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

ObjectiveDisgust is a basic emotion associated with feelings of revulsion and withdrawal behaviors from dangerous situations. The aim of this study was to examine the psychometric properties of the Disgust Scale—Revised (DS-R), a tool designed to measure individuals' responses to various disgust-provoking situations, among Korean populations.MethodsA sample of 1117 healthy volunteers completed self-report questionnaires containing the 27-item DS-R. A subsample (n = 231) completed the Temperament and Character Inventory (TCI), Eysenck Personality Questionnaire (EPQ), and State-Trait Anxiety Inventory (STAI). Principal component analysis using a varimax rotation was conducted. Construct validity was assessed using Pearson correlation analysis for the TCI, EPQ, and STAI. To examine differences in responses on the DS-R among populations, patients with obsessive-compulsive disorder were compared with healthy subjects who were matched with respect to age and sex.ResultsThe Cronbach α estimates for total items and the 3 original subscales of the DS-R, including: core disgust, animal reminder disgust, and contamination-based disgust, were 0.86, 0.77, 0.80, and 0.55, respectively. Principal component analysis identified 5 factors, which accounted for 48% of the total variance of the scale. The 5 newly developed dimensions were labeled as core disgust-touch, core disgust-dirt, contamination-based disgust, animal reminder disgust, and social intolerance disgust. The Cronbach α coefficients were 0.79, 0.64, 0.46, 0.77, and 0.34, respectively, for these subscales. The DS-R was correlated positively with harm avoidance from the TCI, neuroticism from the EPQ, and the anxiety scores of STAI. Furthermore, the contamination-based disgust scores for patients with obsessive-compulsive disorder were higher than those of normal controls.ConclusionThe DS-R may be a reliable, valid, and acceptable tool to measure disgust sensitivity among Korean populations. The psychometric properties of the Korean version of the DS-R and the original DS-R are discussed.     

Disgust sensitivity and psychopathological symptoms in non-clinical children

There is clear evidence in the adult literature that disgust sensitivity is implicated in various psychopathological syndromes. The current study examined the link between disgust sensitivity and psychopathological symptoms in youths. In a sample of non-clinical children aged 9–13 years, disgust sensitivity was assessed by two self-report questionnaires (i.e., the Disgust Scale and the Disgust Sensitivity Questionnaire) and a behavioural test. Furthermore, children completed scales for measuring the personality trait of neuroticism and various types of psychopathological symptoms. Results showed that disgust measures had sufficient to good convergent validity. Further, significant positive correlations were found between disgust sensitivity and symptoms of specific phobias (i.e., spider phobia, blood-injection phobia, small-animal phobia), social phobia, agoraphobia, obsessive-compulsive disorder (OCD), and eating problems, and these links were not attenuated when controlling for neuroticism. The possible role of disgust sensitivity in the aetiology of child psychopathology is discussed.     

The relationship between contamination cognitions, anxiety, and disgust in two ethnic groups

Background and objectivesObsessive-compulsive disorder (OCD) is understudied in African Americans, thus little is known about factors that might predispose this group to obsessive-compulsive anxiety. Prior research has shown that African Americans endorse more concerns about contamination, but it is not known how these differences relate to variables, such as beliefs or cognitions about contamination, the emotion of disgust, and anxiety sensitivity. The current study examined Black-White differences in contamination cognitions in a non-clinical sample (N = 245).MethodsEuropean American and African American participants completed measures of contamination cognitions, anxiety, OCD, and disgust.ResultsAfrican Americans exhibited significantly stronger contamination cognitions, as measured by the Contamination Concerns Scale. Multiple regression analysis showed that contamination concerns were predicted by disgust sensitivity, ethnicity/race, and gender. Neither anxiety sensitivity nor pathological washing behaviors were significant factors in the model.LimitationsStudy should be replicated in additional populations as generalizability beyond a college student population is not known.ConclusionsAfrican Americans are no more sensitive to disgust or anxiety than European Americans, but nonetheless have greater concerns about the severity of contamination surrounding certain items. This may predispose African Americans with OCD to symptoms involving contamination.     

