The relationship between disgust sensitivity, anxiety and obsessions

Three hundred participants, including volunteers from an obsessional support group, filled in questionnaires relating to disgust sensitivity, health anxiety, anxiety, fear of death, fear of contamination and obsessionality as part of an investigation into the involvement of disgust sensitivity in types of obsessions. Overall, the data supported the hypothesis that a relationship does exist between disgust sensitivity and the targeted variables. A significant predictive relationship was found between disgust sensitivity and total scores on the obsessive compulsive inventory (OCI; Psychological Assessment 10 (1998) 206) for both frequency and distress of symptomatology. Disgust sensitivity scores were significantly related to health anxiety scores and general anxiety scores and to all the obsessional subscales, with the exception of hoarding. Additionally, multiple regression analyses revealed that disgust sensitivity may be more specifically related to washing compulsions: frequency of washing behaviour was best predicted by disgust sensitivity scores. Washing distress scores were best predicted by health anxiety scores, though disgust sensitivity entered in the second model. It is suggested that further research on the relationship between disgust sensitivity and obsessionality could be helpful in refining the theoretical understanding of obsessions.     

The role of disgust in patients with hypochondriasis

Theoretically, disgust sensitivity and disgust proneness could play an important role in hypochondriasis, since disgust is a defensive emotion widely believed to protect the organism from illness. However, empirical evidence to support this hypothesis has so far been based only on nonclinical samples, so that the importance and specificity of disgust for hypochondriasis remains unclear. In the current study, 36 patients with hypochondriasis, 27 with an anxiety disorder, and 29 healthy controls completed several measures which included the assessment of disgust sensitivity (Scale for the Assessment of Disgust Sensitivity) and disgust proneness (Questionnaire for the Assessment of Disgust Proneness). We found that patients with hypochondriasis and those with an anxiety disorder had higher scores than those of the healthy controls for several measures of disgust proneness. Moreover, measures of hypochondriacal characteristics were associated with those of disgust proneness and disgust sensitivity. However, no differences were found between patients with hypochondriasis and those with anxiety disorders, with respect to disgust proneness and disgust sensitivity. Therefore, it can be assumed that disgust proneness and disgust sensitivity seem to be less specific than previously suggested for the development and maintenance of hypochondriasis.     

Disgust sensitivity, trait anxiety and anxiety disorders symptoms in normal children.

There is evidence to suggest that disgust sensitivity plays a role in the development of small animal fears and phobias. Recently, Phillips, Senior, Fahy, and David (1998) [Phillips, M. L., Senior, C., Fahy, T., & David, A. S. (1998). Disgust: the forgotten emotion of psychiatry. British Journal of Psychiatry, 172, 373-375.] suggested that disgust sensitivity is also involved in various other anxiety-based symptoms (e.g. obsessive-compulsive complaints, social phobia). The present study sought to test this suggestion in a large sample of normal school children (N = 189). Children completed a measure of disgust sensitivity, the trait anxiety version of the Spielberger State-Trait Anxiety Inventory for Children and the Screen for Child Anxiety Related Emotional Disorders, an instrument that measures DSM-defined anxiety disorders symptoms. Disgust sensitivity was indeed found to be correlated with a broad range of anxiety disorders symptoms. However, results also indicated that these correlations were predominantly carried by trait anxiety. That is, when controlling for levels of trait anxiety, only specific phobia symptoms (including animal phobia, blood-injection-injury phobia and situational-environmental phobia) and separation anxiety disorder symptoms were significantly related to disgust sensitivity, although correlations were rather modest. Taken together, these findings cast doubts on the claim that disgust sensitivity is an unique and independent factor that contributes to a broad range of anxiety disorders.     

Assessment of Disgust Sensitivity in Children With an Age-Downward Version of the Disgust Emotion Scale

The present study examined the psychometric properties of the Disgust Emotion Scale for Children (DES-C). Principal components analysis of the DES-C data revealed five factors reflecting disgust toward (a) rotting foods, (b) injection and blood, (c) odors, (d) mutilation and death, and (e) animals, which were largely in keeping with the intended subscales. The DES-C showed good reliability, excellent convergent validity (as established by correlations with an alternative self-report index of disgust), fairly good predictive validity (as assessed by correlations with measures of fear/anxiety and a behavioral index of disgust), and acceptable parent–child agreement (in particular with the mothers). Importantly, the DES-C proved to perform better on some psychometric indicators than an age-downward version of the Disgust Scale. These findings indicate that the DES-C should be regarded as the preferred scale for measuring disgust sensitivity and its role in the etiology and maintenance of anxiety problems in children.     

