the concept of disgust in psychopathology, psychiatry and psychology

1. DISGUST:DISGUST:
CHARACTERISTICCHARACTERISTIC
FEATURES,FEATURES,
AND CLINICAL IMPLICATIONSAND CLINICAL IMPLICATIONS
ByBy
Shehab HassanShehab Hassan
Assistant lecturer of psychiatryAssistant lecturer of psychiatry

2. Disgust has been identified as one of the basicDisgust has been identified as one of the basic
emotions, recognizable across diverse culturesemotions, recognizable across diverse cultures..
Origins of the word itself began appearing in 16thOrigins of the word itself began appearing in 16th––
century in France and 17thcentury in France and 17th––century in Englandcentury in England..
Disgust has become part of our everydayDisgust has become part of our everyday
nomenclature, encompassing a variety ofnomenclature, encompassing a variety of
synonyms, including revulsion, repugnance,synonyms, including revulsion, repugnance,
abhorrence, repulsion, antipathy, aversion,abhorrence, repulsion, antipathy, aversion,
loathing, sicken, appall, and nauseateloathing, sicken, appall, and nauseate..

3. At its basic definition, disgust meansAt its basic definition, disgust means ““badbad
tastetaste..””
DarwinDarwin who first noted that disgustwho first noted that disgust ““...refers...refers
to something revolting, primarily into something revolting, primarily in
relation to the sense of taste, as actuallyrelation to the sense of taste, as actually
perceived or vividly imagined; andperceived or vividly imagined; and
secondarily to anything which causes asecondarily to anything which causes a
similar feeling, through the sense of smell,similar feeling, through the sense of smell,
touch and even of eyesighttouch and even of eyesight””

4. Curtis & Biran (2001)Curtis & Biran (2001) It was an adaptive
advantage for our ancestors to be disgusted by
things that harbor disease (such as bodily
excretions, wounds and sores, and many living
creatures(.
Provides theProvides the “first quantitative evidence“first quantitative evidence”” that disgustthat disgust
arose as a mean ofarose as a mean of avoidingavoiding diseasedisease toto enenhance ourhance our
chances of survival and reproductionchances of survival and reproduction..
Examined people’s sense of disgust to a series ofExamined people’s sense of disgust to a series of
pictures presented on a BBC websitepictures presented on a BBC website..

5. Disease-related images were rated as moreDisease-related images were rated as more
disgustingdisgusting
Gender Difference (women have a greaterGender Difference (women have a greater
responsibility to avoid diseaseresponsibility to avoid disease((

7. FreudFreud arguing that the manifestation of disgustarguing that the manifestation of disgust
served to restrict sexual fantasies to sociallyserved to restrict sexual fantasies to socially
acceptable practicesacceptable practices..
Freud believed that disgust develops in mid-Freud believed that disgust develops in mid-
childhood, between the ages of 5-11 yrs, duringchildhood, between the ages of 5-11 yrs, during
the latency stage of psychosexual developmentthe latency stage of psychosexual development..
Its is one of three emotions (along with shame andIts is one of three emotions (along with shame and
guilt) which serve as reaction formations to helpguilt) which serve as reaction formations to help
us repress our unconscious sexual desiresus repress our unconscious sexual desires..

8. Rozin et al. (1986)Rozin et al. (1986) have shown that childrenhave shown that children
below the age of 2 yrs will happily consumebelow the age of 2 yrs will happily consume
realistic replicas of faecesrealistic replicas of faeces
Tomkins,Tomkins, alternatively, suggested that disgustalternatively, suggested that disgust
served as a primary reaction to unwantedserved as a primary reaction to unwanted
intimacyintimacy..
DaveyDavey posits that disgust is related to a form ofposits that disgust is related to a form of
““rejectionrejection”” characterized by a desire to distancecharacterized by a desire to distance
oneself from contamination stimuli, nausea, andoneself from contamination stimuli, nausea, and
a feeling of revulsiona feeling of revulsion..

9. Distaste and DisgustDistaste and Disgust
Rozin and FallonRozin and Fallon suggest thatsuggest that distastedistaste is ais a
type of food rejection, motivated by sensorytype of food rejection, motivated by sensory
characteristics such as taste, smell, andcharacteristics such as taste, smell, and
texturetexture..
Disgust,Disgust, on the other hand, is a form of foodon the other hand, is a form of food
rejection motivated by ideational factorsrejection motivated by ideational factors
(i.e., the origin of the disgust stimulus) and(i.e., the origin of the disgust stimulus) and
perceptions of its potential threat relevanceperceptions of its potential threat relevance
(i.e., contamination capabilities(i.e., contamination capabilities(.(.