Developing an implicit measure of disgust propensity and disgust sensitivity: examining the role of implicit disgust propensity and sensitivity in obsessive-compulsive tendencies

Background and objectives

There is increasing evidence that disgust responding occurs at both a primary and secondary level in the form of disgust propensity and disgust sensitivity. The unique contributions of anxiety and disgust need to be established if disgust is to be implicated in the etiology of anxiety disorders such as obsessive-compulsive disorder (OCD). The primary objective of the current study was to develop two separate implicit measures of disgust propensity and sensitivity and to explicate the role of implicit disgust propensity and sensitivity in avoidance behavior and OC tendencies.

Methods

The current study (N = 33 undergraduate students) utilized a measure of implicit cognition, the Implicit Relational Assessment Procedure (IRAP), to independently analyze disgust propensity and disgust sensitivity. In addition, a series of behavioral approach tasks (BAT) and questionnaires measuring general disgust, obsessive-compulsive (OC) tendencies and general psychopathology were implemented to validate the implicit measures.

Results

Disgust sensitivity predicted avoidance behavior on the BATs independent of disgust propensity and anxiety, while disgust propensity did not. Both disgust propensity and sensitivity predicted self-reported OC tendencies and individually predicted obsessing and washing concerns, respectively.

Limitations

Our findings are based on a non-clinical student sample and further research is required for generalization to OCD.

Conclusions

The implicit measures appeared to be measuring two separate constructs and had differential relationships with behavior and OC tendencies. Overall, the results support current theories relating to pathological disgust and OCD.     

Disgust uniquely predicts coping and interpersonal processes beyond anxiety and dysphoria in the context of naturalistic stressors

BackgroundDisgust is theorized to serve a unique function of motivating avoidance of noxious stimuli and setting interpersonal boundaries to prevent contamination. Research has established the relevance of disgust to OCD, posttraumatic stress, and phobias, suggesting transdiagnostic features. However, research has not always accounted for overlap of disgust with other negative emotions, obscuring unique contributions. Moreover, studies have not disentangled between-person (mean levels) and within-person (state) effects. The present study examined within- and between-person relationships of disgust, anxiety, and dysphoria with responses to daily social stressors. We expected disgust would uniquely predict cognitive avoidance and boundary-setting interpersonal behavior.MethodIndividuals (N = 159) meeting ADIS-V anxiety/depressive disorder criteria (n = 55) and healthy controls (n = 104) completed online journals about naturalistic social stressors over five weeks (1,923 records), reporting disgust, anxiety, dysphoria, and responses to social stressors.ResultsAs expected, disgust uniquely predicted lower acceptance, greater thought suppression, greater self-assertion, and less prosocial behavior, above and beyond anxiety and dysphoria. Several disgust effects were present at both between- and within-person levels, suggesting the relevance of both mean disgust and state fluctuations.ConclusionsResults demonstrate unique relevance of disgust for how individuals respond to social stressors.     

The relation between disgust-sensitivity, blood-injection-injury fears and vasovagal symptoms in blood donors: disgust sensitivity cannot explain fainting or blood donation-related symptoms

Background and objectivesPage’s (1994) prominent theory for the explanation of fainting in blood-injection-injury situations holds that disgust sensitivity contributes to syncopal reactions. We investigated if blood donation-related vasovagal symptoms (1) or fainting related to blood donations (2) are associated with disgust sensitivity.MethodsIn an online sample of 361 blood donors, we assessed blood-injection-injury fears, disgust sensitivity, history of blood donation related fainting and retrospective self-ratings of vasovagal symptoms. For the assessment of blood-injection-injury fears we used the BII-Q which has excellent psychometric properties and does not confound disgust and anxiety sensitivity. Vasovagal symptoms were measured by the Blood Donation Reactions Inventory (BDRI) which captures mild and strong vasovagal symptoms and has been used in previous studies with blood donors.ResultsDisgust sensitivity did not significantly contribute to the explanation of self-reported vasovagal symptoms in a regression model with gender, blood-injection-injury fear and disgust sensitivity as predictors. We did not find any significant group differences in disgust sensitivity for blood donors with or without a fainting history (statistical power = 0.95) and a Bayesian model selection procedure showed that it is more likely that both groups are equally disgust sensitive than it is that the fainters are more disgust sensitive.LimitationsFurther research is required to confirm the findings in prospective studies.ConclusionOur results indicate that disgust sensitivity is not relevant for the development of vasovagal syncopes.     

