates completed self-report measures of disgust sensitivity, trait anxiety, and obsessive-compulsive symptoms for course credit. The results indicated that there was insufficient evidence for the mediating role of trait anxiety, and the more parsimonious structural models specifying direct effects between disgust sensitivity and both washing and contamination concerns fit the data well. The results of this research support the central role of disgust in contamination fear.

Gender Differences in Psychophysiological Responses to Disgust

Several studies have revealed that women report stronger feelings of disgust than men ( Gross & Levenson, 1995 ; Schienle, Schäfer, Stark, Walter, & Vaitl, 2005 ). However, the extent to which this gender difference also influences physiological disgust responses remains an open question. In Experiment 1, 54 female and 41 male participants were exposed to slides of different disgust-content. In Experiment 2, 47 women and 53 men watched two film clips showing hygiene-related or food-related disgust stimuli, respectively. Differences between males and females in reported and physiological disgust responses (heart rate, electrodermal activity, salivary cortisol, secretory immunoglobulin A) were tested by analysis of variance. Replicating previous studies, women reported stronger feelings of disgust than men across all disgust inductions. Additionally, in Study 1, women showed a higher increase in skin conductance level than men. In conclusion, gender moderates subjective responses to disgust, whereas physiological disgust responses are only marginally moderated by gender. Gender stereotypes as an explanation for the results are discussed.

The Disgust Propensity and Sensitivity Scale-Revised: psychometric properties and specificity in relation to anxiety disorder symptoms

The present study examined the factor structure and psychometric properties of the Disgust Propensity and Sensitivity Scale-Revised (DPSS-R) in a nonclinical sample (N=340). Principal components analysis of the DPSS-R revealed a two-factor structure consisting of Disgust Propensity and Disgust Sensitivity. Although the two-factor structure converged well with prior research, four of the 16 DPSS-R items did not load onto the predicted factor. The DPSS-R demonstrated good reliability and validity. The DPSS-R and its two factors were moderately correlated with spider fear and contamination fear and mildly correlated with injection fear. The relation between the DPSS-R and these anxiety disorder symptoms remained largely intact after controlling for negative affect. Regression analyses also revealed that the two DPSS-R factors demonstrate specificity in the prediction of anxiety disorder symptoms. These findings are discussed in terms of promoting a more valid and reliable assessment of disgust in anxiety disorders.

Structural differentiation of disgust from trait anxiety in the prediction of specific anxiety disorder symptoms

Research has begun to implicate the role of disgust in the etiology of specific phobias and obsessive-compulsive disorder (OCD). However, it remains unclear if the association between disgust and specific anxiety disorder symptoms is an artifact of trait anxiety or a potential mechanism through which trait anxiety effects specific anxiety disorder symptoms. The present study employed structural equation modeling to differentiate disgust from trait anxiety in the prediction of four types of specific anxiety disorder symptoms in a non-clinical sample (N=352). Results indicate that disgust and trait anxiety latent factors were independently related to spider fears, blood-injection-injury (BII) fears, general OCD symptoms, and OCD washing concerns. However, when both variables were simultaneously modeled as predictors, latent disgust remained significantly associated with the anxiety disorder symptoms, whereas the association between latent trait anxiety and the anxiety disorder symptoms became non-significant or was substantially reduced. Statistical tests of intervening variable effects converged in support of disgust as a significant intervening variable between trait anxiety and spider fears, BII fears, and OCD symptoms (particularly washing concerns). The relevance of these findings for future research investigating the role of disgust in specific anxiety disorders is discussed.

Neural responses to facial expressions of disgust but not fear are modulated by washing symptoms in OCD

BACKGROUND

Washing symptoms in Obsessive-Compulsive Disorder (OCD) are associated with increased trait sensitivity to disgust. This study explored neural systems underlying sensitivity to symptom-unrelated disgust and fear in OCD using functional neuroimaging.

METHODS

Seventeen OCD subjects and 19 controls viewed facial expressions of disgust and fear (versus neutral) presented just above the level of conscious awareness in a backward masking paradigm.

RESULTS

The OCD group showed greater activation than controls in the left ventrolateral prefrontal cortex, but reduced activation in the thalamus, to facial expressions of disgust. There were no between-group differences in response to fear. Further analysis using a median-split to divide OCD subjects into high and low washers suggested that the enhanced ventrolateral prefrontal cortex response was being driven by predominantly female OCD subjects with high washing symptoms. These subjects also reported higher levels of trait sensitivity to disgust.

CONCLUSIONS

These findings are consistent with previous reports of increased response to symptom-relevant and generally disgusting stimuli in neural regions associated with disgust and autonomic response processing in OCD patients with prominent washing symptoms. Together, these findings point to increased sensitivity to disgust stimuli as a component of the pathophysiology of the washing/contamination symptom dimension of OCD.

Specificity of disgust sensitivity in the prediction of behavioral avoidance in contamination fear

This study examined the specificity of disgust sensitivity in predicting contamination-related anxiety and behavioral avoidance. Participants high (n=26) and low (n=30) in contamination fear completed self-report measures of disgust sensitivity, contamination cognitions (overestimation of the likelihood and severity of contamination from everyday objects), anxiety, and depression. They then completed three randomly presented contamination-based behavioral avoidance tasks (BATs) that consisted of exposure to a used comb, a cookie on the floor, and a bedpan filled with toilet water. Results indicated that disgust sensitivity was significantly associated with anxious and avoidant responding to the contamination-related BATs. This association remained largely intact after controlling for gender, contamination fear group membership, anxiety, and depression. Contamination cognitions were also significantly related to BAT responses. However, this relationship was fully mediated by disgust sensitivity. These findings indicate that disgust sensitivity has a specific and robust association with contamination concerns commonly observed in obsessive compulsive disorder. The findings are discussed in the context of a disease-avoidance model.