10. DEVELOPMENTAL CONSIDERATIONS OFDEVELOPMENTAL CONSIDERATIONS OF
DISGUSTDISGUST
studies exposing children to various disgust stimulistudies exposing children to various disgust stimuli
(i.e., imitation feces, foods, animals) have generally(i.e., imitation feces, foods, animals) have generally
indicated that most children belowindicated that most children below eight yearseight years lacklack
the cognitive abilities to experiencethe cognitive abilities to experience disgustdisgust..
This absence does not necessarily undermine itsThis absence does not necessarily undermine its
biological centrality, as it is quite possible thatbiological centrality, as it is quite possible that
maternal monitoring and safetymaternal monitoring and safety––related behaviorsrelated behaviors
during this period render the development of a fullduring this period render the development of a full
disgust response as less imperativedisgust response as less imperative

11. research noting the absence of disgust during theresearch noting the absence of disgust during the
earlier years of life may lend support to aearlier years of life may lend support to a culturalcultural
rationale for the etiology of disgustrationale for the etiology of disgust..
The absence of disgust, as defined by Rozin andThe absence of disgust, as defined by Rozin and
colleagues (2000), in animals also lends support tocolleagues (2000), in animals also lends support to
a culturally derived emotion. What is deemed to bea culturally derived emotion. What is deemed to be
disgusting and to be avoided varies considerablydisgusting and to be avoided varies considerably
by culture, is perpetuated byby culture, is perpetuated by societal norms, and issocietal norms, and is
taught and modeled by individualstaught and modeled by individuals..

12. Douglas (1994)Douglas (1994) believes that disgust is anbelieves that disgust is an
entirely social phenomenonentirely social phenomenon
We like our worlds to be orderly and familiar, andWe like our worlds to be orderly and familiar, and
events in our lives to be easily categorisable. It isevents in our lives to be easily categorisable. It is
our culture which tidily organises our ideas andour culture which tidily organises our ideas and
valuesvalues..
The things we find disgusting are the things we findThe things we find disgusting are the things we find
that do not fit our orderly world-viewthat do not fit our orderly world-view..
Ex;Ex; Dirt is ‘matter out of place’ Soil is not disgustingDirt is ‘matter out of place’ Soil is not disgusting
in the garden, but it is disgusting to put it on thein the garden, but it is disgusting to put it on the
kitchen table; human bone is not disgusting, butkitchen table; human bone is not disgusting, but
seeing it protruding from a limb isseeing it protruding from a limb is..

13. We learn to find things disgusting primarily from ourWe learn to find things disgusting primarily from our
parents, taking on their standards and perceptionsparents, taking on their standards and perceptions
of what is and what is not disgusting. for exampleof what is and what is not disgusting. for example
We internalise their attitude towards faeces,We internalise their attitude towards faeces, A formA form
of social controlof social control....
Therefore, disgust is not an innate reaction which hasTherefore, disgust is not an innate reaction which has
evolved to serve the purpose of diseaseevolved to serve the purpose of disease
prevention. Rather, it is a socially constructedprevention. Rather, it is a socially constructed
emotion, which serves to help us stayemotion, which serves to help us stay
psychologically healthy, and to avoid carrying outpsychologically healthy, and to avoid carrying out
or thinking about inappropriate sexual fantasiesor thinking about inappropriate sexual fantasies

14. A CompromiseA Compromise
Rozin (1987):Rozin (1987): Both culture and biology
play a role.
Rozin has shown that disgust is an evolvedRozin has shown that disgust is an evolved
mechanism. Some aspects of disgust aremechanism. Some aspects of disgust are
present from birth, whilst other aspects ofpresent from birth, whilst other aspects of
disgust are learnt during childhood anddisgust are learnt during childhood and
depend upon cultural ideational factorsdepend upon cultural ideational factors..

15. The experience of disgustThe experience of disgust
Disgust has uniqueDisgust has unique physiological, behavioralphysiological, behavioral,,
and interpretiveand interpretive componentscomponents
11((physiological componentsphysiological components::
disgust appears to be largely mediated by thedisgust appears to be largely mediated by the
parasympathetic autonomic nervous system.parasympathetic autonomic nervous system.
consequences of parasympathetic activity includeconsequences of parasympathetic activity include
reductions in heart ratereductions in heart rate,, blood pressureblood pressure,, respirationrespiration
raterate,, and skin temperatureand skin temperature.. Increased salivationIncreased salivation andand
gastrointestinal mobility,gastrointestinal mobility, have also been observedhave also been observed..

16. There is shared involvement of multiple brainThere is shared involvement of multiple brain
regions in the processing of emotion, suchregions in the processing of emotion, such
as theas the amygdala, basal ganglia,amygdala, basal ganglia,
hippocampus, orbitofrontal cortex, andhippocampus, orbitofrontal cortex, and
occipitooccipito––temporal corticestemporal cortices
Emerging findings from functionalEmerging findings from functional
neuroimagingneuroimaging
studies suggest the unique involvement of thestudies suggest the unique involvement of the
insular cortex,insular cortex, a structure responsible fora structure responsible for
the integration of sensory and visceralthe integration of sensory and visceral
information and parasympatheticinformation and parasympathetic
cardiovascular regulation, in the processingcardiovascular regulation, in the processing
of facial expressions of disgustof facial expressions of disgust..

