Self-disgust as a potential mechanism underlying the association between PTSD and suicide risk

Is self-disgust an implicit or explicit emotional schema?

Self-disgust, a negative self-conscious emotional schema that is associated with mental health difficulties in both clinical and non-clinical populations, is typically assessed with self-reported measures that target physical and behavioural aspects of the self. The aim of the present research was to develop and validate a novel implicit self-disgust measure (ISDM) using an Implicit Association Task (IAT) paradigm, across three studies. Study 1 developed a list of disgust-related and positive words that were rated for emotional valence and arousal and informed the content of the ISDM. Study 2 developed and examined the ISDM using the single-target IAT in a non-clinical population and showed that scores in the ISDM were significantly associated with self-reported self-disgust. Study 3 partly replicated the findings of Study 2 among participants with trauma-related experiences and following a mood induction paradigm, showing a significant association between the ISDM and the physical aspect of self-reported self-disgust. These findings are significant because they have implications about the automaticity of self-disgust in people with traumatic experiences which can further inform clinical practice and interventions targeting self-disgust.

Trauma reminders and disgust: The roles of posttraumatic stress disorder symptom severity, trauma type, and reminder type

Disgust is a common emotional response to trauma but is studied less frequently than fear or other negative emotions. In laboratory settings, individuals with a history of sexual assault report more disgust following exposure to trauma reminders than those exposed to other trauma types, and people with more severe posttraumatic stress disorder (PTSD) symptoms typically report more disgust than those with lower symptom levels. It remains unknown whether this association is also present in ecological contexts and if these associations vary by trauma reminder type. The present sample included 80 trauma-exposed community members (PTSD: n = 39, no PTSD: n = 41) who completed up to 17 prompts per day for 3 days (2,158 total completed surveys). Multilevel models indicated that trauma reminders were associated with increased feelings of disgust, B = 0.16, SE = 0.06, p < .001, which was consistent across trauma reminder types, p < .001-p = .001. PTSD symptom severity moderated the association between trauma reminders and disgust such that it was stronger for participants with higher CAPS-5 scores, B = 0.02, SE = 0.01, p = .011. All trauma reminder types demonstrated the same pattern of moderation, ps = .003-.022, except flashbacks, p = .070. Trauma type was not a significant moderator of any trauma reminder type, ps = .193-.929. These findings suggest that trauma reminders encountered in daily life are associated with feelings of disgust. The results underscore the importance of exploring disgust as a trauma-related emotional experience among trauma survivors.

Self-burdensomeness, other-burdensomeness, and suicidal ideation

Perceiving oneself as a burden to others (other-burdensomeness), as well as perceiving one's selfhood as a burden (self-burdensomeness), have been proposed as risk factors for suicidal ideation. Yet, it is unclear whether the altruistic motive of being a burden to others or the self-oriented motive of being a burden on oneself is more relevant to suicidal ideation. Given this background, two rival mediation models were tested. Data from N = 228 outpatients (64% female; age: M(SD) = 38.69 (12.27), range:17-65) undergoing psychotherapy were collected at two measurement time points over a three-month period (first measurement = T1, second measurement = T2). The significant positive association between other-burdensomeness (T1) and suicidal ideation (T2) was partially mediated by self-burdensomeness (T1). Furthermore, the significant positive association between self-burdensomeness (T1) and suicidal ideation (T2) was partially mediated by other-burdensomeness (T1). Results suggest that suicidal ideation can develop from both an altruistic, self-sacrificial perception of being a burden to others, as well as from a more self-oriented perception of being a burden to oneself. There is no indication that either self-burdensomeness or other-burdensomeness is a stronger indicator in the development of suicidal ideation.

Exploring the role of the self in disgust-related psychopathologies

While clinical research on disgust relies on nonclinical research, the framework of disgust as an immune mechanism is not as central in clinical research. The immune framework for disgust may be integrated into clinical research by acknowledging the role of the self as the critical element protected by the immune system. In this review, we offer the premise that at the center of all disgust-related behaviors, thoughts, and cognitions is an attempt to protect the self (i.e., "disgust is self-centered" or DISC). We offer evidence in support of DISC and explore the relevance of DISC to clinical research for several disgust-related psychopathologies (obsessive-compulsive disorder, posttraumatic stress disorder, anorexia nervosa, and self-disgust). We then offer future directions for DISC research into disgust-related psychopathologies.

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.

The moderating role of sexual minority status in the associations of the experience and tolerance of shame-related emotions to suicide risk

OBJECTIVE

This study examined the associations of the experience and tolerance of shame-related emotions to suicide risk, as well as the moderating role of sexual minority status.