Effect of Partners’ Disgust Responses on Psychological Wellbeing in Cancer Patients

The aim of this study was to explore quantitatively the relationship between disgust responses in cancer patients and their partners, and in turn their relationship to patients’ psychological well-being. We recruited 50 participants with heterogeneous cancer diagnoses and their partners from cancer-related groups (e.g., charities). Patients completed questionnaires to determine levels of disgust propensity, disgust sensitivity, self-disgust, and symptoms of anxiety and depression. Disgust propensity and sensitivity were also assessed in their partners. Partners’ disgust sensitivity was significantly positively correlated with cancer patients’ self-disgust, disgust propensity, and depression. Path analyses suggested that patients’ self-disgust plays a role in mediating the effect of partners’ disgust sensitivity on patients’ psychological well-being. This study provides the first quantitative evidence that psychological well-being in cancer patients is contingent on their partners’ sensitivity to disgust, and that patients’ self-disgust plays a mediating role. Focusing therapeutically on disgust responses could well be beneficial to people with cancer.     

A taxometric study of the latent structure of disgust sensitivity: converging evidence for dimensionality

Disgust sensitivity has recently been implicated as a specific vulnerability factor for several anxiety-related disorders. However, it is not clear whether disgust sensitivity is a dimensional or categorical phenomenon. The present study examined the latent structure of disgust by applying three taxometric procedures (maximum eigenvalue, mean above minus below a cut, and latent-mode factor analysis) to data collected from 2 large nonclinical samples on 2 different measures of disgust sensitivity. Disgust sensitivity in the first sample (n=1,153) was operationalized by disgust reactions to food, animals, body products, sex, body envelope violations, death, hygiene, and sympathetic magic, as assessed by the Disgust Sensitivity Scale (J. Haidt, C. McCauley, & P. Rozin, 1994). Disgust Sensitivity Scale indicators of core, animal reminder, and contamination disgust were also examined in the 1st sample. Disgust sensitivity in the 2nd independent sample (n=1,318) was operationalized by disgust reactions to animals, injections and blood draws, mutilation and death, rotting foods, and odors, as assessed by the Disgust Emotion Scale (R. A. Kleinknecht, E. E. Kleinknecht, & R. M. Thorndike, 1997). Results across both samples provide converging evidence that disgust sensitivity is best conceptualized as a dimensional construct, present to a greater or lesser extent in all individuals. These findings are discussed in relation to the conceptualization and assessment of disgust sensitivity as a specific dimensional vulnerability for certain anxiety and related disorders.     

Individual differences in disgust sensitivity and health-related avoidance: Examination of specific associations

This present study examined the specificity of disgust sensitivity in predicting health-related anxiety and behavioral avoidance. Participants (n = 60) completed self-report measures of disgust sensitivity, health anxiety, anxiety, and depression. They then completed three randomly presented health-related behavioral avoidance tasks (BATs) that consisted of potential exposure to the common cold, the flu, and mononucleosis. Results indicated that disgust sensitivity was significantly associated with anxious and avoidant responding to the health-related BATs. This association also remained largely intact after controlling for gender, anxiety, depression, and health anxiety. These findings indicate that disgust sensitivity has a specific and robust association with health-related anxiety and avoidance commonly observed among those with excessive health anxiety and obsessive compulsive disorder. The unique role of disgust sensitivity in relation to health anxiety is discussed in the context of a disease-avoidance model.     

Social anxiety and interpretation biases for facial displays of emotion: emotion detection and ratings of social cost

The current study assessed the processing of facial displays of emotion (Happy, Disgust, and Neutral) of varying emotional intensities in participants with high vs. low social anxiety. Use of facial expressions of varying intensities allowed for strong external validity and a fine-grained analysis of interpretation biases. Sensitivity to perceiving negative evaluation in faces (i.e., emotion detection) was assessed at both long (unlimited) and brief (60 ms) stimulus durations. In addition, ratings of perceived social cost were made indicating what participants judged it would be like to have a social interaction with a person exhibiting the stimulus emotion. Results suggest that high social anxiety participants did not demonstrate biases in their sensitivity to perceiving negative evaluation (i.e. disgust) in facial expressions. However, high social anxiety participants did estimate the perceived cost of interacting with someone showing disgust to be significantly greater than low social anxiety participants, regardless of the intensity of the disgust expression. These results are consistent with a specific type of interpretation bias in which participants with social anxiety have elevated ratings of the social cost of interacting with individuals displaying negative evaluation.     

