The structural relation between disgust sensitivity and blood-injection-injury fears: a cross-cultural comparison of US and Dutch data

Treatment of disgust in specific emotional disorders

Although conditioning approaches have highlighted potential characteristics of disgust in anxiety disorders, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD), these findings have yet to be translated into evidence-based treatments. Examination of the literature suggests various indicators of disgust that predict treatment outcome in these disorders. However, mechanisms remain unclear because studies examining disgust during the course of treatment are limited. Increasingly, the field has moved toward experimental investigation of strategies that reduce disgust. While cognitive reappraisal and imagery techniques appear promising, such techniques have yet to be examined as anxiety disorder treatments in large-scale randomized clinical trials. The literature also points to novel approaches to treating disgust, ranging from an inhibitory-informed approach to exposure therapy to transcranial direct current stimulation. However, the development of novel treatment approaches will require more rigorous experimental psychopathology approaches that can further elucidate processes that contribute to the etiology and/or maintenance of disorders of disgust.

A comprehensive group-based cognitive behavioural treatment for blood-injection-injury phobia

OBJECTIVES

A key feature of blood-injection-injury (BII) phobia is activation of disgust responses, in addition to fear. Yet, standard treatments have largely neglected addressing disgust responses. The disorder is further complicated by fainting in 75% of sufferers. Moreover, treatments have been traditionally delivered in an individual format, which may not be as efficient as group treatment. The aim of this study was to develop a group-based programme for BII phobia, with components targeting fear, disgust, and fainting, to determine feasibility and effectiveness of such an intervention.

METHODS

Participants took part in an 8-session, group-based Cognitive Behavioural Therapy (CBT) programme for BII phobia (N = 40). The key outcome measure was the Multidimensional Blood/Injury Phobia Inventory, which assesses a range of phobic stimuli and responses (including fear, disgust, and fainting).

RESULTS

There were significant improvements, with large effect sizes, across symptoms over the course of treatment. Participants with higher disgust sensitivity reported higher pre-treatment symptom severity and greater life interference than those with lower disgust scores. Despite this, neither pre-treatment disgust sensitivity nor fainting history impacted on treatment response. For the first time, however, we showed that greater reductions in disgust to BII stimuli were associated with greater overall symptom reductions, highlighting the importance of disgust in the treatment of this disorder, and potentially others.

CONCLUSION

Despite the heterogeneous nature of BII phobia, this group-based, modified CBT intervention was effective in reducing a variety of phobic responses, including fear, disgust, and fainting.

PRACTITIONER POINTS

Disgust is a key maintaining factor in blood-injection-injury phobia, which clinicians should consider in their assessment and treatment of this disorder. There is little in the existing literature to guide clinicians in this regard. This study examined a novel group treatment for blood-injection-injury phobia which included strategies to target disgust, in addition to traditional CBT strategies to address fear and fainting. The treatment was feasible and acceptable. Symptoms of fear, disgust, and fainting reduced significantly over treatment. Changes in disgust symptoms were associated with overall symptom changes, however a control group is needed to determine the effects of individual treatment components and to make more robust conclusions about the benefits of this enhanced approach.

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.

Effects of repeated exposure to fearful and disgusting stimuli on fear renewal in blood-injection-injury phobia

Although exposure is effective for blood-injection-injury (BII) phobia, fear often returns after treatment. While disgust has been implicated in BII phobia, its effects on fear renewal are unclear. To address this knowledge gap, the present study examined the effect of repeated video exposure to fearful and disgusting stimuli in multiple contexts on fear renewal in BII phobia. Individuals with BII phobia (N = 57) were randomized to Disgust-Specific Exposure (DSE) which included exposure to disgusting but threat-irrelevant stimuli (i.e., vomit), Fear-Specific Exposure (FSE) which included exposure to threat-relevant stimuli (i.e., injections), or General Negative Exposure (GNE) which included exposure designed to elicit negative affect (i.e., tornado) without being disgusting or threat-relevant. During session one, participants watched a pre- and post-exposure assessment injection video ("pre/post assessment"), and a novel injection video after exposure to assess renewal effects ("novel 1"). Participants came in one week later to rate the same videos, and a new injection video ("novel 2"). For week one outcomes, comparisons of covariate adjusted means indicated the fear-specific group reported significantly lower levels of anxiety than the general-negative group to the post-exposure and novel 1 stimulus. When presented with the post-exposure stimuli during week two, the disgust-specific and fear-specific groups reported significantly lower levels of anxiety than the general negative group. The fear-specific group also reported significantly lower levels of anxiety than the disgust-specific and general-negative groups when presented with novel 1 and novel 2 stimuli at week two. These findings suggest that repeated exposure to threat-relevant cues in multiple contexts does reduce the return of anxiety. However, repeated exposure to disgusting but threat irrelevant stimuli may also produce some therapeutic effects. The implications of the integration of disgust-relevant processes into exposure-based treatment of BII phobia are discussed.