METHODS

Community adults (N = 360) were recruited via MTurk and completed self-report questionnaires. Hierarchical regression analyses examined the main and interactive associations of sexual minority status and shame-related variables to suicide risk.

RESULTS

Results revealed significant positive associations between self-disgust and suicide risk for sexual minority and heterosexual participants, although the magnitude was greater for sexual minority participants. Additionally, tolerance of shame was significantly negatively related to suicide risk only among sexual minority participants. Finally, exploratory analyses examining the three-way interaction of self-disgust, shame tolerance, and sexual minority status revealed a significant negative association between shame tolerance and suicide risk only among sexual minority participants with high levels of self-disgust.

CONCLUSION

Results highlight the relevance of shame-related experiences to suicide risk among sexual minorities.

Anxious Personality Traits: Perspectives from Basic Emotions and Neurotransmitters

Objective: Recently, many emotional diseases, such as anxiety and depression, have prevailed, and it is expected that emotional disease will be the leading cause of social and economic burden in 2030. These emotional diseases may be due to certain personality traits, which could be the reasons for the development of mental illness. Personality theories have been constantly developed over the past hundreds of years, and different dimensions of personality traits corresponding to different physiological bases and emotional feelings have been proposed. However, personality may be the least studied area in psychology. Methods: In this paper, we will give a short review on the development of personality theories as well as dimensional emotional theory. Then, we will compare the similarities between the emotional dimension and personality dimension. Furthermore, we will also investigate the neural mechanisms of personality and emotions, focusing on neuromodulators for anxiety-related personality traits, in order to provide a clear relationship between different neurotransmitters and anxiety-related personality traits. Results: The results of our study suggest that the emotional dimension and personality dimension may be somewhat related, for example, the extrovert/introvert dimension of personality might be related to the hedonic dimension, which includes happiness/sadness, and the neurotic dimensions might be related to emotional arousal. In addition, our study found that personality traits are also related to basic emotions, for instance, people who are too self-centered are prone to feeling a mood of disgust or depression, while anger and fear correspond to unstable personality traits. The analysis suggested that the neural substrates of both personality and emotions might be described as follows: extroverted–joy–dopamine (DA); introverted–disgust–5-hydroxytryptamine (5-HT); unstable (neuroticism)–anger/fear–noradrenaline (NE); stable–calmness. Conclusions: The results of this study suggest that there is a correlation between personality traits and emotions, and both depend on monoamine neurotransmitters (dopamine, norepinephrine and serotonin). In addition, personality disorders can be interfered via the regulation of emotions and neurotransmitters. This paper opens up a whole new perspective for future research on personality traits and emotional diseases and has great clinical value and practical significance.

'The last thing you feel is the self-disgust'. The role of self-directed disgust in men who have attempted suicide: A grounded theory study

OBJECTIVE

Globally, suicide affects more men than women. Emotional pain underpins many theoretical accounts of suicidality, yet little is known about the role of disgust in suicide. Self-directed disgust, whereby aspects of the self-serve as an object of disgust, has been hypothesised to factor in suicide. This research aimed to explore the processes which link self-disgust to attempted suicide in males.

METHOD

Nine men who had attempted suicide completed semi-structured interviews. The interview data were analysed using a constructivist grounded theory methodology.

RESULTS

Three concepts emerged out of the analysis: (1) self-disgust; (2) worthlessness; and (3) the endured emotional distress of 'the abyss'" - these concepts interweaved, leading the men to experience hopelessness, disconnection and an inability to cope, leading ultimately to their suicide attempt. Throughout this journey, various disgust-related processes worsened men's distress and increased their suicidal risk. Historic adversities prevailed across the data, as did the men's difficulties in understanding their emotions.

CONCLUSION

Self-disgust was an important emotion in the men's experiences of suicide and shaped their views of themselves and their lives. The distancing and repellent properties of self-disgust, in addition to the fear of having their 'disgustingness' exposed, increased suicidal risk. Self-disgust appeared more pervasive in the suicidality of men with a history of multiple childhood adversities. The limitations of this research are discussed as implications for clinical practice and directions for future research.

