Although the proneness to experience disgust shows a strong relationship with contamination and washing concerns in OCD, it still is not clear what mechanisms explain why disgust fuels contamination and washing rituals. We report two studies on university student samples (n = 233, n = 211) where the mediating role of beliefs related to overestimation of threat and harm and to not-just-right experiences and incompleteness is tested. The results showed that not-just-right experiences and levels of incompleteness partially mediated the total effect of disgust on contamination fear. Threat/responsibility beliefs and harm avoidance did not significantly mediate this relationship. The results suggest that sensitivity to sensory phenomena may partly explain why disgust leads to contamination and washing rituals and that the sensation part accompanying disgust experiences may play a role in contamination fear.
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Results for disgust propensity and sensitivity as subfactors of disgust proneness are available upon request. They reveal the exact same pattern as presented for disgust proneness.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington DC: Author.
Ben-Sasson, A., & Podoly, T. Y. (2017). Sensory over responsivity and obsessive compulsive symptoms: a cluster analysis. Comprehensive Psychiatry, 73, 151–159.
Berger, U., & Anaki, D. (2014). The behavioral inhibition system (BIS) mediates major aspects of the relationship between disgust and OCD symptomology. Journal of Obsessive-Compulsive and Related Disorders, 3, 249–256.
Berle, D., Starcevic, V., Brakoulias, V., Sammut, P., Milicevic, D., Hannan, A., & Moses, K. (2012). Disgust propensity in obsessive-compulsive disorder: cross-sectional and prospective relationships. Journal of Behavior Therapy and Experimental Psychiatry, 43, 656–663.
Blakey, S. M., & Abramowitz, J. S. (2018). Interoceptive exposure: an overlooked modality in the cognitive-behavioral treatment of ocd. Cognitive and Behavioral Practice, 25, 145–155.
Brady, R. E., Adams, T. G., & Lohr, J. M. (2010). Disgust in contamination -based obsessive-compulsive disorder: a review and model. Expert Review of Neurotherapeutics, 10, 1295–1305.
Bragdon, L. B., & Coles, M. E. (2017). Examining heterogeneity of obsessive-compulsive disorder: evidence for subgroups based on motivations. Journal of Anxiety Disorders, 45, 64–71.
Brandt, V. C., Hermanns, J., Beck, C., Bäumer, T., Zurowsky, B., & Münchau, A. (2020). The temporal relationship between premonitory urges and covert compulsions in patients with obsessive-compulsive disorder. Psychiatry Research, 262, 6–12.
Burns, G. L., Keortge, S. G., Formea, G. M., & Sternberger, L. G. (1996). Revision of the Padua Inventory of obsessive compulsive disorder symptoms: distinctions between worry, obsessions, and compulsions. Behaviour Research and Therapy, 34, 163–173.
Cervin, M., Perrin, S., Olsson, E., Claesdotter-Knutsson, E., & Lindvall, M. (2020). Involvement of fear, incompleteness, and disgust during symptoms of pediatric obsessive-compulsive disorder. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-020-01514-7.
Cisler, J. M., Brady, R. E., Olatunji, B. O., & Lohr, J. M. (2010). Disgust and obsessive beliefs in contamination-related OCD. Cognitive Therapy and Research, 34, 439–448.
Coles, M. E., Frost, R. O., Heimberg, R. G., & Rhéaume, J. (2003). “Not just right experiences”: perfectionism, obsessive-compulsive features and general psychopathology. Behaviour Research and Therapy, 41, 681–700.
Coles, M. E., Heimberg, R. G., Frost, R. O., & Steketee, G. (2005). Not just right experiences and obsessive-compulsive features: experimental and self- monitoring perspectives. Behaviour Research and Therapy, 43, 153–167.
Cougle, J. R., Goetz, A. R., Fitch, K. E., & Hawkins, K. A. (2011). Termination of washing compulsions: a problem of internal reference criteria or ‘not just right’ experience? Journal of Anxiety Disorders, 25, 801–805.
Dar, R., Kahn, D. T., & Carmeli, R. (2012). The relationship between sensory processing, childhood rituals and obsessive-compulsive symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 43, 679–684.