Disgust sensitivity and contamination fears in spider and blood-injection-injury phobias

Disgust has been implicated in the onset and maintenance of blood-injection-injury (BII) and animal phobias. Research suggests that people with these phobias are characterized by an elevated sensitivity to disgust-evoking stimuli separate from their phobic concerns. The disgust response has been described as the rejection of potential contaminants. Disgust-motivated avoidance of phobic stimuli may therefore be related to fears of contamination or infection. The present study compared BII phobics, spider phobics and nonphobics on two measures of disgust sensitivity and two measures of contamination fears. Positive correlations were found between disgust sensitivity and contamination fear. Specific phobics scored higher than nonphobics on all scales and BII phobics scored higher than spider phobics on contamination fear measures. Furthermore, the contamination fear scales were correlated with the blood phobia measure, but not correlated with the spider phobia measure. The results suggest that while both phobias are characterized by elevated disgust sensitivity, contamination fear is more prominent in BII than spider phobia.     

Selective effects of excessive engagement in health-related behaviours on disgust propensity

The present study examined the extent to which engagement in health-related behaviours modulate disgust propensity, a purportedly stable personality trait. Participants were randomised into a health behaviour (n = 30) or control condition (n = 30). After a baseline period, participants in the health behaviour condition spent one week actively engaging in a clinically representative array of health-related behaviours on a daily basis, followed by a second week-long baseline period. Participants in the control condition monitored their normal use of health behaviours. Compared to control participants, those in the health behaviour condition reported significantly greater increases in disgust propensity after the health behaviour manipulation. This effect was most robust for contamination disgust propensity and remained significant when controlling for changes in health anxiety and disease fear. In contrast, self-disgust and anxiety sensitivity did not significantly differ between the two groups as a function of the health behaviour manipulation. Mediational analyses were consistent with the hypothesis that changes in the frequency of health-related behaviours, but not changes in health anxiety and disease fear, mediated the effects of the experimental manipulation on changes in contamination disgust propensity. These findings suggest that the purportedly stable personality trait of disgust propensity can be modulated by excessive engagement in health-related behaviours.     

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.     

Disgust Sensitivity and Anxiety Disorder Symptoms: Psychometric Properties of the Disgust Emotion Scale

Recent research has implicated disgust sensitivity in the etiology of specific anxiety disorders. The Disgust Emotion Scale (DES) is a newly developed measure that was designed to improve the assessment of disgust sensitivity. The present study examines the psychometric properties of the DES. Exploratory factor analysis in Study 1 revealed five factors of disgust towards: (1) rotting foods, (2) blood and injection, (3) smells, (4) mutilation and death, and (5) small animals. The DES demonstrated adequate internal consistency and convergent validity. Significant positive correlations were found between the five factors of the DES and blood-injection-injury fears and obsessive-compulsive disorder symptoms. Confirmatory factor analysis in Study 2 provided support for the five-factor model. However, there was indication of item overlap within the factors. These findings suggest that the DES is a reliable measure of disgust as it relates to specific anxiety disorder symptoms.     

Sex differences and sex similarities in disgust sensitivity

Across two studies, we test for sex differences in the factor structure, factor loadings, concurrent validity, and means of the Three Domain Disgust Scale. In Study 1, we find that the Three Domain Disgust Scale has indistinguishable factor structure and factor loadings for men and women. In Study 2, we find a small sex difference in sensitivity to pathogen and moral disgust and a large sex difference in sensitivity to sexual disgust, with women more sensitive to disgust across domains. However, correlations between Three Domain Disgust Scale factors and the five factors and 30 facets of the NEO Personality Inventory were indistinguishable between the sexes. These findings suggest that, despite mean sex differences in disgust sensitivity, the Three Domain Disgust Scale measures similar constructs in men and women. Implications for understanding the constructs measured by the Three Domain Disgust Scale are discussed.     

Disgust Sensitivity and Psychopathological Symptoms: Distinctions from Harm Avoidance

The present study examined the relationship between disgust sensitivity and symptoms of somatization, obsessive-compulsive disorder (OCD), interpersonal sensitivity, depression, anxiety, anger/hostility, phobic anxiety, paranoid ideation, and psychoticism in a community sample. Participants (n = 121) completed the Disgust Scale-2, the Symptom Checklist-90, and the harm avoidance subscale of the Temperament and Character Inventory. Disgust sensitivity was found to be correlated with a broad range of psychopathological symptoms. However, results also indicated that these correlations were partially mediated by harm avoidance. That is, when controlling for levels of harm avoidance, the association between disgust sensitivity and psychopathological symptoms was either substantially reduced or became nonsignificant. These findings suggest that the tendency towards behavioral inhibition to avoid punishment and non-reward may partially account for the association between disgust sensitivity and a broad range of psychopathological symptoms.