18. The Neural Basis of DisgustThe Neural Basis of Disgust
The insula:The insula: has been shown by severalhas been shown by several
studies to be the main neural correlate of thestudies to be the main neural correlate of the
feeling of disgust both in humans and infeeling of disgust both in humans and in
monkeys. It is activated by unpleasant tastes,monkeys. It is activated by unpleasant tastes,
smells, and the visual recognition of disgustingsmells, and the visual recognition of disgusting
organisms.organisms.
The anterior insulaThe anterior insula is anis an olfactoryolfactory andand
gustatorygustatory center that controlscenter that controls visceralvisceral
sensations and the related autonomicsensations and the related autonomic
responses.responses.
The posterior insulaThe posterior insula is characterized byis characterized by
connections withconnections with auditoryauditory,, somatosensorysomatosensory, and, and

19. functional magnetic resonance imagingfunctional magnetic resonance imaging
In a study byIn a study by Stark & colleagues (2007), 66Stark & colleagues (2007), 66
participants took part inparticipants took part in fMRIfMRI analysis.analysis. 5050 picturespictures
were presented forwere presented for 44 seconds and participantsseconds and participants
rated each picture on the dimensions disgust andrated each picture on the dimensions disgust and
fearfear..
The results indicated that both fear and disgustThe results indicated that both fear and disgust
stimulus categories resulted in activations in thestimulus categories resulted in activations in the
occipital cortex, prefrontal cortex and in theoccipital cortex, prefrontal cortex and in the
amygdala. However,amygdala. However, insula activation was onlyinsula activation was only
significantly correlated with ratings of disgustsignificantly correlated with ratings of disgust,,

20. In another fMRI study by Wicker & colleaguesIn another fMRI study by Wicker & colleagues
(2003),(2003), disgust reactions to visual anddisgust reactions to visual and
olfactory stimuli were comparedolfactory stimuli were compared..
It was found thatIt was found that the anterior insulathe anterior insula waswas
activated in both the observation ofactivated in both the observation of
disgusted facial expressionsdisgusted facial expressions (visual(visual
condition)condition) and during the emotion of disgustand during the emotion of disgust
evoked by unpleasant odorsevoked by unpleasant odors (olfactory(olfactory
condition(.

21. Neuropsychological StudiesNeuropsychological Studies
Both Calder and Adolphs (2003)Both Calder and Adolphs (2003) showed that lesions onshowed that lesions on
the anterior insula lead to deficits in the experience ofthe anterior insula lead to deficits in the experience of
disgust and recognizing facial expressions of disgustdisgust and recognizing facial expressions of disgust
in othersin others..
Furthermore, electrical stimulation of the anterior insulaFurthermore, electrical stimulation of the anterior insula
triggered nausea and uneasiness in the stomachtriggered nausea and uneasiness in the stomach..
Finally, electrically stimulating the anterior insula throughFinally, electrically stimulating the anterior insula through
implanted electrodes produced sensations in theimplanted electrodes produced sensations in the
throat and mouth that were “difficult to standthroat and mouth that were “difficult to stand”.”.

22. 22((The behavioral manifestationsThe behavioral manifestations
of disgustof disgust::
IncludingIncluding::
Facial ExpressionsFacial Expressions
Action TendenciesAction Tendencies

23. facial expression of disgustfacial expression of disgust is characterizedis characterized
byby::
--furrowing of the eyebrowsfurrowing of the eyebrows,,
--closure of the eyes and pupil constrictionclosure of the eyes and pupil constriction,,
--wrinkling of the nose, upper lip retractionwrinkling of the nose, upper lip retraction
--upward movement of the lower lip and chinupward movement of the lower lip and chin,,
--and drawing the corners of the mouth down andand drawing the corners of the mouth down and
backback
--Facial EMG at the levator labii region provides aFacial EMG at the levator labii region provides a
reliable, physiological index that appears to bereliable, physiological index that appears to be
unique to the emotion of disgustunique to the emotion of disgust

25. The dominant action tendency for disgust isThe dominant action tendency for disgust is
behavioral avoidance,behavioral avoidance, which serves awhich serves a
defensive function for the individualdefensive function for the individual..
11----Active avoidance,Active avoidance, or escape responding,or escape responding,
involves moving away from the disgustinginvolves moving away from the disgusting
stimulus upon exposurestimulus upon exposure..
22----Passive avoidance,Passive avoidance, strategies, which do notstrategies, which do not
involve active escape, include pushing theinvolve active escape, include pushing the
stimulus away, closing of the eyes, looking away,stimulus away, closing of the eyes, looking away,
or plugging oneor plugging one’’s noses nose..