Posttraumatic stress disorder hyperarousal event detection using smartwatch physiological and activity data

Posttraumatic Stress Disorder (PTSD) is a psychiatric condition affecting nearly a quarter of the United States war veterans who return from war zones. Treatment for PTSD typically consists of a combination of in-session therapy and medication. However; patients often experience their most severe PTSD symptoms outside of therapy sessions. Mobile health applications may address this gap, but their effectiveness is limited by the current gap in continuous monitoring and detection capabilities enabling timely intervention. The goal of this article is to develop a novel method to detect hyperarousal events using physiological and activity-based machine learning algorithms. Physiological data including heart rate and body acceleration as well as self-reported hyperarousal events were collected using a tool developed for commercial off-the-shelf wearable devices from 99 United States veterans diagnosed with PTSD over several days. The data were used to develop four machine learning algorithms: Random Forest, Support Vector Machine, Logistic Regression and XGBoost. The XGBoost model had the best performance in detecting onset of PTSD symptoms with over 83% accuracy and an AUC of 0.70. Post-hoc SHapley Additive exPlanations (SHAP) additive explanation analysis showed that algorithm predictions were correlated with average heart rate, minimum heart rate and average body acceleration. Findings show promise in detecting onset of PTSD symptoms which could be the basis for developing remote and continuous monitoring systems for PTSD. Such systems may address a vital gap in just-in-time interventions for PTSD self-management outside of scheduled clinical appointments.

Self-disgust as a potential mechanism underlying the association between body image disturbance and suicidal thoughts and behaviours

This study examined whether self-disgust added incremental variance to and mediated the multivariate association between measures of body image disturbance and suicidal thoughts and behaviours. We hypothesized that self-disgust would be associated with suicidal ideation above the effects of body image disturbance, and that self-disgust would mediate the relationship between body image disturbance and suicidal ideation. A total of N=728 participants completed The Body Image Disturbance Questionnaire, The Self-Disgust Scale, and the Suicidal Behaviours Questionnaire-Revised. Suicidality was significantly related to increased levels of self-disgust and body image disturbance, whereas self-disgust was associated with greater body image disturbance. Linear regression analysis showed that self-disgust was associated with suicidal thoughts and behaviours, over and above the effects of body image disturbance. Multiple mediation modelling further showed that self-disgust mediated the relationship between body image disturbance and suicidal thoughts and behaviours. Our findings highlight the role of self-disgust in the context of body image disturbance and support the notion that body image disturbance is associated with aversive self-conscious emotions. Interventions aiming to reduce the risk of suicidality in people with body image disturbance may address self-disgust and negative self-conscious emotions.

Fluid vulnerability theory as a framework for understanding the association between posttraumatic stress disorder and suicide: A narrative review

Suicide is a persistent issue in the United States and across the globe. A large body of published research shows that posttraumatic stress disorder (PTSD) increases the risk of suicidal ideation, suicidal behaviors, and death by suicide. However, the existing literature examining why that association might pertain is widely dispersed across disciplines (e.g., psychology, nursing) and lacks an integrative theoretical framework, making it difficult to conceptualize the current state of science in this area. Therefore, the primary aims of this narrative review were to (a) provide a comprehensive and interdisciplinary critique of the current state of knowledge regarding mechanisms that underlie the association between PTSD and suicide and (b) organize that knowledge according to a specified theoretical framework. The framework guiding this review is "fluid vulnerability theory," a diathesis-stress model of suicide that emphasizes the dynamic nature of suicide risk across cognitive, emotional, behavioral, and physiological domains. A summary of the findings, including patterns that emerged, gaps that remain, and recommendations for the advancement of science and practice in this area are addressed in this narrative review.

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.

Self-Disgust Is Associated With Loneliness, Mental Health Difficulties, and Eye-Gaze Avoidance in War Veterans With PTSD

In the present study, we examined, for the first time, the association between self-disgust, loneliness, and mental health difficulties in war veterans diagnosed with PTSD. For this purpose, we used a mixed methods design, incorporating surveys and a novel eye-tracking paradigm, and compared the findings from the PTSD veteran group (n = 19) to those from a general population group (n = 22). Our results showed that the PTSD veteran group reported almost three times higher scores in self-disgust, and significantly higher scores in loneliness and mental health difficulties (anxiety and depression), compared to the general population. Furthermore, self-disgust mediated the association between loneliness and anxiety symptoms in both groups. The results from the eye-tracking paradigm further showed that veterans with PTSD displayed a self-avoidance gaze pattern, by looking significantly more toward pictures of faces of unknown others and away from their own face—a pattern that was not replicated in the general population group. Higher self-disgust scores were significantly associated with longer total gaze to the pictures of others (vs. the self). Our findings have implications for the role of self-disgust in the mental health of war veterans.

