Disgust and OCD: A Revolting Romance
Dr Jon White
Abstract and Introduction
Obsessive compulsive disorder (OCD) is a common
mental health disorder characterized by obsessions
(repetitive, unwanted intrusive thoughts causing
anxiety and compulsions (mental and or physical
actions aimed at reducing the anxiety associated
with intrusive thoughts). Burgeoning evidence
supports a role for the emotion of disgust in the
pathology of OCD.
Disgust is a feeling of revulsion that is aroused by an
unpleasant/offensive stimulus.
The current study, engaged in a literature review of
studies exploring the relationship between disgust and
OCD: focusing on its links to its psychopathology,
neurobiology and applications for treatment.
Disgust
Three domains of disgust
1. Core disgust triggered by noxious physical
stimuli (e.g. rotten food) being in close
proximity to the body.
2. Social disgust is defined being by revulsed
due to infringement of social norms e.g. in
response to another person's appearance,
actions, ideas or social standing.
3. Moral disgust is subjective sensitivity to
and negative evaluations of moral
transgressions these can involve
inappropriate use of the body (e.g.,
cannibalism, paedophilia, torture) or social
behaviours/character traits e.g. dishonesty,
infidelity, cheating, stealing etc. (Russell,
2013).
Psychopathology of OCD and
Disgust
Patients with OCD have a greater predisposition to disgust (disgust
propensity) and find it more distressing when it arises (disgust
sensitivity)
Core disgust is related to contamination OCD (cOCD), disgust
propensity positively predicting obsessive beliefs and
symptomatology in these patients (Cisler et al., 2010).
Moral and social disgust can be triggered by “ego dystonic
thoughts” that violate a person internalized beliefs about
themselves or how they wish to be perceived by others.
These types of disgust trigger feelings of deontological guilt, which
arises from the belief that he or she has violated a moral code
Deontological guilt has been shown to increase OCD like checking
and washing behaviours (D’Olimpio & Mancini, 2014).
Neurobiology of OCD and disgust
 Disgust processing engages a bilateral network :
insula, amygdala, occipital and prefrontal regions.
 fMRI studies have shown patients with OCD, have
normal basic disgust processing but this network is
erroneously recruited during symptom provocation (Viol
et al., 2019).
Future Applications
Psychological
 CBT interventions with exposure reduces disgust, this reduction
is greater in those with OCD, and is correlated with
symptom reduction (Taboas et al., 2015).
 Addition of an anti-disgust cognitive intervention to CBT,
significantly reduces OCD symptoms when compared to
CBT alone (Salmani et al., 2022)
Pharmacological
 Serotonin plays a key role in the development of disgust
with 5HT3a receptor being activatied in disgust reactions
 5HT3a antagonists e.g. ondansetron have been shown to be
effective at reducing obsessive symptoms
Neuromodulation
 A proof of concept transcranial magnetic stimulation study
Noiseux et al., 2021 has shown cathodal stimulation of the
inula leads to reduction in disgust and moral rigidity with
more robust change was seen in those with obsessive
compulsive traits.
Conclusion
 Emerging evidence has shown disgust plays a key
role in the symptomatology of OCD, with these
patients being more sensitive and prone to disgust
with neuroimaging studies suggesting this network
is erroneously co-opted in response to intrusive
thoughts.
 More research into this area is warranted in order
to continue to create new and more effective
treatments for OCD.
References
Adams, T. G., Brady, R. E., Lohr, &, & Adams, T. G. (2012). The effects of cognitive and affective priming on law of contagion appraisals. Journal of
Experimental Psychopathology JEP, 3, 470–478.
Ahmad J, N. A. N. A. G. B. A. M. T. A. (2021). Ondansetron in combination with fluoxetine for obsessive–compulsive disorder: A randomized, double-blind,
placebo-controlled study from North India. Ndian Journal of Health Sciences and Biomedical Research KLEU.
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(5), 439.
Daniele Serata, G. D. K. C. R. D. J. S. D. P. G. C. D. P. C. G. R. B. V. R. F. N. G. R. T. S. F. (2015). Are 5-HT3 antagonists effective in obsessive-compulsive
disorder? A systematic review of literature. Human Pscyhopharmacology.