DSM-IV obsessive-compulsive personality disorder: prevalence in patients with anxiety disorders and in healthy comparison subjects

The relationship between obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) has not yet been fully clarified. The aim of the present study was to analyze DSM-IV OCPD prevalence rates in OCD and panic disorder (PD) patients to test for the specificity of the OCPD-OCD link, and to compare them to OCPD prevalence in a control group of subjects without any psychiatric disorder. A total of 109 patients with a principal diagnosis of DSM-IV (SCID-I) OCD and 82 with PD were interviewed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) in order to assess the prevalence of OCPD. All patients with a coexisting axis I diagnosis were excluded from the study to eliminate confounding factors when evaluating the association between prevalence rates of OCPD and anxiety disorder diagnoses. An exclusion criteria was also a Hamilton Depression Rating Scale (HAM-D) score >/=16. A sample of comparison subjects (age 18 to 65 years) without any psychiatric disorder was recruited from people registered with two general practitioners (GPs), whether or not they consulted the doctor, in order to evaluate OCPD prevalence rate in the community. A significant difference was found between the prevalence of OCPD in OCD (22.9%) and in PD (17.1%) on one hand, and that in the comparison sample (3.0%) on the other. No differences were found between the two psychiatric groups, even when splitting the samples according to gender. Our study failed to support the hypothesis of a specific relationship between OCPD and OCD; we confirmed the higher prevalence rate of this personality disorder in OCD subjects with regard to the general population, but we also confirmed the higher rate of OCPD in another anxiety disorder which is phenomenologically well characterized and different from OCD, such as PD.     

Does ‘Yuck’ mean ‘Eek’? Fear responses in children after a disgust manipulation

Background and objectivesDisgust is a basic emotion that is thought to play a role in the development of animal phobias. This study was conducted to test whether experimentally induced disgust also results in higher levels of fear and interpretation bias.MethodsChildren aged 9–13 years (N = 94) were asked to inspect a set of specimen characteristic of a novel animal and requested to form themselves an impression of it based on those characteristics. Half of the children were given a set of disgust-eliciting products in relation to the animal, whereas the other half received a set of neutral materials.ResultsThe main results indicated that children in the disgust specimen group exhibited an increase in fear towards the novel animal and a stronger inclination to interpret ambiguous situations involving this animal in a more negative way as compared to children in the neutral specimen group.ConclusionThese findings confirm that disgust has a fear-promoting effect.     

Disgust sensitivity as a predictor of obsessive-compulsive contamination symptoms and associated cognitions

Disgust sensitivity has been hypothesized to play a key role in the etiology and maintenance of several anxiety disorders. The association between disgust sensitivity, trait anxiety, and washing and contamination-related concerns was tested using two different measures of obsessive-compulsive contamination fears using linear structural modeling. Two different models were tested, one where trait anxiety mediated the relationship between disgust sensitivity and contamination fear, and a second model unmediated by trait anxiety. A total of 740 undergraduates completed self-report measures of disgust sensitivity, trait anxiety, and obsessive-compulsive symptoms for course credit. The results indicated that there was insufficient evidence for the mediating role of trait anxiety, and the more parsimonious structural models specifying direct effects between disgust sensitivity and both washing and contamination concerns fit the data well. The results of this research support the central role of disgust in contamination fear.     

Disgust sensitivity and obsessive-compulsive symptoms in a non-clinical sample

Disgust sensitivity has been posited to play a role in the etiology and/or maintenance of obsessive-compulsive disorder (OCD); however, results of studies in this area have been mixed. We examined the relationship between specific domains of disgust sensitivity and specific OCD symptom patterns. One thousand and five undergraduate volunteers completed an internet battery of questionnaires including measures of OCD symptoms, depression, anxiety, and disgust sensitivity. Results indicated that even when controlling for depression and anxiety, several OCD symptom groups (checking, ordering, and washing) were associated with disgust sensitivity. Analysis of residuals, in which we controlled for every other OCD and disgust sensitivity domain for each paired comparison, indicated that the clearest relationship was between washing symptoms of OCD and disgust sensitivity toward hygiene-related stimuli. Examination of these items, however, raises questions about whether commonly accepted measures of disgust sensitivity might confound disgust with other forms of aversion. We discuss possible strategies for clarifying the degree to which fear and disgust are involved in OCD symptoms.     

