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.     

Components of attentional biases in contamination fear: Evidence for difficulty in disengagement

Attentional bias for threat has been implicated in the contamination fear (CF) subtype of obsessive-compulsive disorder, but the components of the bias (facilitated attention versus difficulty in disengagement) and the stage of processing during which the bias occurs (early versus late stage of processing) remains unclear. Further, it is unclear whether attentional biases in CF are towards fear or disgust-related stimuli. The present study examined attentional biases in a group of individuals selected to have elevated CF (n = 23) and a control group (n = 28) using the spatial cueing task. Stimuli were neutral, disgusting, or frightening pictures presented for either 100 or 500 ms. Results revealed evidence for delayed disengagement from both fear and disgust stimuli in the CF group, but not in the control group. The effect appeared to be greater at 500 ms stimulus presentation, but did not appear to differ between fear and disgust stimuli. The CF group was associated with delayed disengagement from threat even when controlling for generic response slowing. Theoretical and clinical implications are discussed.     

The effects of safety behaviors on the fear of contamination: an experimental investigation

The strategies used by anxious individuals to prevent feared outcomes, known as safety behaviors, are thought to maintain pathological anxiety by preventing the disconfirmation of inaccurate threat beliefs. However, it is possible that safety behaviors might also contribute to the development and exacerbation of anxiety symptoms. The present study tested this notion in a sample of undergraduate participants with either low (n=30) or high (n=26) levels of contamination fear. After a week-long baseline period, participants spent 1 week engaging in a clinically representative array of contamination-related safety behaviors on a daily basis, followed by a second baseline period. Subsequent to the safety behavior manipulation, participants evidenced statistically significant increases in threat overestimation, contamination fear symptoms, and emotional and avoidant responses to three contamination-related behavioral avoidance tasks (BATs). In contrast, anxiety and depressive symptoms remained stable. The magnitude of change in contamination concerns was equivalent among participants in both contamination fear groups. Our findings suggest that contamination-related safety behaviors elicit a modest and specific increase in the fear of contamination. Possible mechanisms for this effect, as well as implications for the role of safety behaviors in the psychopathology of anxiety disorders, are discussed.     

Feelings of mental pollution subsequent to sexual assault

This paper describes an investigation of the phenomenon of mental pollution in a sample of 50 female victims of sexual assault. Feelings of mental pollution were assessed using an interview and a questionnaire. An experimental procedure was employed to determine if feelings of dirtiness and the urge to wash could be provoked by deliberate attention to the assault memory. Thirty (60%) of the 50 participants reported some feelings of mental pollution subsequent to the assault, and feelings of mental pollution were related to post-assault washing behaviour. Deliberate recall of the assault resulted in stronger feelings of dirtiness and the urge to wash than did deliberate attention to a pleasant memory or scene. Nine women reported washing their hands in response to deliberate recall of the assault. These findings suggest that feelings of mental pollution may be prominent in victims of sexual assault.     

Temperament and Vulnerability to Psychopathology: Introduction to the Special Section

Several authors have highlighted associations with temperament as promising avenues for understanding vulnerability to psychopathology (e.g., Muris and Ollendick, Clinical Child and Family Psychology Review, 8, 271–289, 2005; Nigg, Journal of Child Psychology and Psychiatry, and Allied Disciplines, 47, 395–422, 2006). The successful integration of models of temperament and models of psychopathology will undoubtedly increase our understanding of both. The current special section intends to present important new ideas and evidence in this field and tries to formulate answers to a couple of emerging questions. To set the stage for the papers, we provide a brief state of the art of research on temperament—psychopathology associations. After that, we discuss emerging questions in the field, some of which are addressed in the papers of this special section. To conclude, we point out a couple of future research perspectives.     

The Meta-Cognitive Beliefs Questionnaire: development of a measure of obsessional beliefs

A 67 item self-report questionnaire called the Meta-Cognitive Beliefs Questionnaire (MCBQ) was developed to assess endorsement of beliefs about the importance of control and negative consequences associated with unwanted, ego-dystonic intrusive thoughts, images and impulses. The MCBQ and a battery of questionnaires that assessed symptoms and cognitions of worry, obsessive-compulsive disorder, anxiety, and depression were administered to large samples of undergraduate students. Beliefs about control of intrusive thoughts and perceived negative consequences due to uncontrolled mental intrusions had a unique significant relationship with obsessions, and to a lesser extent, worry. These findings are consistent with current cognitive behavioral theories that suggest an important role for meta-cognitive beliefs in the pathogenesis of obsessions.     