Revisiting the factor structure of the 12-item Disgust Propensity and Sensitivity Scale – Revised: Evidence for a third component

The 12-item Disgust Propensity and Sensitivity Scale – Revised (DPSS-12) is widely used to assess the tendency for an individual to respond with disgust (i.e., disgust propensity) and how bothered an individual is by the experience of disgust (i.e., disgust sensitivity). However, heterogeneous items included in the DPSS-12 call into question the adequacy of its two-factor structure. The current study examined the factor structure of the DPSS-12 using two large, nonclinical student samples. Exploratory factor analyses revealed three lower order factors: (1) disgust propensity, (2) disgust sensitivity, and (3) self-focused/ruminative disgust. Confirmatory factor analyses supported the three-factor solution and demonstrated that the model fit better than a unidimensional or two-factor model. Further, a modified two-factor model that excluded the third factor provided a better fit than the original two-factor model. Additionally, the third domain explained a significant portion of the total variance, and evidenced a distinctive pattern of association with relevant constructs including obsessional symptoms. These data suggest the need to refine our knowledge about the latent structure of disgust reflected by this measure.     

“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.     

Pavlovian Disgust Conditioning and Generalization: Specificity and Associations With Individual Differences

Although studies have identified differences between fear and disgust conditioning, much less is known about the generalization of conditioned disgust. This is an important gap in the literature given that overgeneralization of conditioned disgust to neutral stimuli may have clinical implications. To address this knowledge gap, female participants (n = 80) completed a Pavlovian conditioning procedure in which one neutral food item (conditioned stimulus; CS+) was followed by disgusting videos of individuals vomiting (unconditioned stimulus; US) and another neutral food item (CS–) was not reinforced with the disgusting video. Following this acquisition phase, there was an extinction phase in which both CSs were presented unreinforced. Importantly, participants also evaluated generalization stimuli (GS+, GS?) that resembled, but were distinct from, the CS after each conditioning phase. As predicted, the CS+ was rated as significantly more disgusting and fear inducing than the CS? after acquisition and this pattern persisted after extinction. However, disgust ratings of the CS+ after acquisition were significantly larger than fear ratings. Participants also rated the GS+ as significantly more disgusting, but not fear inducing, than the GS? after acquisition. However, this effect was not observed after extinction. Disgust proneness did predict a greater increase in disgust and fear ratings of the CS+ relative to the CS? after acquisition and extinction. In contrast, trait anxiety predicted only higher fear ratings to the CS+ relative to the CS? after acquisition and extinction. Disgust proneness nor trait anxiety predicted the greater increase in disgust to the GS+ relative to the GS? after acquisition. These findings suggest that while conditioned disgust can generalize, individual difference variables that predict generalization remain unclear. The implications of these findings for disorders of disgust are discussed.     

A test of a disease-avoidance model of animal phobias

This study examined the relationship between disgust/contamination sensitivity and fear of animals. The results suggested that sensitivity to disgust and contamination was directly related to scores on the animal phobia and fear of illness and death sub-scales of the Fear Survey Schedule (FSS). Further analysis suggested that disgust/contamination sensitivity was related only to fear of certain groups of animals: namely those animals that are not considered to attack and harm human beings but are considered fear-evoking (e.g. rat, spider, cockroach), and those animals that are normally considered to evoke revulsion (e.g. maggot, snail, slug). Disgust/contamination sensitivity was not related to fear of animals that are considered highly likely to attack and harm human beings (e.g. tiger, lion, shark). These results are discussed as support for a disease-avoidance model of common animal fears.     

The Disgust Scale: item analysis, factor structure, and suggestions for refinement

In the 4 studies presented (N = 1,939), a converging set of analyses was conducted to evaluate the item adequacy, factor structure, reliability, and validity of the Disgust Scale (DS; J. Haidt, C. McCauley, & P. Rozin, 1994). The results suggest that 7 items (i.e., Items 2, 7, 8, 21, 23, 24, and 25) should be considered for removal from the DS. Secondary to removing the items, exploratory and confirmatory factor analyses revealed that the DS taps 3 dimensions of disgust: Core Disgust, Animal Reminder Disgust, and Contamination-Based Disgust. Women scored higher than men on the 3 disgust dimensions. Structural modeling provided support for the specificity of the 3-factor model, as Core Disgust and Contamination-Based Disgust were significantly predictive of obsessive- compulsive disorder (OCD) concerns, whereas Animal Reminder Disgust was not. Results from a clinical sample indicated that patients with OCD washing concerns scored significantly higher than patients with OCD without washing concerns on both Core Disgust and Contamination-Based Disgust, but not on Animal Reminder Disgust. These findings are discussed in the context of the refinement of the DS to promote a more psychometrically sound assessment of disgust sensitivity.     

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

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