Self-Disgust and Its Relationship With Lifetime Suicidal Ideation and Behavior

Abstract. Background: The emotion disgust is typically directed toward stimuli in the external environment, but sometimes people develop self-directed disgust responses. Aims: The current questionnaire study focused on the role of self-disgust in lifetime suicidal ideation and behavior. Method: A total of 1,167 individuals participated in an Internet-based survey containing self-report measures of self-disgust, externally directed disgust proneness, coping styles, diagnoses of mental disorders, and suicide risk. Hierarchical regression analyses as well as mediation analyses were computed. Results: Self-disgust was the most relevant predictor of suicide risk among the assessed variables. Self-disgust was negatively associated with the use of support by others, and positively associated with evasive coping (self-blame, venting, denial), which in turn was positively associated with suicidality. Limitations: This cross-sectional study provided information on the relationship between self-disgust and suicidality in a self-selected sample. Longitudinal studies are warranted. Conclusion: Future studies are required to replicate these findings. Additionally, stronger research designs are needed in order to investigate whether self-disgust should be targeted in suicide prevention programs and interventions.

Questionnaire for the Assessment of Self-Disgust: The psychometric testing among mental disorders in China

Research on self-disgust is relevant to psychopathologic tendencies because it has been shown to play a critical role in several mental disorders. Examining self-disgust and exploring its role in mental health are significant goals. The purpose of this study was to translate the Questionnaire for the Assessment of Self-Disgust (QASD) into Chinese and evaluate its validity and reliability. The translation and validation of the QASD were guided by the World Health Organization's Process of Translation and Adaptation of Instruments. Three phases were undertaken: (a) professional translation and expert panel review, (b) pretesting, and (c) psychometric evaluation. The psychometric evaluation was tested among 1,068 patients who were recruited from two psychiatric hospitals and three psychological clinics of tertiary hospitals. In this study, multigroup confirmatory factor analysis (CFA) supported the two-factor structure of the original QASD construct. Measurement invariance showed that the QASD is invariant across the patients with heterogeneous mental health diagnoses. The correlation of QASD with the Self-Esteem Scale (SES) and the Trait Anger Scale (TAS) showed that it has good convergent validity and discriminative validity. Internal consistency and test-retest yielded acceptable results. Thus, the findings suggest that the Chinese version of the QASD is a reliable and valid instrument with adequate psychometric properties for assessment of self-disgust among patients with mental disorders in China.

Self-disgust, loneliness and mental health outcomes in older adults: An eye-tracking study

BACKGROUND

Self-disgust has been associated with loneliness and mental health difficulties in clinical and non-clinical populations, but there is limited research on the role of self-disgust in loneliness and mental health outcomes in older adults.

METHODS

In Study 1 (N = 102; M age = 68.4 years, SD = 10.9, 68% females) we used a cross-sectional survey to explore the association between loneliness, self-disgust and mental health outcomes. In Study 2 (N = 80; M age = 68.8 years, SD = 11.4, 57% females) we used eye-tracking to investigate attentional vigilance, maintenance and avoidance in individuals with high (vs. low) self-disgust.

RESULTS

In study 1 we found that self-disgust mediated the associations of loneliness with anxiety and depressive symptoms, and in study 2 it was demonstrated that older adults with high (vs. low) self-disgust displayed attentional avoidance to their own faces, compared to the faces of unknown others, a process that may perpetuate loneliness.

LIMITATIONS

The cross-sectional design used in Study 1 limits our potential to make causal inferences. Additionally, both studies included a wide age range of older adults.

CONCLUSIONS

Our findings are novel and highlight the importance of self-disgust experiences in the context of loneliness and mental health outcomes in older adults. Implications for practice and interventions against loneliness in this age group are discussed.

Perceived burdensomeness, bullying, and suicidal ideation in suicidal military personnel

OBJECTIVE

Suicide is a major public health concern among military servicemembers and previous research has demonstrated an association between bullying and suicide. This study evaluated the association between workplace bullying and suicidal ideation via perceived burdensomeness and thwarted belongingness which were hypothesized to mediate this association.

METHOD

Four hundred and seventy-one suicidal Army Soldiers and U.S. Marines completed self-report measures of suicidal ideation, thwarted belongingness, perceived burdensomeness, and bullying. A series of regressions were used to test the hypothesized mediation model using the baseline data from a larger clinical trial.

RESULTS

Perceived burdensomeness was a significant mediator of the association between bullying and the level of suicidal ideation, but thwarted belongingness was not a significant mediator.

