Mental Contamination in Obsessive-Compulsive Disorder: Associations With Contamination Symptoms and Treatment Response

The most common symptom of obsessive-compulsive disorder (OCD) is contamination fear. Feelings of contamination can be provoked through contact with a physical contaminant, referred to as contact contamination (CC), as well as in the absence of one, referred to as mental contamination (MC). Prior research indicates that CC and MC are distinct, and MC may interfere with treatment for CC. However, no study to date has examined how MC may be associated with responses to physical contaminants and treatment response for CC. This study examined the relationships between CC and MC in a sample of individuals with elevated contamination symptoms (N = 88), half of whom met diagnostic criteria for OCD. Participants engaged in three sessions of exposure and response prevention (ERP) for CC and completed self-report measures and behavioral tasks assessing CC and MC at pretreatment, posttreatment, and follow-up. As hypothesized, at pretreatment, MC was positively associated with reactivity to physical contaminants, even after participants washed their hands. ERP for CC was associated with unique changes in CC and MC across self-report and behavioral measures, and greater pretreatment MC predicted greater posttreatment CC, though this effect was evident in only one of two CC measures. Additionally, specificity analyses indicated changes in MC were independent of changes in disgust propensity, a related construct. Pretreatment disgust propensity also predicted treatment outcome, though the addition of pretreatment disgust propensity as a covariate reduced the relationship between pretreatment MC and posttreatment CC to nonsignificance. Results suggest MC plays an important role in the manifestation and treatment of CC symptoms and may represent a manifestation of disgust proneness. Theoretical and clinical implications are discussed.     

The Three Domains of Disgust Scale: factor structure, psychometric properties, and conceptual limitations

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

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.     

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

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

Core,animal reminder,and contamination disgust: Three kinds of disgust with distinct personality,behavioral, physiological,and clinical correlates

We examined the relationships between sensitivity to three kinds of disgust (core, animal-reminder, and contamination) and personality traits, behavioral avoidance, physiological responding, and anxiety disorder symptoms. Study 1 revealed that these disgusts are particularly associated with neuroticism and behavioral inhibition. Moreover, the three disgusts showed a theoretically consistent pattern of relations on four disgust-relevant behavioral avoidance tasks in Study 2. Similar results were found in Study 3 such that core disgust was significantly related to increased physiological responding during exposure to vomit, while animal-reminder disgust was specifically related to physiological responding during exposure to blood. Lastly, Study 4 revealed that each of the three disgusts showed a different pattern of relations with fear of contamination, fear of animals, and fear of blood–injury relevant stimuli. These findings provide support for the convergent and divergent validity of core, animal-reminder, and contamination disgust. These findings also highlight the possibility that the three kinds of disgust may manifest as a function of different psychological mechanisms (i.e., oral incorporation, mortality defense, disease avoidance) that may give rise to different clinical conditions. However, empirical examination of the mechanisms that underlie the three disgusts will require further refinement of the psychometric properties of the disgust scale.     

Disgust domains in the prediction of contamination fear

Previous research has shown a relationship between the emotion of disgust and the fear of contamination. Heightened sensitivity to disgust and increased concerns over contamination has been observed in various disorders, such as obsessive-compulsive disorder (OCD) and specific phobias. However, there is a paucity of research identifying the specific domains of disgust that contribute to contamination fear. The present study soughts to determine which domains of disgust elicitors reliably predict scores on a measure of OCD contamination obsessions and washing compulsions. We further conducted exploratory analyses that examined differences in disgust sensitivity among individuals classified as high and low in contamination fear. Three hundred and twenty-three undergraduate participants completed two measures of disgust sensitivity (Disgust Scale; Disgust Emotion Scale) and a measure of contamination fear (Padua inventory, contamination obsessions and washing compulsions subscale). Stepwise multiple regression analyses indicated that contamination fear was best predicted by seven different disgust domains, thereby suggesting that contamination fear is accounted for by generalized, rather than domain-specific, disgust elicitors. The categories of disgust that predicted contamination fear appeared to have an underlying commonality of threat of contagion. The relationship between fear of contamination and disgust sensitivity was more pronounced for animal reminder disgust elicitors as opposed to core disgust elicitors. Results also showed that individuals classified as high in contamination fear scored significantly higher than the low contamination fear group on all disgust domains. Clinical and research implications regarding the interrelationships between fear, disgust, and the fear of contamination are discussed.     

Multimodal assessment of disgust in contamination-related obsessive-compulsive disorder

The present study utilizes multiple methods to examine the relationship between disgust and contamination-related obsessive-compulsive disorder (OCD) symptoms in an analogue sample. Questionnaire findings revealed that participants with high OCD contamination concerns showed stronger disgust sensitivity than did participants with low OCD contamination symptoms after controlling for negative affect. High OCD participants (N=30) also reported significantly more disgust than did low OCD participants (N=30) when exposed to a disgust-inducing video, whereas no significant between-group differences were detected on other negative emotional dimensions. Results from a series of disgust-specific behavioral avoidance tasks (BATs) revealed that high OCD participants demonstrated both less compliance and less approach behavior. Subsequent analysis also revealed that disgust sensitivity generally mediated avoidance on the BATs among high OCD subjects. High OCD participants also rated the BATs as more fearful and disgusting than did low OCD participants, with disgust generally emerging as the dominant emotional response. The results are consistent with a disgust-based, disease-avoidance approach in understanding contamination-related OCD themes.     