D’Olimpio, F., & Mancini, F. (2014). Role of Deontological Guilt in Obsessive-Compulsive Disorder-Like Checking and Washing Behaviors. Clinical
Psychological Science, 2(6), 727–739.
emence Noiseux, C., eronique Desbeaumes Jodoin, V., Blumberger, D., Lesp erance, P., Miron, J.-P., & Ren Chu, T. (2021). Efficacy of Transcranial Direct
Current Stimulation (tDCS) To Decrease Disgust and Moral Rigidity. Implications For the Treatment of Obsessive-Compulsive Disorder (OCD). Brain
Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, 14(6), 1595–1596.
Gan, X., Zhou, X., Li, J., Jiao, G., Jiang, X., Biswal, B., Yao, S., Klugah-Brown, B., & Becker, B. (2022). Common and distinct neurofunctional
representations of core and social disgust in the brain: Coordinate-based and network meta-analyses. Neuroscience & Biobehavioral Reviews, 135, 104553.
Irene Parisi, A. M. F. M. S. M. A. and M. S. P. (2021). Deontological Guilt and Disgust Sensitivity Modulate Moral Behaviour. Clinical Neuropsychiatry.
Karas, P. J., Lee, S., Jimenez-Shahed, J., Goodman, W. K., Viswanathan, A., & Sheth, S. A. (2019). Deep brain stimulation for obsessive compulsive
disorder: Evolution of surgical stimulation target parallels changing model of dysfunctional brain circuits. Frontiers in Neuroscience, 13(JAN), 998.
Kim, H. W., Kang, J. I., Lee, S. H., An, S. K., Sohn, S. Y., Hwang, E. H., Lee, S. Y., & Kim, S. J. (2016). Common variants of HTR3 genes are associated
with obsessive-compulsive disorder and its phenotypic expression. Scientific Reports 2016 6:1, 6(1),
Noh, H. J., Tang, R., Flannick, J., O’dushlaine, C., Swofford, R., Howrigan, D., Genereux, D. P., Johnson, J., van Grootheest, G., Grünblatt, E., Andersson,
E., Djurfeldt, D. R., Patel, P. D., Koltookian, M., Hultman, C. M., Pato, M. T., Pato, C. N., Rasmussen, S. A., Jenike, M. A., … Lindblad-Toh, K. (2017).
Integrating evolutionary and regulatory information with a multispecies approach implicates genes and pathways in obsessive-compulsive disorder. Nature
Communications 2017 8:1, 8(1), 1–13.
P Rozin, L. L. R. E. (1994). Varieties of disgust faces and the structure of disgust. Pers Soc Psychol .
Salmani, B., Mancini, F., Hasani, J., & Zanjani, Z. (2022). Anti-Disgust Cognitive Behavioral Therapy for Contamination-Based Obsessive Compulsive
Disorder: A Randomized Controlled Clinical Trial. Journal of Clinical Medicine, 11(10), 2875
Sophie Russell, R. G.-S. (2013). Bodily Moral Disgust: What It Is, How It Is Different From Anger, and Why It Is an Unreasoned Emotion. Psychological
Bulletin .
Taboas, W., Ojserkis, R., & McKay, D. (2015). Change in disgust reactions following cognitive-behavioral therapy for childhood anxiety disorders.
International Journal of Clinical and Health Psychology : IJCHP, 15(1)
Tuerke, K. J., Limebeer, C. L., Fletcher, P. J., & Parker, L. A. (2012). Double Dissociation between Regulation of Conditioned Disgust and Taste Avoidance
by Serotonin Availability at the 5-HT3 Receptor in the Posterior and Anterior Insular Cortex. The Journal of Neuroscience, 32(40), 13709.
Veale, D. (2007). Psychopathology of obsessive–compulsive disorder. Psychiatry.
Viol, K., Aas, B., Kastinger, A., Kronbichler, M., Schöller, H. J., Reiter, E. M., Said-Yürekli, S., Kronbichler, L., Kravanja-Spannberger, B., Stöger-Schmidinger, B., Aichhorn, W., & Schiepek, G. K. (2019). Erroneously Disgusted: fMRI Study Supports Disgust-Related Neural Reuse in Obsessive-Compulsive Disorder (OCD). Frontiers in Behavioral Neuroscience,
13.