26. 33((The interpretive componentThe interpretive component::
involve beliefs directly related to the threat value of theinvolve beliefs directly related to the threat value of the
stimulus and/or concerns about onestimulus and/or concerns about one’’s owns own
physiological and behavioral reactions to thephysiological and behavioral reactions to the
repulsive Materialrepulsive Material..
Stimuli that become associated with disgustStimuli that become associated with disgust
are often avoided due to concerns over possibleare often avoided due to concerns over possible
infection, contamination, and disease acquisitioninfection, contamination, and disease acquisition

27. Overestimation of oneOverestimation of one’’s own vulnerability to being infected,s own vulnerability to being infected,
can serve a central role in more profoundcan serve a central role in more profound
manifestations of avoidance and rejectionmanifestations of avoidance and rejection..
The law of contagionThe law of contagion operates according to theoperates according to the
principle ofprinciple of “once in contact, always in contact,”“once in contact, always in contact,” inin
that previously benign objects can ac-quire enduring,that previously benign objects can ac-quire enduring,
even permanent infectious qualities after even briefeven permanent infectious qualities after even brief
contact with a disgusting stimuluscontact with a disgusting stimulus

28. For instance,For instance, individuals will often refuse to drinkindividuals will often refuse to drink
from a glass that has been repeatedly and thoroughlyfrom a glass that has been repeatedly and thoroughly
sanitized if it had once been used to hold dog fecessanitized if it had once been used to hold dog feces..
The law of similarityThe law of similarity suggests that objectivelysuggests that objectively
safe objects may be avoided and rejected if theysafe objects may be avoided and rejected if they
resemble a threatresemble a threat––relevant disgust elicitor in somerelevant disgust elicitor in some
way.way. For example,For example, fudge shaped like dog feces mayfudge shaped like dog feces may
be rendered completely inedible due to its sharedbe rendered completely inedible due to its shared
visual representationvisual representation

30. THE DOMAINS OF DISGUSTTHE DOMAINS OF DISGUST
Rozin and colleagues (2000) suggest aRozin and colleagues (2000) suggest a
fourfour––factor model of disgustfactor model of disgust::
--Core elicitorsCore elicitors..
--Animal-reminderAnimal-reminder..
--Interpersonal, andInterpersonal, and
--Socio–moral disgust elicitorsSocio–moral disgust elicitors

31. 11--Core disgust elicitorsCore disgust elicitors
Core disgust elicitors are characterized by three mainCore disgust elicitors are characterized by three main
componentscomponents::
11--a real or perceived threat of oral incorporationa real or perceived threat of oral incorporation..
22--re-active sense of aversion or offensivenessre-active sense of aversion or offensiveness..
33--evaluation of the substance as a contaminantevaluation of the substance as a contaminant..
Foods, bodily waste products, and animals areFoods, bodily waste products, and animals are
subsumed within this category. The sight of moldy bread,subsumed within this category. The sight of moldy bread,
the smell of spoiled milk, and the taste of rotting fruitthe smell of spoiled milk, and the taste of rotting fruit
can all carry seemingly objectivecan all carry seemingly objective
qualities that warrant repugnance and avoidancequalities that warrant repugnance and avoidance..

32. Cross cultural differencesCross cultural differences::
----Food like Meat, nutritious parts of the animal,Food like Meat, nutritious parts of the animal,
including entrails, eyes, brainsincluding entrails, eyes, brains..
----snails, worms, and slugssnails, worms, and slugs..
----Animals seemingly close to humans by meansAnimals seemingly close to humans by means
of being a pet (e.g., dogs) or sharing physicalof being a pet (e.g., dogs) or sharing physical
resemblance (e.g., primatesresemblance (e.g., primates((
----In contrast to the food and animal domains, considerablyIn contrast to the food and animal domains, considerably
less cross–cultural variation exists in regard to theless cross–cultural variation exists in regard to the
evaluation ofevaluation of bodily waste products.bodily waste products. Aversion towardAversion toward
excrement, urine, mucous, blood, bile, and vomitexcrement, urine, mucous, blood, bile, and vomit is ais a
shared reaction across many culturesshared reaction across many cultures..