Erratum

Abstract

Recent research has highlighted the central role of disgust in the etiology and maintenance of contamination aversion (CA). Data would also suggest that, although amendable to the treatment of choice for CA (exposure and response prevention [ERP]), disgust is resistant to habituation. However, with regard to CA, it is not yet known if disgust's resistance to habituation is an artifact of the emotion or the disorder. Specifically, research has not yet indicated if severity of CA moderates the effect of ERP on disgust. Utilizing an undergraduate convenience sample (n=33), the present study compared emotional responding (disgust and fear) with repeated exposure to a disgusting contamination-relevant stimulus between participants who are high in contamination aversion (HCA; n=17) and low in contamination aversion (LCA; n=16). Results indicated that, habituation of disgust was slower than fear within the HCA group but not the LCA group. Contrasts revealed that the decay of fear across trials was faster for HCA participants when compared with LCA participants, although decay of disgust was similar between groups. These results indicate that habituation of disgust is slower than fear when elevated CA is present.     

“May I present you: my disgust!” – Declared disgust sensitivity in the presence of attractive models

Disgust sensitivity differs among men and women, and this phenomenon has been observed across numerous cultures. It remains unknown why such sex differences occur, but one of the reasons may relate to differences in self-presentation. We tested that hypothesis in an experiment comprising 299 participants (49% women) randomly allocated into three groups. Each group completed the Three Domains Disgust Scale (TDDS) and rated how disgusting they found olfactory, visual, gustatory, and tactile disgust elicitors either when a male experimenter was present, a female experimenter was present, or no experimenter was present. We hypothesised that male participants in the female experimenter group would declare decreased levels of disgust sensitivity, and female participants in the male experimenter group would declare increased levels of disgust sensitivity. Results showed that despite sex differences in pathogen and sexual disgust, attractive experimenters did not evoke any differences in declared disgust across groups with one exception–both men and women self-presented as more sensitive to sexual disgust in the presence of the female experimenter. We discuss our findings in the light of evolutionary and social theories.     

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.     

Within a hair's breadth of buying the product: The impact of tangible and intangible bodily cues of contamination: The role of disgust and mental imagery

In most retail environments, customers can handle products. However, the downside of this freedom to touch products is product contamination. The objectives of this paper are threefold: (a) to examine the effects of contamination cues (tangible vs. intangible) on consumer responses; (b) to show the mediating role of contamination, disgust, and mental imagery; and (c) to assess the robustness of the results on three product categories for different levels of contact intimacy. Three experimental laboratory studies on different product categories (a book [n = 95], T‐shirt [n = 118], and apple [n = 102]) showed that tangible contamination cues decreased product evaluation and purchase intentions more than intangible contamination cues did. Moreover, contamination, disgust, and mental imagery mediated the effects of contamination cues on product evaluation and purchase intention. The findings provide theoretical and practical insights to help researchers and retailers understand the effect of tangible contamination cues on consumer responses.     

Assessing State Mental Contamination: Development and Preliminary Validation of the State Mental Contamination Scale

This 2-part study described the development and preliminary validation of the State Mental Contamination Scale (SMCS), a multi-item self-report measure of state mental contamination. In Study 1, community adults (N = 211) in the United States were randomly assigned to a pathogen disgust, moral disgust, or neutral condition and then completed the SMCS. Study 1 results supported a 1-factor structure of the SMCS items. Scores on the SMCS items evidenced good internal consistency and strong interitem correlations. SMCS scores were significantly greater following the 2 disgust conditions relative to the neutral condition and a full range of SMCS scores were found in the disgust conditions. An independent sample of community adults (N = 121) from the United States participated in Study 2 to extend Study 1 results. Study 2 results indicated that SMCS scores were manipulated independently of trait mental contamination, more strongly related to convergent than a discriminant measure, and shared unique variance with a criterion measure after controlling for convergent measures. The future use of the SMCS is discussed.     

Consequences of agreement versus disagreement on physical disgust: How do people perceive the cleanliness and morality of someone who expresses inappropriate disgust

We examined how people perceived a person who expressed inappropriate physical disgust—a person who was either under-disgusted by physically disgusting stimuli or over-disgusted by neutral stimuli. Participants formed an impression of a target after receiving information on how s/he rated disgusting (Studies 1, 2) or neutral (Studies 2, 3) pictures, and disgusting or angering scenarios (Study 4). Studies 1, 2 and 4 found that a target person who failed to experience disgust was seen as disgusting, immoral (but only to the extent that s/he was also seen unclean), and not socially desirable. A target who rated neutral stimuli as disgusting was not judged as disgusting but was nevertheless judged as immoral and not socially desirable (Studies 2, 3). Our results show that a target whose judgments of physical disgust deviate from one's own by showing either too much or too little disgust is perceived to be immoral.     