Obsessive-compulsive personality disorder traits and personality dimensions in parents of children with obsessive-compulsive disorder

PurposeTo compare patterns of temperament and character and the prevalence of Obsessive-Compulsive Personality Disorder (OCPD) and OCPD traits in parents of children with OCD and parents of healthy controls.MethodsTCI and SCID-II were administered to 63 parents of 32 children with OCD and 63 parents of age- and sex-matched controls with no psychiatric diagnosis. Interviewers were not blind to proband status. Personality dimension scores and frequencies of OCPD criteria in both groups were compared after excluding parents with a diagnosis of OCD. Relationships between TCI dimensions and OCPD symptoms in parents and the clinical characteristics of OCD children were also studied.ResultsParents of OCD children presented significantly higher scores in harm avoidance and lower scores in self-directedness, cooperativeness and reward dependence than parents of healthy children. A higher incidence of OCPD was found in parents of probands (p < 0.02). Hoarding, perfectionism and preoccupation with details were significantly more frequent in parents of OCD children. Counting, ordering and cleaning compulsions in OCD children predicted elevated odds of perfectionism and rigidity in their parents.ConclusionsThe existence of the dimensional personality profile associated with OCD in parents of children with OCD and the higher number of OCPD criteria in these parents in comparison to parents of healthy children highlight the importance of the role of personality factors in familial OCD.     

An internet-based study on the relation between disgust sensitivity and emetophobia

In the etiology of disgust-relevant psychopathology, such as emetophobia (fear of vomiting), two factors may be important: disgust propensity, i.e., how quickly the individual experiences disgust, and disgust sensitivity, i.e., how negatively does the individual evaluate this disgust experience [van Overveld, W. J. M., de Jong, P. J., Peters, M. L., Cavanagh, K., & Davey, G. C. L. (2006). Disgust propensity and disgust sensitivity: separate constructs that are differentially related to specific fears. Personality and Individual Differences, 41, 1241-1252]. Hence, the current study examines whether emetophobic participants display elevated levels of disgust propensity and sensitivity, and whether these factors are differentially related to emetophobia. A group of emetophobic members of a Dutch website on emetophobia (n=172), and a control group (n=39) completed an internet survey containing the Emetophobia Questionnaire, Disgust Propensity and Sensitivity Scale-Revised, Disgust Scale, and Disgust Questionnaire. Results showed that the emetophobic group displayed significantly elevated levels of both disgust propensity and disgust sensitivity compared to the control group. Most importantly, disgust sensitivity consistently was the best predictor of emetophobic complaints.     

Comorbid obsessive-compulsive personality disorder in obsessive-compulsive disorder (OCD): a marker of severity

Introduction

Comorbid obsessive-compulsive personality disorder (OCPD) is well-described in obsessive-compulsive disorder (OCD). It remains unclear, however, whether OCPD in OCD represents a distinct subtype of OCD or whether it is simply a marker of severity in OCD.

Materials and methods

The aim of this study was to compare a large sample of OCD subjects (n = 403) with and without OCPD on a range of demographic, clinical and genetic characteristics to evaluate whether comorbid OCPD in OCD represents a distinct subtype of OCD, or is a marker of severity.

Results

Our findings suggest that OCD with and without OCPD are similar in terms of gender distribution and age at onset of OC symptoms. Compared to OCD − OCPD (n = 267, 66%), those with OCD + OCPD (n = 136, 34%) are more likely to present with the OC symptom dimensions which reflect the diagnostic criteria for OCPD (e.g. hoarding), and have significantly greater OCD severity, comorbidity, functional impairment, and poorer insight. Furthermore there are no differences in distribution of gene variants, or response to treatment in the two groups.

Conclusion

The majority of our findings suggest that in OCD, patients with OCPD do not have a highly distinctive phenomenological or genetic profile, but rather that OCPD represents a marker of severity.     