Psychometric Properties, Factor Structure, and Evidence for Measurement Invariance in the Greek Version of the Disgust Scale-Revised (DS-R)

The Disgust Scale has been designed to measure disgust propensity—the individual ease in experiencing disgust. The present study aimed to explore the validity, reliability, the factor structure, and the measurement invariance of the Greek version of the Disgust Scale-Revised (DS-R). A sample of 754 healthy participants completed the Greek version of the DS-R. A subset (n = 363) also completed the revised Symptom checked list and the Eysenck Personality Questionnaire, in order to examine the concurrent validity. Exploratory and Confirmatory factor analyses in different subsets were used to examine the factor structure. Multiple indicators–multiple causes model (MIMIC) models were used to assess the measurement invariance across gender and age. Demographic influences were assessed using t-tests, ANOVA, and Pearson’s correlations. Exploratory factor analysis concluded to two and three factor models, with a factor structure similar to the ones proposed in the literature. Confirmatory factor analysis and bi-factor analysis provided evidence in favor of the three-factor solution. Measurement invariance test revealed differences in six items across gender, and three items across age. The psychometric properties of the factors were satisfactory. Demographic influences on the responses were present, especially with respect to gender. The Greek version of the DS-R demonstrated satisfactory psychometric properties, making it suitable for use for the Greek population.

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.

Disgust stimuli reduce heart rate but do not contribute to vasovagal symptoms

BACKGROUND AND OBJECTIVES

The vasovagal response demonstrates a unique form of stress response, common in medical settings yet provoked by a variety of blood-injury-injection stimuli. This study aimed to better understand the psychophysiological mechanisms of the vasovagal response..

METHODS

16 undergraduates with and 42 without a self-reported history of fainting watched five 3-5 min videos with different emotional content. One documentary clip (Neutral condition) described a campus environmental project while another (Blood/Injury) depicted portions of an open heart surgery. Three additional clips were also used, including Medical, Threat, and Contamination stimuli. Vasovagal symptoms and physiological variables were assessed during each video.

RESULTS

As predicted, while the disgust-related stimuli (Blood/Injury, Medical, Contamination) were associated with generally lower heart rate, the Blood/Injury video produced the highest symptoms and the only significant difference between previous fainters and non-fainters. The physiological measures also revealed that participants with a fainting history experienced higher stroke volume and lower systolic blood pressure throughout, as well as several main effects of video.

LIMITATIONS

An additional decrease in systolic blood pressure and respiration produced by watching the Blood/Injury video may have been sufficient to trigger symptoms in some, though results also suggest that systemic variables do not entirely explain susceptibility to symptoms. More careful evaluation of regional blood flow may be required.

CONCLUSIONS

Participants who had previously experienced strong vasovagal responses displayed what appeared to be an anticipatory response to the Blood/Injury video. Finally, disgust stimuli may reduce heart rate but do not appear to contribute to vasovagal symptoms.

An Initial Test of Reconsolidation in Disgust-Related Learning and Extinction

This study examines whether the spacing of a single unreinforced retrieval trial relative to extinction learning allows for "rewriting" the original disgust association, thereby preventing the return of disgust using a paradigm that employs disgust-relevant unconditioned stimuli (US). During conditioning, disgusting US were paired with a color square that served as the conditioned stimuli (CS). Participants (n = 54) then returned to the lab 24 hours later and received a "reactivation" intervention which consisted of one unpaired presentation of the CS+. Participants were then randomized to receive extinction trials either 10 min (Group A) or 6 hours (Group B) after reactivation. A third control group (Group C) did not receive the reactivation manipulation before extinction. Participants returned 24 hours later for additional extinction trials and at a 1-month follow-up for disgust reinstatement. Although the paradigm resulted in participants evaluating the CS+ as significantly more unpleasant after being associated with a disgust-relevant US, extinction learning within the reconsolidation window did not influence self-reported reduction or return of disgust. However, there was some evidence suggesting that those who received reactivation (Groups A and B), regardless of timing, evaluated the CS+ as less unpleasant after extinction relative to acquisition, whereas this pattern was not observed among those who did not receive reactivation (Group C). The implications of these findings for anxiety-related disorders in which disgust has been implicated will be discussed.

Existential Threat or Dissociative Response? Examining Defensive Avoidance of Point-of-Care Testing Devices Through a Terror Management Theory Framework

Using a terror management theory framework, this study investigated if providing mortality reminders or self-esteem threats would lead participants to exhibit avoidant responses toward a point-of-care testing device for cardiovascular disease risk and if the nature of the device served to diminish the existential threat of cardiovascular disease. One hundred and twelve participants aged 40-55 years completed an experimental questionnaire. Findings indicated that participants were not existentially threatened by established terror management methodologies, potentially because of cross-cultural variability toward such methodologies. Highly positive appraisals of the device also suggest that similar technologies may beneficially affect the uptake of screening behaviors.