Depressive Symptomatology and College Persistence among African American College Students

ABSTRACT. While many studies find women self-report higher disgust sensitivity than men, few studies have examined gender differences with behavioral tasks in senses other than vision. On a haptic task, we tested the hypothesis that women would report greater disgust but not greater unpleasantness than men. Forty-four undergraduates (29 women) touched 8 out-of-sight stimuli with sensory (unpleasantness) and emotional (disgust) responses recorded. The stimuli consisted of 2 neutral, 2 pleasant, and 4 unpleasant (3 disgust-evoking) objects. No gender differences were found for reporting stimuli unpleasantness. In contrast, women rated their disgust significantly higher than men when touching the high disgust-evoking objects. Unpleasantness of the stimuli correlated with disgust to the objects, but disgust sensitivity (Disgust Scale-Revised) was not a strong predictor of disgust responses. Besides differentiating unpleasantness from disgust, this was also the first study to show gender differences in a disgust-evoking haptic task.     

Motivated to confront: How experiencing anger affects anchoring bias

Prior research has asserted that emotions affect anchoring bias in decision making through the emotion's certainty appraisal or through the emotion's action tendencies, but these prior studies investigate the role of each component—appraisal or action tendency—without accounting for potential effects of the other one. The current research investigates whether anger exerts a significant effect on anchoring bias by activating a desire to confront a potential anchor. Importantly, the studies compare the effect of anger versus disgust, emotions that differ in their action tendency but are similar in their certainty appraisal. In Study 1, participants completed an emotion induction task and then a negotiation task where the first offer from the negotiation partner served as a potential anchor. Anger led to more deviation from the anchor compared with disgust or neutral feelings. Subsequent studies provide evidence that the angry participants are less anchored when the anchor value comes from a more confrontable source (someone else vs. themselves in Study 2 and an out‐group member vs. an in‐group member in Study 3).     

Shaking That Icky Feeling: Effects of Extinction and Counterconditioning on Disgust-Related Evaluative Learning

Learned disgust appears to play an important role in certain anxiety disorders, and can be explained by the process of evaluative conditioning, in which an affective evaluative reaction evoked by an unconditional stimulus (US) is transferred to a conditional stimulus (CS). Much remains unknown about how disgust-related evaluative learning can be effectively eliminated. Study 1 of the present investigation examined the effects of extinction on reducing the negative evaluation of a CS that was acquired during disgust conditioning. Participants completed acquisition trials, with a disgusting picture as US and two neutral pictures as CS (CS + was paired with the US; CS- was unpaired), followed by extinction trials ("CS only"; experimental condition) or a filler task (control condition). Extinction trials reduced acquired US expectancy to the CS +, but did not extinguish negative evaluations of the CS +. Study 2 examined the effects of counterconditioning on evaluative learned disgust. After disgust acquisition trials, counterconditioning trials followed in which the CS + was paired with a pleasant US (experimental condition) or a filler task (control condition). Counterconditioning trials reduced acquired US expectancy to the CS + and reduced evaluative conditioned disgust. Implications of the potential differential effects of extinction and counterconditioning on evaluative learning for exposure-based treatment of specific anxiety disorders are discussed.     

Physiological and self-reported disgust reactions to obesity

There is accumulating evidence that disgust plays an important role in prejudice toward individuals with obesity, but that research is primarily based on self-reported emotions. In four studies, we examined whether participants displayed a physiological marker of disgust (i.e. levator labii activity recorded using facial electromyography) in response to images of obese individuals, and whether these responses corresponded with their self-reported disgust to those images. All four studies showed the predicted self-reported disgust response toward images of obese individuals. Study 1 further showed that participants exhibited more levator activity to images of obese individuals than to neutral images. However, Studies 2–4 failed to provide any evidence that the targets’ body size affected levator responses. These findings suggest that disgust may operate at multiple levels, and that the disgust response to images of obese individuals may be more of a cognitive-conceptual one than a physiological one.     

恐惧与厌恶情绪图片系统的编制：基于两种情绪的区分

基于恐惧与厌恶情绪刺激材料界定模糊的问题,实验一在总结前人研究中实验材料方面混淆恐惧和厌恶的基础上,通过问卷法完成了对恐惧与厌恶图片系统初步的搜集、整理工作;实验二通过进一步测评得到了具有良好信度的恐惧与厌恶情绪图片系统,图片系统中的恐惧与厌恶情绪很好的分离,且图片系统中动物、场景、物体三类图片的恐惧、厌恶程度均存在显著差异,可适用于需要不同种类情绪刺激的具体应用性研究。     

恐惧与厌恶情绪图片系统的编制：基于两种情绪的区分

基于恐惧与厌恶情绪刺激材料界定模糊的问题,实验一在总结前人研究中实验材料方面混淆恐惧和厌恶的基础上,通过问卷法完成了对恐惧与厌恶图片系统初步的搜集、整理工作;实验二通过进一步测评得到了具有良好信度的恐惧与厌恶情绪图片系统,图片系统中的恐惧与厌恶情绪很好的分离,且图片系统中动物、场景、物体三类图片的恐惧、厌恶程度均存在显著差异,可适用于需要不同种类情绪刺激的具体应用性研究。