论人的脆弱性和依赖性

人类所有的脆弱性是人性的一个基本事实。人类的脆弱性与人类的德性需要是内在相关的。但是,在漫长的西方哲学史上,对于人的脆弱性以及人的依赖性这一基本的人性事实却很少有人注意。然而,人类需要承认依赖性的德性。     

An investigation of self-ambivalence in obsessive-compulsive disorder

Individuals vulnerable to obsessive-compulsive disorder (OCD) are hypothesized to have ambivalence about their self-worth, morality and lovability [Guidano, V., & Liotti, G. (1983). Cognitive processes and emotional disorders. New York: Guildford Press]. The purpose of this study was to examine whether self-ambivalence was associated with OCD phenomena and beliefs relevant to OCD. It also examined whether patients with OCD had higher levels of self-ambivalence compared to non-clinical controls and patients with other anxiety disorders. Participants were 73 OCD patients, 50 patients with another anxiety disorder, 225 non-clinical undergraduate students and 43 non-clinical community controls. They completed measures of self-ambivalence, OCD phenomena, OCD-relevant beliefs, depression, anxiety and self-esteem. Self-ambivalence was significantly associated with OCD phenomena and OCD-relevant beliefs, after controlling for self-esteem, depression and anxiety. Further, OCD participants were significantly more ambivalent than the non-clinical groups, but did not differ from anxious controls. It was argued that these results provide a basis for extending the cognitive-behavioural model of OCD to include ambivalent self-perceptions as a component of the cognitive mechanisms relevant to the disorder.     

Functional links of obsessive,dysmorphic, hypochondriac,and eating-disorders related mental intrusions

Background/Objective

Unwanted mental intrusions (UMIs) are the normal variants of obsessions in Obsessive-Compulsive Disorder (OCD), preoccupations about defects in Body Dysmorphic Disorder (BDD), images about illness in Hypochondriasis (HYP), and thoughts about eating in Eating Disorders (EDs). The aim was to examine the similarities and differences in the functional links of four UMI contents, adopting a within-subject perspective. Method: 438 university students and community participants (M_age = 29.84, SD = 11.41; 70.54% women) completed the Questionnaire of Unpleasant Intrusive Thoughts (QUIT) to assess the functional links (emotions, appraisals, and neutralizing/control strategies) of the most upsetting UMIs with OCD, BDD, HYP and EDs-contents. Results: HYP-related intrusions caused the highest emotional impact, OCD-related intrusions were the most interfering, and EDs-related intrusions interfered the least. The four UMI were equally ego-dystonic. Women appraised OCD-related intrusions more dysfunctionally, but men appraised the four intrusive contents similarly. All UMI instigated the urge to “do something”, to keep them under control and/or neutralizing them. Conclusions: Similarities among the functional links of intrusions related to OCD, BDD, HYP and EDs contents support their transdiagnostic nature and they might contribute to understanding common factors in these disorders.     

Fear of contamination

Compulsive cleaning is an attempt to remove feelings of contamination that threaten one's physical health, mental health or ability to function socially. The fear of becoming contaminated can be complex, powerful, persistent and easily spread. Contamination is defined, the main types of contaminants set out and the characteristics of the fear are described. The distinction between normal and abnormal feelings of contamination is considered, and abnormal beliefs about contamination are analysed. Attention is drawn to the fact that contamination can occur without any physical contact, and the concept of mental pollution is used to elucidate this process. The causes and consequences of contamination fears are described, and some connections between fear and disgust are considered. The concept of cognitive co-morbidity is applied to an analysis of associations between the fear of contamination and obsessions, social fears and phobias. It is suggested that applying cognitive analyses and tactics may improve our ability to treat these powerful and tenacious fears.     

How to suppress obsessive thoughts

Thought suppression (i.e. consciously trying to avoid certain thoughts from entering consciousness) has been argued to be an inadequate strategy in case of unwanted intrusions. That is, thought suppression seems to result in more rather than less intrusions. Although this experimental finding has been explained in terms of failing attempts to distract oneself from the target thought, the White Bear Suppression Inventory (WBSI; a scale that measures chronic thought suppression tendencies) does not address the means by which respondents try to suppress unwanted thoughts. To examine which strategies of mental control people use to suppress unwanted thoughts, obsessive-compulsive disorder patients (N=47) completed the WBSI, the Thought Control Questionnaire, and two measures of psychopathology. Results suggest that the crucial mechanism in thought suppression may not be distraction, but self-punishment.     

