Specific and differential prediction of health anxiety by disgust sensitivity and propensity

Current models of health anxiety suggest that fear resulting from false alarms to perceived threats to one's health results in the development of hypochondriasis and related disorders. Disgust has been proposed as an affective response that may function as an etiological and maintenance mechanism in health anxiety. Moreover, the way in which an individual perceives the disgust response (disgust sensitivity) may affect health anxiety, separately from their likelihood of experiencing disgust (disgust propensity). The present study utilized multiple hierarchical regression analysis to investigate the degree to which self-reported disgust sensitivity and disgust propensity differentially predict elevated health anxiety in a sample of 620 non-treatment-seeking undergraduates. Further, this effect is tested in comparison to that of anxiety sensitivity, a construct demonstrated to be strongly related to health anxiety. Analyses indicate that disgust sensitivity, rather than disgust propensity, is primarily responsible for this relation. An additional analysis tested the specificity of disgust sensitivity relative to anxiety sensitivity. Disgust sensitivity was no longer significant after including anxiety sensitivity in the model. Suggestions for further evaluation of this relation are provided. These results suggest that although disgust sensitivity may appear related to health anxiety, this relation may be confounded by anxiety sensitivity.     

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.     

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.     

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.     

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.     

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.     

Health anxiety and hypochondriasis in the light of DSM-5

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.     

“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.     

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.     

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.     

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.     

Differential disgust responding in people with cancer and implications for psychological wellbeing

Objectives: Evidence suggests that disgust responses, known to negatively affect psychological wellbeing, may differ in people with cancer. We performed the first quantitative investigation of three discrete types of disgust trait – disgust propensity, sensitivity and self-directed disgust – in people diagnosed with a broad range of cancers (versus cancer-free controls), and explored their associations with psychological wellbeing.

Design: In a cross-sectional survey design, 107 participants with heterogeneous cancer diagnoses, recruited from cancer charities and support groups, were matched with cancer-free controls by age and gender.

Outcome measures: Measures of the three disgust traits were taken alongside measures of anxiety and depression.

Results: Disgust sensitivity and physical self-disgust were significantly higher in the cancer than control sample, while disgust propensity and behavioural self-disgust were lower. The disgust traits had a different pattern of associations to psychological wellbeing across the two groups, with disgust sensitivity predicting depressive symptoms to a significantly greater extent in the cancer than control group.

Conclusions: People with cancer differ from matched controls in their disgust responses and these responses have significant predictive relationships with aspects of their psychological wellbeing. The results suggest that emotion-based interventions may be useful for improving psychological wellbeing in people with cancer.     

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.     

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.     

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.     

厌恶加工的神经基础

厌恶是由令人不愉悦、反感的事物诱发的情绪。根据刺激类型的不同, 厌恶可以分为不同的类型。脑岛和基底节是厌恶加工的主要脑区, 前扣带回、杏仁核、丘脑、内侧前额叶也参与厌恶加工。对已有研究的总结发现, 不同类型的厌恶、不同感觉通道的厌恶加工可能具有不同的神经基础。在未来的研究中, 应当注重研究厌恶加工的认知机制、神经基础以及与厌恶相关的神经递质等问题。     

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 and psychopathological symptoms in a nonclinical sample

There is little doubt that disgust sensitivity plays a role in the development of small animal phobias. However, it has been suggested that the basic emotion of disgust is implied in a broad range of psychopathological conditions. The present study examined the relationship between disgust sensitivity and symptoms of phobias (other than animal phobias), obsessive–compulsive disorder, depression, and eating disorder in a nonclinical sample. Undergraduate psychology students were asked to complete the Disgust Sensitivity Questionnaire, as well as measures of phobic (Fear Questionnaire), obsessive–compulsive (Maudsley Obsessive–Compulsive Inventory), depressive (Beck Depression Inventory), and eating disorder (Restraint Scale) symptomatology. Results showed that disgust sensitivity was only related to symptoms of agoraphobia and obsessive–compulsive disorder. The present findings cast doubts on the idea that disgust sensitivity is a central factor underlying a broad range of psychopathological conditions.     

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.

Effects of "Dirty" Information on Disgust Responding to an Unknown Animal in Children: The Moderating Role of Maternal Disgust Proneness

Although research has shown that disgust facilitates avoidance of small animals among adults, much less is known about disgust appraisals of small animals in children as well as the predictors of such appraisals. To address this gap, children (ages 5–13) were exposed to dirt-related and cleanliness-related information about unknown animals. The extent to which these types of information influenced children's feelings of fear, disgust, positivity, and avoidance behavior in relation to the animals was examined. The present study then examined the extent to which child and maternal disgust proneness predicted feelings of disgust to the ‘dirty’ animal. The findings show that providing dirt-related information resulted in a significant increase in disgust, but not fear, responding to the animal. Dirt-related information also resulted in a significant decrease in positive feelings toward the animal. Conversely, providing cleanliness-related information resulted in a significant decrease in disgust, but not fear, responding to the animal. In addition, providing cleanliness-related information resulted in a significant increase in positive feelings toward the animal. Children also engage in more avoidance of the animal described as dirty compared to the animal described as clean. In addition, subsequent analysis revealed an interaction between child and maternal disgust propensity in predicting learned disgust to the dirty animal such that the highest levels of feelings of disgust to the dirty animal were observed among children with high disgust proneness who also have mothers with high disgust proneness. The implications of these findings for conceptualizing the role of disgust in animal phobias among youth will be discussed.