Deacon, B., & Olatunji, B. O. (2007). Specificity of disgust sensitivity in the prediction of behavioral avoidance in contamination fear. Behaviour Research and Therapy, 45, 2110–2120.
Feinstein, S. B., Fallon, B. A., Petkova, E., & Liebowitz, M. R. (2003). Item-by-item factor analysis of the Yale-Brown Obsessive Comulsive Scale Symptom Checklist. Journal of Neuropsychiatry and Clinical Neurosciences, 15, 187–193.
Fitch, K. E., & Cougle, J. R. (2013). An evaluation of obsessive beliefs as predictors of performance on in vivo assessments of obsessive-compulsive symptoms. Cognitive Therapy and Research, 37, 207–220.
Foa, E. B., Abramowitz, J. S., Franklin, M. E., & Kozak, M. J. (1999). Feared consequences, fixity of belief, and treatment outcome in patients with obsessive-compulsive disorder. Behavior Therapy, 30, 717–724.
Ghisi, M., Chiri, L. R., Sanavio, E., & Sica, C. (2010). In search of specificity: “not just right experiences” and obsessive compulsive symptoms in non-clinical and clinical Italian individuals. Journal of Anxiety Disorders, 24, 879–886.
Gomes de Alvaranga, P., de Mathis, M. A., Dominguez Alves, A. C., do Rosário, M. C., Fossaluza, V., Hounie, A. G., et al. (2012). Clinical features of tic-related obsessive-compulsive disorder: results from a large multicenter study. CNS Spectrums, 17, 87–93.
Haidt, J., McCauley, C., & Rozin, P. (1994). Individual differences in sensitivity to disgust: a scale sampling seven domains of disgust elicitors. Personality and Individual Differences, 16, 701–713.
Hale, L., Strauss, C., & Taylor, B. L. (2013). The effectiveness and acceptability of mindfulness-based therapy for obsessive compulsive disorder: a review of the literature. Mindfulness, 4, 375–384.
Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: a regression-based approach (2nd ed.). New York: Guilford.
Hayes, A. F. (2019). PROCESS macro for SPSS and SAS [Computer software]. Downloaded from http://www.processmacro.org/index.html.
Hazen, E. P., Reichert, E. L., Piascentini, J. C., Miguel, E. C., do Rosario, M., Pauls, D., et al. (2008). Case series: sensory intolerance as a primary symptom of pediatric OCD. Annals of Clinical Psychiatry, 20, 199–203.
Jones, M. K., & Menzies, R. G. (1997). The cognitive mediation of obsessive–compulsive handwashing. Behaviour Research and Therapy, 35, 843–850.
Jónsdóttir, S. C., & Smári, J. (2000). Measuring obsessions without worry: convergent and discriminant validity of the revised Padua inventory in an Icelandic student population. Scandinavian Journal of Behaviour Therapy, 29, 49–56.
Krause, S., Wong, S., O’Meara, M. G., Aardema, F., & Radomsky, A. S. (2020). It’s not so much about what you touch: mental contamination mediates the relationship between feared self-perceptions and contact contamination. Journal of Obsessive-Compulsive and Related Disorders, 25, 100507.
Lewin, A. B., Wu, M., Murphy, T. K., & Storch, E. A. (2015). Sensory over-responsivity in pediatric obsessive compulsive disorder. Journal of Psychopathology and Behavioral Assessment, 37, 134–143.
Magnússon, A., Axelsson, J., Karlsson, M. M., & Óskarsson, H. (2000). Lack of seasonal mood change in the Icelandic population: results of a cross-sectional study. American Journal of Psychiatry, 157, 234–238.
Mancini, F., Gragnani, A., & D’Olimpio, F. (2001). The connection between disgust and obsessions and compulsions in a non-clinical sample. Personality and Individual Differences, 31, 1173–1180.
Mathes, B. M., Kennedy, G. A., Wilver, N. L., Carlton, C. N., & Cougle, J. R. (2019a). A multi-method analysis of incompleteness in behavioral treatment of contamination-based OCD. Behaviour Research and Therapy, 114, 1–6.
Mathes, B. M., McDermott, K. A., Okey, S. A., Vazquez, A., Harvey, A. M., & Cougle, J. R. (2019b). Mental contamination in obsessive-compulsive disorder: associations with contamination symptoms and treatment response. Behavior Therapy, 50, 15–24.