The family roles of siblings of people diagnosed with a mental disorder: Heroes and lost children

In order to cope with the diagnosis of mental illness in a family member, siblings may be forced to adjust their roles in the family. Taking into account the crucial role that some siblings play in caregiving for the mentally ill especially when the parents are no longer available, it is imperative to develop awareness of their unique needs and address them. Thirty‐three adult siblings of people diagnosed with a mental disorder completed the Role Behaviour Inventory (RBI) and a general questionnaire including open‐ended questions regarding the roles they played in their families of origin. Findings from the inventory and general questionnaire suggest that the well siblings score higher on two roles, the Hero and Lost Child, and lower on the Mascot and Scapegoat roles relative to a comparison group (N = 33). Being a sibling caregiver emerged as a risk factor to assume certain dysfunctional roles in the family. Implications for future research and therapy are discussed.     

Identification and explanation of racial differences on contamination measures

Compared with published norms, African Americans endorse significantly more items intended to assess pathological anxiety about contamination on self-report instruments for obsessive–compulsive disorder. The current study suggests that this is not due to greater psychopathology in African Americans, but rather to differences in normal attitudes about cleanliness that also influence responses to items intended to assess anxiety pathology. Contamination items from obsessive–compulsive disorder (OCD) scales including the Padua Inventory [Sanavio E. (1988). Obsessions and compulsions: The Padua Inventory. Behaviour Research and Therapy, 26(2), 169–177] were supplemented with cleanliness attitude items and administered to Black and White participants (N=1483). An exploratory factor analysis suggested a three-factor solution: one factor that encompassed pathological anxiety, and two that expressed attitudes about cleanliness, grooming, and domestic animals. African Americans scored significantly higher on all three factors. A confirmatory factor analysis demonstrated that the difference between Black and White participants on the pathological anxiety factor was eliminated when differences on the attitude factors were controlled statistically.     

Vulnerability associations and symptoms of post-traumatic stress disorder in soldiers deployed to Iraq

The purpose of this prospective study was to examine whether explicit and implicit vulnerability associations before and after trauma exposure predict the onset and persistence of post-traumatic stress disorder (PTSD) symptoms. The implicit association test (IAT) was modified to assess associations of self with vulnerability related cues. Dutch soldiers completed the IAT 6 weeks before being deployed to Iraq, and again 5 months upon return home. They also rated an explicit vulnerability scale. PTSD symptoms were assessed 5 and 15 months after deployment with a clinical interview and questionnaire. The results showed that (1) the pre-deployment vulnerability measures did not predict PTSD symptoms at 5 months, (2) both explicit and implicit post-deployment vulnerability measures explained unique variance in concurrent PTSD symptoms, over and above pre-existing neuroticism, and (3) only the explicit post-deployment vulnerability measure predicted unique variance in later PTSD symptoms (at 15 months), after controlling for earlier symptoms. This was no longer the case after controlling for neuroticism. The results suggest that strong implicit associations between the self and vulnerability are a consequence rather than a cause of PTSD symptoms.     

Directed forgetting in obsessive-compulsive disorder: replication and extension

Previous research indicates that patients with obsessive-compulsive disorder (OCD) show impaired ability to forget negative material (Behav Res Ther 34 (1996) 633). The present study was intended to replicate and extend these findings by separating emotional valence from personal relevance, using idiographic stimulus selection to control for heterogeneity of OCD concerns, and the addition of an anxious control group. We used a directed forgetting paradigm, in which participants were instructed to either remember or forget a series of words. No differences in impairment were found among the groups during a free recall test, in which they were asked to recall both "remember" and "forget" words. However, during a recognition test, OCD patients showed greater impaired forgetting for OCD-relevant words than did nonanxious and anxious controls. Valence of words did not emerge as a contributing factor to impaired forgetting.     

Rates of abuse in body dysmorphic disorder and obsessive-compulsive disorder

Body dysmorphic disorder (BDD) continues to challenge professionals due to symptom severity, co-morbidity, suicidal ideation, and overvalued ideation. Despite the disorder's severity, little research exists. Clinical observation suggests a noteworthy history of abuse; therefore the present study investigated the reported rate of physical, sexual, and emotional abuse in BDD patients. OCD patients were chosen as a comparison group because BDD is considered to be an obsessive-compulsive spectrum disorder. A group survey design was used (N = 50 for each group). Results show significantly higher levels of emotional and sexual abuse in the BDD sample versus the OCD sample. No significant differences were found in physical abuse. Abuse may be a contributing factor in BDD, but not in OCD.     

