OCD

OCD Contamination Fears and Your “Disgust” Emotion

OCD, contamination fears, and the coronavirus pandemic.

Posted Mar 22, 2020

We are living in unprecedented times. Much of the world is in lockdown in an attempt to fight a new and dangerous virus called COVID-19. The pandemic has generated much stress and anxiety, and none more so than in those individuals already suffering from health anxiety and obsessive-compulsive disorder (OCD) contamination fears.

Around half of all individuals diagnosed with OCD have significant contamination fears, including obsessions related to dirt and disease, and have developed compulsions and rituals around cleanliness (Rachman, 2004[1]). However, while anxiety is an obvious emotion that drives these obsessions and compulsions, one other central feature of these contamination-based fears is the disease-avoidance emotion of disgust.

The disgust emotion is described as a specially evolved natural defensive emotion whose primary biological function is to protect the individual specifically against pathogens, illness, disease and contamination (Davey, 2011[2]; Tybur, Lieberman, Kurzban & DeScioli, 2013[3]), and studies have demonstrated a significant positive correlation between obsessive-compulsive contamination fears and disgust proneness (Olatunji, Ebesutani, David, Fan & McGrath, 2011[4]). The main features of the disgust emotion are a distinctive, universal facial expression involving a wrinkling of the nose and down-turning of the corners of the mouth that would facilitate the ejection of bitter substances or poisons from the mouth; feelings of revulsion and nausea; fear of contagion; and physical avoidance of ‘disgusting’ objects. These are all reactions that can potentially serve to prevent contact with pathogens or sources of illness, disease, and contamination and—in more specific cases—to prevent the oral incorporation of items that might potentially be causes of illness and disease.

Being oversensitive to the emotion of disgust (and so being oversensitive to disgusting stimuli such as faeces, mucus, vomit, and other vehicles of disease and illness) may be a significant risk factor for developing OCD contamination fears, and measures of disgust sensitivity have been shown to predict subsequent OCD symptoms (Olatunji & Sawchuk, 2005[5]), and facilitate avoidance behaviour (Goetz, Lee, Cougle & Turkel, 2013[6]). Because of this apparent causal role of disgust proneness in the development of OCD contamination fears, it has become important to consider decreasing disgust proneness during treatment for contamination fears. For example, decreasing disgust proneness predicts decreases in obsessive-compulsive washing symptoms (Athey, Elias, Crosby, Jenike, Pope et al., 2015[7]), and individuals with high levels of disgust sensitivity exhibit the worst treatment outcomes (Andersson, Ljótsson, Hedman, Enander, Kaldo et al, 2015[8]). Taken together, this evidence suggests that targeting disgust during exposure-based treatment for OCD contamination fears is likely to be a key component of successful treatment.

So, if you have high disgust sensitivity does it mean you’re likely to become significantly more anxious during the coronavirus pandemic? If you are diagnosed with OCD contamination fear, then yes, this may well increase the severity of your symptoms and increase your anxieties, and good advice on how to cope with your OCD during the current pandemic can be found here. But what if you merely have high disgust sensitivity? This is not so clear, because visceral disgust is an emotion that usually needs specific and well-recognized elicitors to affect behaviour (such as mucus, faeces, vomit, etc.), and COVID-19 is an invisible enemy. So most people’s anxieties are probably raised by the stressful effects that self-isolation and other imposed regulations are having on their life and the uncertainty that goes with this. But if individuals with high disgust sensitivity learn to associate the virus with other perceptible outward signs (such as others sneezing and coughing, strangers in close proximity, unwashed hands), then this may well give their high disgust levels opportunity to raise anxiety and affect behaviour when these stimuli are encountered.

References

[1] Rachman S (2004) Fear of contamination. Behaviour Research & Therapy, 42, 1227-1255.

[2] Davey, G. C. (2011). Disgust: the disease-avoidance emotion and its dysfunctions. Philosophical Transactions of the Royal Society B: Biological Sciences, 366(1583), 3453-3465.

[3] Tybur JM, Lieberman D, Kurzban R & DeScioli (2013) Disgust: Evolved function and structure. Psychological Review, 120, 65-84.

[4] Olatunji BO, Ebesutani C, David B, Fan Q & McGrath PB (2011) Disgust proneness and obsessive-compulsive symptoms in a clinical sample: Structural differentiation from negative affect. Journal of Anxiety Disorders, 25, 932-938.

[5] Olatunji BO & Sawchuk CN (2005) Disgust: Characteristic features, social manifestations, and clinical implications. Journal of Social & Clinical psychology, 24, 932-962.

[6] Goetz AR, Lee HJ, Cougle JR & Turkel JE (2013) Disgust propensity and sensitivity: Differential relationships with obsessive-compulsive symptoms and behavioral approach task performance. Journal of Obsessive & Compulsive Related Disorders, 2, 412-419.

[7] Athey AJ, Elias JA, Crosby JM, Jenike MA, Pope HG et al. (2015) Reduced disgust propensity is associated with improvement in contamination/washing symptoms in obsessive-compulsive disorder. Journal of Obsessive & Compulsive Related Disorders, 4, 20-24.

[8] Andersson E, Ljótsson B, Hedman E, Enander J, Kaldo V et al. (2015) Predictors and moderators of internet-based cognitive behavior therapy for obsessive-compulsive disorder: Results from a randomized trial. Journal of Obsessive & Compulsive Related Disorders, 4, 1-7.