McKay, D. (2006). Treating disgust reactions in contamination-based obsessive-compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 37, 53–59.
Melli, G., Bulli, F., Carraresi, C., & Stopani, E. (2014). Disgust propensity and contamination-related OCD symptoms: the mediating role of mental contamination. Journal of Obsessive-Compulsive and Related Disorders, 3, 77–82.
Melli, G., Chiorri, C., Carraresi, C., Stopani, E., & Bulli, F. (2015). The two dimensions of contamination fear in obsessive-compulsive disorder: harm avoidance and disgust avoidance. Journal of Obsessive-Compulsive and Related Disorders, 6, 124–131.
Melli, G., Moulding, R., & Poli, A. (2016). Is it more disgusting if I think about it? Examining the interaction of obsessive beliefs and disgust propensity in clinical obsessive-compulsive disorder. Journal of Obsessive-Compulsive Disorder, 11, 74–81.
Melli, G., Bulli, F., Carraresi, C., Tarantiona, F., Gelli, S., & Poli, A. (2017). The differential relationship between mental contamination and the core dimensions of contact contamination fear. Journal of Anxiety Disorders, 45, 9–16.
Miguel, E. C., do Rosario-Campos, M. C., Prado, H. S., et al. (2000). Sensory phenomena in obsessive-compulsive disorder and Tourette’s disorder. Journal of Clinical Psychiatry, 61, 150–156.
Miller, W. I. (1997). The anatomy of disgust. Cambridge: Harvard University Press.
Muris, P., Merckelbach, H., Nederkoorn, S., Rassin, E., Candel, I., & Horselenberg, R. (2000). Disgust and psychopathological symptoms in a nonclinical sample. Personality and Individual Differences, 29, 1163–1167.
Obsessive Compulsive Cognitions Working Group. (2005). Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory—part II: factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527–1542.
Ólafsson, R. P., Arngrímsson, J. B., Árnason, P., Kolbeinsson, Þ., Emmelkamp, P. M. G., Kristjánsson, Á., & Ólason, D. Þ. (2013a). Validity and factor structure of the Dimensional Obsessive Compulsive Scale (DOCS) and its relationship with obsessive beliefs. Journal of Obsessive-Compulsive and Related Disorders, 2, 149–156.
Ólafsson, R. P., Emmelkamp, P. M., Gunnarsdóttir, E. R., Snæbjörnsson, T., Ólason, D. T., & Kristjánsson, A. (2013b). Suppressing disgust related thoughts and performance on a subsequent behavioural avoidance task: implications for OCD. Behaviour Research and Therapy, 51, 152–160.
Ólafsson, R. P., Reynisdóttir, K. G., Sævarsson, S. Þ., Emmelkamp, P. M. G., Kristjánsson, Á., & Ólason, D. Þ. (2016). Mat á alvarleika áráttu- og þráhyggjueinkenna með DOCS spurningalistanum [Assessing severity of OCD symptoms with the Icelandic version of the DOCS]. Sálfræðiritið [The Icelandic Journal of Psychology], 20.-21., 23-37.
Olatunji, B. O., Williams, N. L., Lohr, J. M., & Sawchuk, C. N. (2005). The structure of disgust: domain specificity in relation to contamination ideation and excessive washing. Behaviour Research and Therapy, 43, 1069–1086.
Olatunji, B. O., Lohr, J. M., Sawchuk, C. N., & Tolin, D. F. (2007a). Multimodal assessment of disgust in contamination-related obsessive-compulsive disorder. Behaviour Research and Therapy, 45, 263–276.
Olatunji, B. O., Williams, N., Lohr, J. M., Connolly, K., Cisler, J., & Meunier, S. (2007b). Structural differentiation of disgust from trait anxiety in the prediction of specific anxiety disorder symptoms. Behaviour Research and Therapy, 45, 3002–3017.
Olatunji, B. O., Unoka, Z. S., Beran, E., David, B., & Armstrong, T. (2009a). Disgust sensitivity and psychopathological symptoms: distinctions from harm avoidance. Journal of Psychopathology and Behavioral Assessment, 31, 137–142.