Insight in body dysmorphic disorder (BDD) relative to obsessive-compulsive disorder (OCD) and psychotic disorders: Revisiting this issue in light of DSM-5

IntroductionIn DSM-5, body dysmorphic disorder (BDD) was reclassified under the obsessive-compulsive and related disorders (OCRDs), but little is known about the nature of BDD beliefs. This study aimed to compare level of insight in BDD and consider related implications for DSM-5 classification.MethodParticipants were 27 BDD, 19 obsessive-compulsive disorder (OCD), and 20 psychosis (SZ) participants as well as 42 non-clinical controls (NC), who completed the Brown Assessment of Beliefs Scale (BABS) and Peters Delusions Inventory (PDI).ResultsFor total (and most individual) BABS items, BDD and SZ participants scored significantly higher than OCD and NC participants. On the PDI, there were significant group differences in number of questions endorsed, with clinical groups scoring significantly higher than the NC group on dimensions of distress and preoccupation, but not conviction.ConclusionThese findings suggest appearance-related concerns in BDD somewhat resemble delusions seen in psychosis (and not OCD), and convey important nosological and therapeutic implications.     

Disgust trait modulates frontal-posterior coupling as a function of disgust domain

Following the two-stage model of disgust, ‘core disgust’ (e.g. elicited by rotten food) is extended to stimuli that remind us of our animal nature ‘AR disgust’ (e.g. mutilations, animalistic instincts). There is ample evidence that core and AR represent distinct domains of disgust elicitors. Moreover, people show large differences in their tendency to respond with disgust to potential disgust elicitors (propensity), as well as in their appraisal of experiencing disgust (sensitivity). Thus these traits may be important moderators of people''s response patterns. Here, we aimed to find brain mechanisms associated with these distinct disgust domains and traits, as well as the interaction between them. The right ventrolateral occipitotemporal cortex, which preferentially responded to visual AR, was functionally coupled to the middle cingulate cortex (MCC), thalamus and prefrontal cortex (medial, dorsolateral), as a function of disgust domain. Coupling with the anterior part of MCC was modulated by disgust ‘propensity’, which was strongest during AR. Coupling with anterior insula and ventral premotor cortex was weaker, but relied fully on this domain–trait interaction. Disgust ‘sensitivity’ modulated left anterior insula activity irrespective of domain, and did not affect functional connectivity. Thus a frontal-posterior network that interacts with disgust ‘propensity’ dissects AR and core disgust.     

Disgust and fear reactions uniquely affect intrusions and posttraumatic stress symptoms

Disgust reactions commonly occur during/following trauma and predict posttraumatic stress (PTS) symptoms. Yet, disgust is not mentioned in DSM-5 PTSD criteria. To investigate disgust’s clinical significance in PTSD, we measured the relationship between disgust (and fear) reactions to a personal trauma, and problematic intrusion characteristics (e.g., distress) and intrusion symptom severity. We focused on intrusions because they are a transdiagnostic PTSD symptom, though we also measured overall PTS symptoms to replicate prior work. Participants (N = 471) recalled their most traumatic/stressful event from the past six months. They then rated disgust and fear reactions to this event and completed the Posttraumatic Stress Disorder Checklist-5. Participants who had experienced intrusions about their event in the past month (n = 261) rated these intrusions on several characteristics (e.g., distress, vividness). We found stronger traumatic event-related disgust reactions were associated with more problematic intrusion characteristics, higher intrusion symptom severity, and higher overall PTS symptom severity. Notably, disgust reactions uniquely predicted these variables after statistically controlling for fear reactions. We conclude disgust reactions to trauma may be similarly pathological to fear reactions for intrusion and broader PTS symptoms. Therefore, PTSD diagnostic manuals and treatments should recognize disgust as a trauma-relevant emotion.     

The Disgust Propensity and Sensitivity Scale–Revised: An examination of a reduced-item version

The Disgust Propensity and Sensitivity Scale–Revised (DPSS–R [Pers. Indiv. Differ. 41 (2006) 1241–1252]) is a new assessment tool thought to assess two distinguishable factors contributing to disgust reactions, Disgust Propensity and Disgust Sensitivity. Extant data though indicate the presence of four unreliable DPSS–R items. The present study examined the psychometric properties of a reduced-item version of the DPSS–R, in which these four problematic items were removed, using data from two large independent samples of nonclinical college students. Results from Study 1 revealed that the reduced-item DPSS–R factor structure provided more favorable goodness-of-fit indices than the two previous full-length DPSS–R factor structures. In Study 2, the reduced-item DPSS–R scales showed good reliability, stronger relationships with symptoms of disgust-relevant than fear-relevant phobias, and adequate incremental concurrent validity in predicting symptoms of disgust-relevant phobias. The present study suggests that the reduced-item DPSS–R is both reliable and valid, and likely addresses the limitations of the full-length version.     