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.

Attentional bias in injection phobia: overt components, time course, and relation to behavior

Blood-injection-injury (BII) phobia is an anxiety disorder that can cause serious health consequences by interfering with medical treatment. Although attentional bias for threat appears to be a core feature of many anxiety disorders and a potential target of treatment, very little is known about attentional bias in BII phobia. In the present study, eye movements were recorded in individuals high and low in injection fear (HIF, LIF) during 18-s exposures to stimulus arrays containing injection, attack, appetitive, and neutral images. Evidence for attentional vigilance was mixed, as HIF individuals oriented to injection images more often than LIF individuals, but did not orient to injection images more often than other emotional images. In contrast, evidence of attentional avoidance was highly robust. HIF individuals rapidly disengaged from injection images on initial viewing and viewed these images less overall compared to other image types, a pattern not observed in the LIF group. Furthermore, attentional avoidance of injection threat was found to uniquely predict behavioral avoidance on an injection behavioral avoidance task (BAT), and group differences on the BAT were mediated by group differences in attentional avoidance. The implications of these findings for further delineating the nature and function of attentional biases in BII phobia are discussed.

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

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

The role of disgust emotions in the observer response to facial disfigurement

Social intrusions by observers are commonly reported by those with disfiguring conditions. This study examined the role of disgust emotions in the observer response. A group of students (N=48) completed quantitative questionnaires measuring extent of disfigurement, whilst viewing images of faces with varying disfigurements. Another group of students (N=84) completed quantitative questionnaires measuring level of disgust elicited by the same images. Disgust sensitivity was measured using the Disgust Scale Revised. Observers reported greater levels of disgust (p<.01) with increasing severity of facial disfigurement. Individuals with a higher disgust sensitivity reported increased levels of disgust in response to faces of mild (p=.03), moderate (p=.02) and severe (p<.01) disfigurement compared to those with a lower disgust sensitivity. This provides an explanatory framework for the avoidance reactions of observers and may be important in understanding variability in adjustment following disfigurement.

Psychometric analysis of the Korean version of the Disgust Scale-Revised

OBJECTIVE

Disgust is a basic emotion associated with feelings of revulsion and withdrawal behaviors from dangerous situations. The aim of this study was to examine the psychometric properties of the Disgust Scale--Revised (DS-R), a tool designed to measure individuals' responses to various disgust-provoking situations, among Korean populations.

METHODS

A sample of 1117 healthy volunteers completed self-report questionnaires containing the 27-item DS-R. A subsample (n = 231) completed the Temperament and Character Inventory (TCI), Eysenck Personality Questionnaire (EPQ), and State-Trait Anxiety Inventory (STAI). Principal component analysis using a varimax rotation was conducted. Construct validity was assessed using Pearson correlation analysis for the TCI, EPQ, and STAI. To examine differences in responses on the DS-R among populations, patients with obsessive-compulsive disorder were compared with healthy subjects who were matched with respect to age and sex.

RESULTS

The Cronbach α estimates for total items and the 3 original subscales of the DS-R, including: core disgust, animal reminder disgust, and contamination-based disgust, were 0.86, 0.77, 0.80, and 0.55, respectively. Principal component analysis identified 5 factors, which accounted for 48% of the total variance of the scale. The 5 newly developed dimensions were labeled as core disgust-touch, core disgust-dirt, contamination-based disgust, animal reminder disgust, and social intolerance disgust. The Cronbach α coefficients were 0.79, 0.64, 0.46, 0.77, and 0.34, respectively, for these subscales. The DS-R was correlated positively with harm avoidance from the TCI, neuroticism from the EPQ, and the anxiety scores of STAI. Furthermore, the contamination-based disgust scores for patients with obsessive-compulsive disorder were higher than those of normal controls.

CONCLUSION

The DS-R may be a reliable, valid, and acceptable tool to measure disgust sensitivity among Korean populations. The psychometric properties of the Korean version of the DS-R and the original DS-R are discussed.

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.

A Preliminary Investigation of the Efficacy of Disgust Exposure Techniques in a Subclinical Population With Blood and Injection Fears

The current study examined whether a traditional exposure-based treatment for blood-injection-injury (BII) phobia would be effective at reducing disgust responses to BII stimuli and whether the addition of modules targeting disgust would provide incremental efficacy. Participants, many of whom reported subclinical BII phobia symptoms, underwent one of two single-session exposure protocols, one targeting fear alone, and the other targeting both fear and disgust. Both treatments consisted of education components (fear-only or fear-disgust) and in vivo exposure (fear-only or fear-disgust). Both the fear-only and the fear-disgust treatment groups significantly decreased fear and avoidance behaviour toward BII stimuli over time. The two groups also experienced similar reductions in disgust responses to BII-related stimuli and global as well as domain-specific disgust sensitivity. The effect sizes indicated that the fear-disgust group evidenced greater reduction in symptoms than did the fear-only group. The implications of the results for models of phobia maintenance and treatment are discussed.