Olatunji, B. O., Wolitzky-Taylor, K. B., Willems, J., Lohr, J. M., & Armstrong, T. (2009b). Differential habituation of fear and disgust during repeated exposure to threat-relevant stimuli in contamination-based OCD: an analogue study. Journal of Anxiety Diosrders, 23, 118–123.
Olatunji, B. O., Cisler, J., McKay, D., & Phillips, M. L. (2010). Is disgust associated with psychopathology? Emerging research in the anxiety disorders. Psychiatry Research, 175, 1–10.
Olatunji, B. O., Ebesutani, C., & Kim, E. H. (2016). Does the measure matter? On the association between disgust proneness and OCD symptoms. Journal of Anxiety Disorders, 44, 63–72.
Olatunji, B. O., Armstrong, T., & Elwood, L. (2017). Is disgust proneness associated with anxiety and related disorders? A qualitative review and meta-analysis of group comparisons and correlational studies. Perspectives on Psychological Science, 12, 613–648.
Pétursdóttir, S. L. (2008). Sálmælingalegir eiginleikar OBQ-44 [Psychometric properties of the OBQ-44]. Unpublished BA Thesis. Faculty of Social Sciences, University of Iceland, Reykjavík.
Pietrefesa, A. S., & Coles, M. E. (2008). Moving beyond an exclusive focus on harm avoidance in obsessive compulsive disorder: considering the role of incompleteness. Behavior Therapy, 39, 224–231.
Rachman, S. (2004). Fear of contamination. Behavior Research and Therapy, 42, 1227–1255.
Rachman, S. (2006). Fear of contamination: assessment and treatment. New York: Oxford University Press Inc..
Rapoport, J. L. (1991). Basal ganglia dysfunction as a proposed cause of obsessive-compulsive disorder. In B. J. Carroll & J. E. Barrett (Eds.), Psychopathology and the brain (pp. 77–95). New York: Raven Press.
Rasmussen, S. A., & Eisen, J. L. (1992). The epidemiology and clinical features of obsessive compulsive disorder. Psychiatric Clinics of North America, 15, 743–758.
Rozin, P., & Fallon, A. E. (1987). A perspective on disgust. Psychological Review, 94, 23–41.
Rozin, P., Haidt, J., & McCauley, C. R. (2000). Disgust. In M. Lewise & J. M. Haviland (Eds.), Handbook of emotions (pp. 637–353). New York: Guilford Publications.
Salkovskis, P. M. (1998). Psychological approaches to the understanding of obsessional problems. In R. P. Swinson, M. M. Antony, S. Rachman, & M. A. Richter (Eds.), Obsessive-Compulsive Disorder: theory, research and treatment (pp. 33–50). New York: Guilford.
Salkovskis, P. M., Wroe, A. L., Gledhill, A., Morrison, N., Forrester, E., Richards, C., et al. (2000). Responsibility attitudes and interpretations are characteristics of obsessive compulsive disorder. Behaviour Research and Therapy, 38, 347–372.
Schaaber, Ú., Smári, J., & Óskarsson, H. (1990). Comparison of the Hospital Anxiety and Depression Rating Scale (HAD) with other depression and anxiety scales. Nordic Journal of Psychiatry, 44, 507–512.
Schienle, A., Zorjan, S., Ubel, S., & Wabnegger, A. (2018). Prediction of automatic and focused skin picking based on trait disgust and emotion dysregulation. Journal of Obsessive-Compulsive and Related Disorders, 16, 1–5.
Schwartz, R. A. (2018). Treating incompleteness in obsessive-compulsive disorder: a meta-analytic review. Journal of Obsessive-Compulsive and Related Disorders, 19, 50–60.
Sekhen, S., Hawley, L. L., Regev, R., Richter, P., & Rector, N. A. (2018). Mindfulness-based cognitive therapy for OCD: stand-alone and post-cbt augmentation approaches. International Journal of Cognitive Therapy, 11, 58–79.
Sica, C., Caudek, C., Belloch, A., Bottesi, G., Ghisi, M., Melli, G., García-Soriano, G., & Olatunji, B. O. (2019). Not just right experiences, disgust proneness and their associations to obsessive-compulsive symptoms: a stringent test with structural equation modeling analysis. Cognitive Therapy and Research, 43, 1086–1096.