CONCLUSIONS

Perceived burdensomeness may represent a malleable target for intervention to prevent suicide among military service members, and should be evaluated further as an intervening variable with regard to suicidality in the setting of bullying victimization.

Self-disgust as a potential mechanism explaining the association between loneliness and depression

BACKGROUND

Loneliness and self-disgust have been considered as independent predictors of depressive symptoms. In the present study, we hypothesized that self-disgust can explain the association between loneliness and depression, and that emotion regulation strategies interact with self-disgust in predicting depressive symptoms.

METHODS

Three hundred and seventeen participants (M = 29.29 years, SD = 14.11; 76.9% females) completed structured anonymous self-reported measures of loneliness, self-disgust, emotion regulation strategies, and depressive symptoms.

RESULTS

One-way MANOVA showed that participants in the high-loneliness group reported significantly higher behavioural and physical self-disgust, compared to those in the middle and low-loneliness groups. Bootstrapped hierarchical linear regression analysis showed that self-disgust significantly improved predicted variance in depressive symptoms, after controlling for the effects of loneliness. Regression-based mediation modelling showed that both physical and behavioural self-disgust significantly mediated the association between loneliness and depression. Finally, moderated regression analysis showed that expressive suppression interacted with self-disgust in predicting depressive symptoms.

LIMITATIONS

A cross-sectional design was used, and our study focused on expressive suppression and cognitive reappraisal but not on other aspects of emotion regulation or the modulation of emotional arousal and responses.

CONCLUSIONS

We demonstrated, for the first time, that self-disgust plays an important role in the association between loneliness and depressive symptoms. Furthermore, variations in emotion regulation strategies can explain the association between self-disgust and depressive symptoms.

Posttraumatic stress and hazardous alcohol use in trauma-exposed young adults: indirect effects of self-disgust

BACKGROUND

Posttraumatic stress disorder (PTSD) and alcohol use disorders are highly co-occurring. Several explanatory models of the relation between PTSD and hazardous alcohol use have been identified. However, the exact nature of this relation is not fully understood. Self-disgust may explain the relation between PTSD symptoms and hazardous drinking.

OBJECTIVES

The goal of the current study was to examine whether there was an indirect effect of probable PTSD on hazardous alcohol use via two domains of self-disgust: (disgust with characteristics of the self, disgust with one's behavior). Participants were 376 undergraduate students who reported experiencing at least one Diagnostic and Statistical Manual for DSM Disorders, 5th edition-defined traumatic event. Participants completed self-report measures online, which assessed their trauma exposure, PTSD symptoms, self-disgust, and their alcohol use behaviors.

RESULTS

Probable PTSD was indirectly associated with an increased likelihood of engaging in hazardous drinking through the pathway of increased disgust toward one's behaviors. Although probable PTSD was also positively linked to disgust with characteristics of the self, this form of self-disgust was associated with a decreased likelihood of engaging in hazardous drinking, leading to a negative indirect relationship between probable PTSD and hazardous drinking. Conclusions/Importance: Overall, this study suggests that the role of self-disgust in the association between PTSD and hazardous drinking is complex, highlighting the need for further research in this area.

Suicidality in Subjects With Anxiety or Obsessive-Compulsive and Related Disorders: Recent Advances

PURPOSE OF REVIEW

Historically, anxiety disorders have not been considered as important determinants of suicide, but in the last years, many works have challenged this assumption. Here, we will review the available evidence on the relationship between suicide and anxiety disorders (e.g., obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, panic disorder, and body dysmorphic disorder), with special emphasis on findings published in the last years.

RECENT FINDINGS

Overall, anxiety disorders increase the risk of suicide. Specifically, 16% of patients with social anxiety disorder reported suicidal ideation in the previous month, and 18% of them had a history of suicide attempts. Similarly, in patients with panic disorder, suicidal ideation prevalence ranged between 17 and 32%, and 33% of them had a history of suicide attempts. Generalized anxiety disorder (GAD) was the most frequent anxiety disorder in completed suicides (present in 3% of people who committed suicide) and also subthreshold GAD was clearly linked to suicide ideation. Post-traumatic stress disorder was positively associated with suicidal ideation, and in patients with obsessive-compulsive disorder, suicide ideation rates ranged from 10 to 53% and suicide attempts from 1 to 46%. Body dysmorphic disorders presented a suicide ideation prevalence of about 80%. Suicide risk is increased in subjects with anxiety disorder. This risk is higher in the presence of comorbidities, but it is not clear whether it is independent from such comorbidities in some disorders.