Sex differences in neural responses to disgusting visual stimuli: implications for disgust-related psychiatric disorders.

BACKGROUND: A majority of patients with disgust-related psychiatric disorders such as animal phobias and contamination-related obsessive-compulsive disorder are women. The aim of this functional magnetic resonance imaging (fMRI) study was to examine possible sex differences in neural responses to disgust-inducing stimuli that might help explain this female predominance. METHODS: Thirty-four healthy adult volunteers (17 women, all right-handed) were scanned while viewing alternating blocks of disgusting and neutral pictures from the International Affective Picture System. Using a partially-silent fMRI sequence, the participants rated their level of discomfort after each block of pictures. Skin conductance responses (SCR) were measured throughout the experiment. All participants completed the Disgust Scale. RESULTS: Both women and men reported greater subjective discomfort and showed more SCR fluctuations during the disgusting picture blocks than during the neutral picture blocks. Women and men also demonstrated a similar pattern of brain response to disgusting compared with neutral pictures, showing activation in the anterior insula, ventrolateral and dorsolateral prefrontal cortices, and visual regions. Compared with men, women had significantly higher disgust sensitivity scores, experienced more subjective discomfort, and demonstrated greater activity in left ventrolateral prefrontal regions. However, these differences were no longer significant when disgust sensitivity scores were controlled for. CONCLUSIONS: In healthy adult volunteers, there are significant sex-related differences in brain responses to disgusting stimuli that are irrevocably linked to greater disgust sensitivity scores in women. The implications for disgust-related psychiatric disorders are discussed.     

Individual differences in disgust sensitivity modulate neural responses to aversive/disgusting stimuli

Little is known about how individual differences in trait disgust sensitivity modulate the neural responses to disgusting stimuli in the brain. Thirty-seven adult healthy volunteers completed the Disgust Scale (DS) and viewed alternating blocks of disgusting and neutral pictures from the International Affective Picture System while undergoing fMRI scanning. DS scores correlated positively with activations in brain regions previously associated with disgust (anterior insula, ventrolateral prefrontal cortex–temporal pole, putamen–globus pallidus, dorsal anterior cingulate, and visual cortex) and negatively with brain regions involved in the regulation of emotions (dorsolateral and rostral prefrontal cortices). The results were not confounded by biological sex, anxiety or depression scores, which were statistically controlled for. Disgust sensitivity, a behavioral trait that is normally distributed in the general population, predicts the magnitude of the individual's neural responses to a broad range of disgusting stimuli. The results have implications for disgust-related psychiatric disorders.     

Does an unconditioned stimulus memory devaluation procedure decrease disgust memories and conditioned disgust? Results of two laboratory studies

Research has demonstrated that disgust can be installed through classical conditioning by pairing neutral conditioned stimuli (CSs) with disgusting unconditioned stimuli (USs). Disgust has been argued to play an important role in maintaining fear-related disorders. This maintaining role may be explained by conditioned disgust being less sensitive to extinction (i.e., experiencing the CS in the absence of the US). Promising alternatives to extinction training are procedures that focus on the devaluation of US memory representations. In the current study, we investigated whether such devaluation procedures can be successful to counter conditioned disgust. We conducted two laboratory studies (N = 120 and N = 51) in which disgust was conditioned using audio-visual USs. Memory representations of the USs were devalued by having participants recall these USs while they performed a taxing eye-movement task or executed one of several control tasks. The results showed successful conditioned disgust acquisition. However, no strong evidence was obtained that an US memory devaluation procedure modulates disgust memory and diminishes conditioned disgust as indicated by subjective, behavioral, or psychophysiological measures. We discuss the relevance of our results for methodological improvements regarding US memory devaluation procedures and disgust conditioning.