33. 22--Animal-reminderAnimal-reminder
Attitudes and practices surrounding sex, personalAttitudes and practices surrounding sex, personal
hygiene, injury to the body, and death are shaped byhygiene, injury to the body, and death are shaped by
cultural standards. Collectively known as thecultural standards. Collectively known as the ““animalanimal––
reminderreminder”” domaindomain..
Here, disgustHere, disgust––mediated rejection appears to serve amediated rejection appears to serve a
defensive function bydefensive function by maintaining the hierarchical divisionmaintaining the hierarchical division
between humans and animalsbetween humans and animals

34. Sex & HygieneSex & Hygiene
Most cultures highly regulate sexual and hygienicMost cultures highly regulate sexual and hygienic
behaviorsbehaviors..
Considerable efforts are made to maintain theConsiderable efforts are made to maintain the
positive attributes of passion and intimacy withpositive attributes of passion and intimacy with
sexsex..
Incest and gaining sexual gratification throughIncest and gaining sexual gratification through
unconventional means are oftentimes consideredunconventional means are oftentimes considered
repulsiverepulsive..
Likewise, washing, grooming, dressing, andLikewise, washing, grooming, dressing, and
deodorizing are expected personaldeodorizing are expected personal
responsibilitiesresponsibilities..

35. Body InjuryBody Injury
Injuries that expose our blood, veins, tissues, andInjuries that expose our blood, veins, tissues, and
bones can evoke strong feelings of disgustbones can evoke strong feelings of disgust..
When separated from the host, our internalWhen separated from the host, our internal
biological features are virtually indistinguishablebiological features are virtually indistinguishable
from other animalsfrom other animals..
Even needed medical procedures designed toEven needed medical procedures designed to
improve our longevity, such as blood draws andimprove our longevity, such as blood draws and
surgical interventions, may be delayed andsurgical interventions, may be delayed and
avoided secondary to their propensity to elicitavoided secondary to their propensity to elicit
intense disgustintense disgust

36. DeathDeath
Death is the most definitive reflection of our
mortality and issues of death, mortality, and
decay are the central property of the animal–
reminder disgust domain.
In support of this notion, it was found that reminders
of death led to an increased emotional reaction of
disgust to animals, Corpses and cues
representative of death (e.g., graveyards, funeral
homes, caskets) can evoke a unique interplay
between the emotions of disgust and fear

37. 33--Interpersonal DisgustInterpersonal Disgust
Interpersonal disgust functions to protect theInterpersonal disgust functions to protect the
““soulsoul”” and maintain oneand maintain one’’s personals personal territoryterritory
and integrityand integrity..
Four domains of interpersonal disgust elicitorsFour domains of interpersonal disgust elicitors
have been proposedhave been proposed::
11--First, strangenessFirst, strangeness refers to unwanted contactrefers to unwanted contact
with unfamiliar individuals or materials ofwith unfamiliar individuals or materials of
unknown originunknown origin..

38. 22--Second, moral taintSecond, moral taint refers to repugnancerefers to repugnance
directed at those individuals engaging indirected at those individuals engaging in
irreprehensible behaviors.irreprehensible behaviors. Enemies, molesters, andEnemies, molesters, and
rapistsrapists are often deemed to be interpersonallyare often deemed to be interpersonally
offensive and thus avoided. Similarly, those whooffensive and thus avoided. Similarly, those who
behave without dignity or with hypocrisy, cruelty,behave without dignity or with hypocrisy, cruelty,
fawning, and betrayal may also become associatedfawning, and betrayal may also become associated
with disgustwith disgust..
fear of Contamination in this case is not related to diseasefear of Contamination in this case is not related to disease
acquisition, but rather in acquiring the characteristics,acquisition, but rather in acquiring the characteristics,
behaviors, or qualities of the undesirable individualbehaviors, or qualities of the undesirable individual..

40. 33--Third, diseaseThird, disease refers to aversive reactionsrefers to aversive reactions
towardtoward
those stricken with illness. Disgust reactivity may notthose stricken with illness. Disgust reactivity may not
only be motivated by disease acquisition, but ratheronly be motivated by disease acquisition, but rather
by avoidance of the reminder of our humanby avoidance of the reminder of our human
vulnerabilityvulnerability..
44--Fourth, misfortuneFourth, misfortune refers to a sense of repulsionrefers to a sense of repulsion
around individuals who have been disfigured inaround individuals who have been disfigured in
some way. Amputees, for example, may also besome way. Amputees, for example, may also be
avoided due to human frailty concerns or simplyavoided due to human frailty concerns or simply
viewingviewing ““unfortunateunfortunate”” individuals as less thanindividuals as less than
humanhuman..

41. 44--Moral DisgustMoral Disgust
Moral disgust operates to protect andMoral disgust operates to protect and
preservepreserve social order,social order, and historically, hasand historically, has
been largely shaped bybeen largely shaped by religious and legalreligious and legal
institutionsinstitutions..
Racism, child abuse, and incestRacism, child abuse, and incest are amongare among
the most common examples associatedthe most common examples associated
with moral disgust. Overt, physical acts,with moral disgust. Overt, physical acts,
such as murder or rape, are typicallysuch as murder or rape, are typically
involved in evaluations of moral violationinvolved in evaluations of moral violation