Smári, J., & Holmsteinsson, H. E. (2001). Intrusive thoughts, responsibility attitudes, thought-action fusion, and chronic thought suppression in relation to obsessive-compulsive symptoms. Behavioural and Cognitive Psychotherapy, 29, 13–20.
Snorrason, Í (2016). Examining heightened sense of incompleteness as a candidate endophenotypic marker for skin picking disorder. Unpublished Doctoral dissertation. The University of Wisconsin-Milwaukee, USA.
Steinarsson, B. S. (2014). Próffræðilegir eiginleikar íslenskrar þýðingar Disgust Propensity and Sensitivity Scale [Psychometric properties of the Icelandic translation of the Disgust Propensity and Sensitivity Scale]. Unpublished B.A. thesis, Faculty of Psychology, University of Iceland, Reykjavík.
Summerfeldt, L. J. (2004). Understanding and treating incompleteness in obsessive-compulsive disorder. Journal of Clinical Psychology, 60, 1155–1168.
Summerfeldt, L. J. (2007). Treating incompleteness, ordering, and arranging concerns. In M. M. Antony, C. Purdon, & L. J. Summerfeldt (Eds.), Psychological treatment of obsessiveöcompulsive disorder: fundamentals and beyond (pp. 187–207). Washington: American Psychological Association.
Summerfeldt, L. J., Kloosterman, P. H., Antony, M. M., & Swinson, R. P. (2014). Examining and obsessive-compulsive core dimensions model: structural validity and harm avoidance and incompleteness. Journal of Obsessive-Compulsive and Related Disorders, 3, 83–94.
Summers, B., Matheny, N. L., & Cougle, J. R. (2017). ‘Not just right’ experiences and incompleteness in body dysmorphic disorder. Psychiatry research, 247, 200–207.
Szechtman, H., & Woody, E. (2004). Obsessive-compulsive disorder as a disturbance of security motivation. Psychological Review, 111, 111–127.
Tallis, F. (1996). Compulsive washing in the absence of phobic and illness anxiety. Behaviour Research and Therapy, 34, 361–362.
Taylor, J., & Purdon, C. (2016). Responsibility and hand washing behavior. Journal of Behavior Therapy and Experimental Psychiatry, 51, 43–50.
Taylor, S., Conselea, C. A., McKay, D., Crowe, K. B., & Abramowitz, J. S. (2014a). Sensory intolerance: latent structure and psychopathologic correlates. Comprehensive Psychiatry, 55, 1279–1284.
Taylor, S., McKay, D., Crowe, K., Abramowitz, J. S., Conselea, C., Calamari, J. E., et al. (2014b). The sense of incompleteness as a motivator of obsessive-compulsive symptoms: an empirical analysis of concepts and correlated. Behavior Therapy, 45, 254–262.
Tolin, D. F., Brady, R. E., & Hannan, S. (2008). Obsessional beliefs and symptoms of obsessive-compulsive disorder in a clinical sample. Journal of Psychopathology and Behavioral Assessment, 30, 31–42.
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.
Wahl, K., Salkovskis, P. M., & Cotter, I. (2008). ‘I wash until it feels right’ the phenomenology of stopping criteria in obsessive compulsive washing. Journal of Anxiety Disorders, 22, 143–161.
Whitton, A. E., Henry, J. D., & Grisham, J. R. (2015). Cognitive and psychophysiological correlates of disgust in obsessive-compulsive disorder. British Journal of Clinical Psychology, 54, 16–33.
Woody, S. R., & Teachman, B. A. (2000). Intersection of disgust and fear: normative and pathological views. Clinical Psychology: Science and Practice, 7, 291–311.
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.
The studies were reported to the Data Protection Authority of Iceland and approved by the National Bioethics Committee.
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Ólafsson, R.P., Emmelkamp, P.M.G., Ólason, D.Þ. et al. Disgust and Contamination Concerns: the Mediating Role of Harm Avoidance and Incompleteness. J Cogn Ther 13, 251–270 (2020). https://doi.org/10.1007/s41811-020-00076-5
- Contamination fear
- Harm avoidance