Linking obsessional beliefs to OCD symptoms in older and younger adults

There are many open questions about the phenomenology of obsessive-compulsive disorder (OCD) in the elderly, and theories about the development of OCD have rarely been applied to older populations. The current study uses structural equation models to evaluate the relationship between obsessional beliefs and OCD symptoms across young and older adult age groups in a large community sample (aged 18-93; N=335), and to examine whether subjective concerns about cognitive decline partially mediate this relationship. Results support partial mediation, and follow-up analyses suggest that the pattern of relationships among subjective cognitive concerns, obsessional beliefs and OCD symptoms is invariant for younger and older adults, but older adults report relatively greater levels of subjective cognitive concerns.     

Automatic avoidance tendencies in individuals with contamination-related obsessive-compulsive symptoms

We used an approach-avoidance task (AAT) to examine response to threatening stimuli in 20 individuals high in contamination-related obsessive-compulsive symptoms (HCs) and 21 individuals low in contamination-related obsessive-compulsive symptoms (LCs). Participants were instructed to respond to contamination-related and neutral pictures by pulling a joystick towards themselves or by pushing it away from themselves. Moving the joystick changed the size of the image to simulate approaching or distancing oneself from the object. Consistent with our hypothesis, the HC group was significantly slower in pulling contamination-related pictures than in pulling neutral pictures, whereas in the LC group there was no difference between speed of pulling contamination-related pictures and neutral pictures. Contrary to our hypothesis, we did not find support for faster pushing away of contamination-related pictures than neutral pictures by the HC group. Moreover, the degree of avoidance of contamination-related stimuli when pulling - but not when pushing - was significantly correlated with self-reported contamination-related obsessive-compulsive symptoms. These results suggest a biased behavioral response for threatening objects in individuals high in contamination fears only when inhibiting the prepotent response to avoid threatening stimuli and not when performing a practiced avoidance response. Thus, our results validate the use of the AAT as a measure of inhibited and uninhibited automatic avoidance reactions to emotional information in individuals with contamination-related obsessive-compulsive symptoms.     

Beyond Empathy: Vulnerability,Relationality and Dementia

ABSTRACT

This paper brings together a phenomenological and vulnerability-theoretic approach to dementia. The paper challenges the view that subjects with dementia can simply be understood in terms of diminished cognitive capacities or that they have lost all vestiges of personhood or the capacity for meaningful interaction. Instead, drawing on vulnerability theory and the phenomenological work of Kristin Zeiler and Lisa Käll, an alternative view of persons with dementia is offered that is based on intersubjective and intercorporeal relations and accomplishments. A vulnerability approach to dementia is developed that not only provides the basis for empathetic responses to illnesses such as dementia but also points to the intersubjective constitution of subjects more generally. The argument developed is that the notion of vulnerability designates a form of openness to others and that such openness is a precondition for empathy.     

Obsessive-compulsive disorder subtypes: an attempted replication and extension of a symptom-based taxonomy

A symptom-based subgroup taxonomy for obsessive-compulsive disorder (OCD) was evaluated and refined. The Yale-Brown Obsessive-Compulsive Scale symptom checklist was scored and cluster analysis was conducted with a sample of OCD patients (N = 114). Results were compared to Calamari et al.'s (Behaviour Research and Therapy 37 (1999) 113) five subgroup model. Rules for determining the number of subgroups supported a more complex model. In between sample comparisons, a stable contamination subgroup was found in both a five and seven subgroup taxonomy. Between sample stability was not as strong for Harming, Obsessionals, Symmetry, and Certainty subgroups. Hoarding, as a distinctive subgroup, was unstable in separate samples. When the Calamari et al. sample and the present sample were combined (N = 220), we found a reliable Hoarding subgroup. More interpretable and stable models emerged with the combined samples suggesting that large clinical samples are needed to identify OCD subgroups. Greater support was found for a seven subgroup taxonomy based subgroup interpretability and validation measure differences. The potential utility of symptom-based subgroup models of OCD and alternative approaches are discussed. Identification of reliable and valid OCD subtypes may advance theory and treatment.