42. Disgust andDisgust and
psychopathologypsychopathology
DISGUST IN SPECIFICDISGUST IN SPECIFIC
PHOBIASPHOBIAS

43. Animal PhobiaAnimal Phobia
Across many animal phobias, fearful avoidance tendsAcross many animal phobias, fearful avoidance tends
to serve a predatorto serve a predator––defensive function, in that suchdefensive function, in that such
animals are avoided due to fears of being attackedanimals are avoided due to fears of being attacked
and physically harmedand physically harmed..
Spider phobics,Spider phobics, for instance, often perceive afor instance, often perceive a
spiderspider’’s movements to be fast, unpredictable, ands movements to be fast, unpredictable, and
aggressive in natureaggressive in nature..
Although fears of being bitten may be a dreadedAlthough fears of being bitten may be a dreaded
outcome, contact with spiders may be also avoidedoutcome, contact with spiders may be also avoided
due to their perceived dirtiness, ugliness, and to theirdue to their perceived dirtiness, ugliness, and to their
potential as a disease vectorpotential as a disease vector..

45. BloodBlood––injectioninjection––injury (Bii)injury (Bii)
PhobiaPhobia
BII phobia is a disorder characterized by extremeBII phobia is a disorder characterized by extreme
aversion to the sight of blood or injuries, receivingaversion to the sight of blood or injuries, receiving
injections, or invasive medical proceduresinjections, or invasive medical procedures..
Exposure to blood, veins, and mutilation tends toExposure to blood, veins, and mutilation tends to
evoke reactions of nausea, aversion, and disgust,evoke reactions of nausea, aversion, and disgust,
at times even in the complete absence of anyat times even in the complete absence of any
reported fearreported fear..
The striking facial expression of disgust is commonlyThe striking facial expression of disgust is commonly
observed among individuals sensitive to BIIobserved among individuals sensitive to BII
materialmaterial..

46. Perhaps the most unique feature ofPerhaps the most unique feature of BIIBII phobiaphobia
that does not appear to occur in any otherthat does not appear to occur in any other
phobic or anxiety disorder is the experiencephobic or anxiety disorder is the experience
ofof vasovagal syncope or faintingvasovagal syncope or fainting uponupon
exposure to threatexposure to threat––relevant stimulirelevant stimuli..
Approximately 70 to 80% of BII phobics report aApproximately 70 to 80% of BII phobics report a
history of partial and full fainting episodes inhistory of partial and full fainting episodes in
the presence of bloodthe presence of blood..

47. The physiological response pattern of fainting inThe physiological response pattern of fainting in
response to blood and mutilation suggests theresponse to blood and mutilation suggests the
involvement of a biphasic processinvolvement of a biphasic process..
The biphasic responseThe biphasic response is characterized by an initialis characterized by an initial
increase in sympathetic nervous system arousalincrease in sympathetic nervous system arousal
rapidly followed by activation of the parasympatheticrapidly followed by activation of the parasympathetic
nervous systemnervous system..
The emotion of disgust also appears to beThe emotion of disgust also appears to be
highly regulated by the parasympathetichighly regulated by the parasympathetic
nervous system, thus disgust may serve anervous system, thus disgust may serve a
central role in BII–related phobiascentral role in BII–related phobias..

48. Social phobiaSocial phobia
As described by Phillips et al (1998),As described by Phillips et al (1998), social phobiasocial phobia
may reflect an internalisation of disgust (i.e. self-may reflect an internalisation of disgust (i.e. self-
disgust) that is reflected in shame.disgust) that is reflected in shame.
There is evidence that social phobia may involveThere is evidence that social phobia may involve
dysfunction with disgust in relation to others. Fordysfunction with disgust in relation to others. For
example, a recent study found that patients withexample, a recent study found that patients with
social anxiety disorder are more sensitive to thesocial anxiety disorder are more sensitive to the
negative facial expressions of anger and disgustnegative facial expressions of anger and disgust
compared with controls.compared with controls.

49. Furthermore,Furthermore, it has been shown thatit has been shown that
individuals with social phobia exhibited aindividuals with social phobia exhibited a
significant increase in anterior cingulatesignificant increase in anterior cingulate
cortex activity compared with control groupcortex activity compared with control group
participants when processing disgust v.participants when processing disgust v.
neutral faces.neutral faces.
Additionally,Additionally, compared with a control group,compared with a control group,
people with social phobia were faster inpeople with social phobia were faster in
making accurate ratings of disgust faces.making accurate ratings of disgust faces.