Understanding disgust

Disgust is characterized by a remarkably diverse set of stimulus triggers, ranging from extremely concrete (bad tastes and disease vectors) to extremely abstract (moral transgressions and those who commit them). This diversity may reflect an expansion of the role of disgust over evolutionary time, from an origin in defending the body against toxicity and disease, through defense against other threats to biological fitness (e.g., incest), to involvement in the selection of suitable interaction partners, by motivating the rejection of individuals who violate social and moral norms. The anterior insula, and to a lesser extent the basal ganglia, are implicated in toxicity- and disease-related forms of disgust, although we argue that insular activation is not exclusive to disgust. It remains unclear whether moral disgust is associated with insular activity. Disgust offers cognitive neuroscientists a unique opportunity to study how an evolutionarily ancient response rooted in the chemical senses has expanded into a uniquely human social cognitive domain; many interesting research avenues remain to be explored.

The Multi-Dimensional Blood/Injury Phobia Inventory: its psychometric properties and relationship with disgust propensity and disgust sensitivity

The Multi-Dimensional Blood Phobia Inventory (MBPI; Wenzel & Holt, 2003) is the only instrument available that assesses both disgust and anxiety for blood-phobic stimuli. As inflated levels of disgust propensity (i.e., tendency to experience disgust more readily) are often observed in blood phobia, the MBPI appears a promising instrument for disgust research. First, we examined its psychometric properties. Next, it was examined whether disgust sensitivity (i.e., considering experiencing disgust as something horrid) had added predictive value compared to disgust propensity in blood phobia. Therefore, students and university employees (N = 616) completed the MBPI, indices on blood phobia, disgust propensity and sensitivity. The MBPI proved to be reliable and valid. Further, it correlated moderately to high with disgust propensity and sensitivity. Additionally, disgust propensity and sensitivity were both significant predictors for blood phobia. In conclusion, the MBPI appears a valuable addition to the currently available arsenal of indices to investigate blood phobia.

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.

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

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

Confirming the Three-Factor Structure of the Disgust Scale—Revised in Eight Countries

The current study evaluates the factor structure of the Disgust Scale—Revised (DS-R) in eight countries: Australia, Brazil, Germany, Italy, Japan, the Netherlands, Sweden, and the United States ( N = 2,606). Confirmatory factor analysis is used to compare two different models of the DS-R and to investigate the invariance of the factor structure of the DS-R across countries and gender. A three-factor solution consisting of three different but interrelated disgust factors (a 12-item core disgust factor, an 8-item animal-reminder disgust factor, and a 5-item contamination disgust factor) best accounted for the data in all countries except the Netherlands. Relative to the United States, the three-factor solution is invariant in Australia, Brazil, and Japan but not in Germany, Italy, the Netherlands, and Sweden. The three-factor solution is also invariant across gender in most countries. The implications of these cross-cultural findings for promoting a more valid and reliable assessment of disgust dimensions, as assessed by the DS-R, 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.

Recent trends in the study of specific phobias

PURPOSE OF REVIEW

Specific phobias are prevalent and often disabling anxiety disorders. The present review examines relevant investigations that have been published during the last 2 years on major aspects of this group of disorders.

RECENT FINDINGS

Recent studies have come mainly from epidemiology, brain imagery and cognitive-behavioral therapy, including virtual reality exposure therapy.

SUMMARY

Studies published in the last 2 years confirm the high prevalence of specific phobias in the general population and provide new insights into the mechanisms underlying the fear reaction after exposure to a phobic stimulus.

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.

Examination of the decline in fear and disgust during exposure to threat-relevant stimuli in blood-injection-injury phobia

In the present study, participants (N=22) displaying marked fear of blood-injection-injury (BII) stimuli were provided 30 min of in vivo exposure to threat-relevant stimuli, during which time their fear and disgust levels were repeatedly assessed. Growth curve analyses were then conducted to examine the decay slopes in both fear and disgust and their relationship. Results indicated that exposure led to significant declines in fear and disgust across trials. However, the decay slope observed for fear was significantly greater than that for disgust. Further analyses revealed that the decline in fear across trials remained significant after accounting for the changes in disgust. However, the effect of trial on disgust was no longer significant after controlling for the reduction in fear. Global disgust sensitivity levels prior to exposure did not moderate the level of fear activation or fear reduction during exposure. BII-specific digust sensitivity was also not associated with initial levels of fear. However, levels of BII-specific disgust sensitivity were independently negatively associated with fear decline. Theoretical and clinical implications of the findings are discussed.