50. OBSESSIVE COMPULSIVEOBSESSIVE COMPULSIVE
DISORDERDISORDER
Recurring intrusive thoughts of contaminationRecurring intrusive thoughts of contamination areare
reported in overreported in over 50%50% of individuals diagnosed withof individuals diagnosed with
Obsessive-Compulsive Disorder (OCD), TheObsessive-Compulsive Disorder (OCD), The
functional value of intense washing rituals uponfunctional value of intense washing rituals upon
perceived contact with contaminants serves aperceived contact with contaminants serves a
protective, sanitizing function as these personsprotective, sanitizing function as these persons
attempt to disinfect themselves and theirattempt to disinfect themselves and their
environments.environments.
OCD sufferers may not only perceive themselves toOCD sufferers may not only perceive themselves to
be more vulnerable to infection,be more vulnerable to infection, but they also tendbut they also tend
to fear rapid, spreading contamination uponto fear rapid, spreading contamination upon
exposure to agents believed to be dirtyexposure to agents believed to be dirty

51. The motivation for avoidance among OCDThe motivation for avoidance among OCD
washers shares remarkable similarities to thewashers shares remarkable similarities to the
disease–avoidance function in various smalldisease–avoidance function in various small
animal phobias.animal phobias.
The underlying relation between disgust and OCDThe underlying relation between disgust and OCD
may be mediated by the fear of contaminationmay be mediated by the fear of contamination
Indeed, studies have found significantIndeed, studies have found significant
correlations between self–report measures ofcorrelations between self–report measures of
disgust sensitivity and measures of OCDdisgust sensitivity and measures of OCD
symptoms. The measures of disgust are bettersymptoms. The measures of disgust are better
predictors of compulsive washing and checkingpredictors of compulsive washing and checking
behaviors than other measures of anxiety andbehaviors than other measures of anxiety and
depressiondepression

52. Functional magnetic resonance imagingFunctional magnetic resonance imaging
(fMRI)(fMRI) studies have also provided support forstudies have also provided support for
the proposed role between disgust and OCDthe proposed role between disgust and OCD
with obsessive washers displaying activation ofwith obsessive washers displaying activation of
the insula (which is important for the perceptionthe insula (which is important for the perception
of disgust) secondary to the presentation ofof disgust) secondary to the presentation of
disgusting pictures.disgusting pictures.
Cognitive appraisals based on magicalCognitive appraisals based on magical
thinkingthinking may be useful in illuminating themay be useful in illuminating the
relation between disgust and OCD.relation between disgust and OCD.

53. touched a clean pencil to an object that OCD patientstouched a clean pencil to an object that OCD patients
identified as contaminated. A second pencil wasidentified as contaminated. A second pencil was
touched to the first pencil and was then rated andtouched to the first pencil and was then rated and
this process was continued for 12 pencils.this process was continued for 12 pencils.
The results indicated that those subjects with OCDThe results indicated that those subjects with OCD
seemed to perceive aseemed to perceive a “chain of contagion”“chain of contagion” ThusThus
it appears that thought processes related toit appears that thought processes related to
magical thinkingmagical thinking (once in contact always in contact)(once in contact always in contact)
have some value in better understanding OCDhave some value in better understanding OCD

54. DISGUST AND EATINGDISGUST AND EATING
DISORDERSDISORDERS
Elevated disgust responses among bulimiaElevated disgust responses among bulimia
nervosa and anorexia nervosa disordersnervosa and anorexia nervosa disorders
may be apparent in two domains:may be apparent in two domains:
First,First, food itself tends to be negatively evaluatedfood itself tends to be negatively evaluated
and may acquire threatening and nausea–and may acquire threatening and nausea–
provoking properties.provoking properties.
SecondSecond,, the negative evaluation of one’s ownthe negative evaluation of one’s own
body (and its products) as disgusting orbody (and its products) as disgusting or
grotesque is commonly observed.grotesque is commonly observed.

55. Furthermore,Furthermore, societal pressuresocietal pressure to be thinto be thin
provides a context in which overeating andprovides a context in which overeating and
being overweight is viewed with disgust.being overweight is viewed with disgust.
There is interesting findings have beenThere is interesting findings have been
generated from the sparse literatures in thisgenerated from the sparse literatures in this
subject:subject:
First,First, measures of disgust sensitivity do tendmeasures of disgust sensitivity do tend
to correlate positively with eating disorderto correlate positively with eating disorder
symptoms in females.symptoms in females.

56. Second,Second, when comparing samples with andwhen comparing samples with and
without eating disorders, significant groupwithout eating disorders, significant group
differences emerge only on those disgustdifferences emerge only on those disgust
domains directly related to food, the physicaldomains directly related to food, the physical
body, and bodily products.body, and bodily products.
Third,Third, high-caloric foods and overweight bodyhigh-caloric foods and overweight body
shapes tend to be evaluated as more disgustingshapes tend to be evaluated as more disgusting
and fearful by women reporting more abnormaland fearful by women reporting more abnormal
eating attitudes than those women without sucheating attitudes than those women without such
attitudes toward eatingattitudes toward eating

57. Finally,Finally, women in remission from an eatingwomen in remission from an eating
disorder show significant reductions indisorder show significant reductions in
bodily focused disgust sensitivity inbodily focused disgust sensitivity in
comparison to those females continuing tocomparison to those females continuing to
meet diagnostic criteria.meet diagnostic criteria.

58. Disgust and depressionDisgust and depression
Although disgust is an important negativeAlthough disgust is an important negative
emotion, its role in depression has beenemotion, its role in depression has been
largely unrecognizedlargely unrecognized..
The experience of disgust in depression mayThe experience of disgust in depression may
be associated with social interactions, and, inbe associated with social interactions, and, in
some cases could be directed to one's selfsome cases could be directed to one's self,,
These social and self-related aspects ofThese social and self-related aspects of
disgust are especially relevant to depressiondisgust are especially relevant to depression..

59. In particular, since the facial expressions of disgustIn particular, since the facial expressions of disgust
may convey social rejection, increased sensitivitymay convey social rejection, increased sensitivity
to disgust (expressed by others) may beto disgust (expressed by others) may be
characteristic to depressioncharacteristic to depression..
Indeed, there have been reports demonstrating thatIndeed, there have been reports demonstrating that
the processing of facial expressions of disgust isthe processing of facial expressions of disgust is
enhanced in people with depressionenhanced in people with depression..
For example, Hayward et al. (2005)For example, Hayward et al. (2005) observedobserved
enhanced recognition of facial expressions ofenhanced recognition of facial expressions of
disgust in a recovered depressed sampledisgust in a recovered depressed sample
compared with healthy control subjectscompared with healthy control subjects..

60.  Regarding self-directed disgust,Regarding self-directed disgust, somesome
authors argued that the commonly experiencedauthors argued that the commonly experienced
secondary emotions of shame and guilt insecondary emotions of shame and guilt in
depression are derived from the basic emotion ofdepression are derived from the basic emotion of
disgust, and that depression may in part dependdisgust, and that depression may in part depend
on a coupling ofon a coupling of sadness and self-disgust.sadness and self-disgust.
 This proposal was supported in a study (PowerThis proposal was supported in a study (Power
and Tarsia, 2007) found that the emotion ofand Tarsia, 2007) found that the emotion of
disgust was experienced significantly more bydisgust was experienced significantly more by
individuals with depression, anxiety or withindividuals with depression, anxiety or with
comorbid anxiety and depression when comparedcomorbid anxiety and depression when compared
with healthy controls.with healthy controls.

61. Another study (Overton et al., 2008) providedAnother study (Overton et al., 2008) provided
direct evidence that self-disgust (asdirect evidence that self-disgust (as
measured by Self-Disgust Scale)measured by Self-Disgust Scale) played anplayed an
important role in depression by mediating theimportant role in depression by mediating the
relationship between dysfunctional cognitions andrelationship between dysfunctional cognitions and
depressive symptomatologydepressive symptomatology..
Finally, in one FMRI study patients withFinally, in one FMRI study patients with
major depressivemajor depressive disorder show greaterdisorder show greater
activation than healthy controls inactivation than healthy controls in right middleright middle
temporal gyrus and left inferior temporal gyrustemporal gyrus and left inferior temporal gyrus
extending to left middle temporal gyrus, orbito-extending to left middle temporal gyrus, orbito-
frontal cortex and insulafrontal cortex and insula in response to thein response to the
expressions of disgust and fear.expressions of disgust and fear.

62. Disgust and SchizophreniaDisgust and Schizophrenia
It was found that there is elevated global disgustIt was found that there is elevated global disgust
proneness in patients with schizophrenia and theproneness in patients with schizophrenia and the
presence of psychotic symptoms irrespectivepresence of psychotic symptoms irrespective
of whether they were part of different schizophreniaof whether they were part of different schizophrenia
subtypes (paranoid v. non-paranoid) – predictedsubtypes (paranoid v. non-paranoid) – predicted
enhanced disgust reactivityenhanced disgust reactivity..
This propensity for emotional disgust in psychologicalThis propensity for emotional disgust in psychological
tests, is especially obvious in the domains of foodtests, is especially obvious in the domains of food
and body secretionand body secretion

63. In one study, the researchers assessed disgustIn one study, the researchers assessed disgust
propensity in 69 patients with schizophrenia, 68propensity in 69 patients with schizophrenia, 68
patients with depression, and 70 mentally healthypatients with depression, and 70 mentally healthy
controls.controls.
Patients with schizophrenia reported morePatients with schizophrenia reported more
pronounced overall disgust propensity than patientspronounced overall disgust propensity than patients
with depression and mentally healthy individuals onwith depression and mentally healthy individuals on
thethe Questionnaire for the Assessment of DisgustQuestionnaire for the Assessment of Disgust
Sensitivity (QADS),Sensitivity (QADS), Whereas food-related disgustWhereas food-related disgust
was characteristic of schizophrenia, depressedwas characteristic of schizophrenia, depressed
patients experienced elevated death-relatedpatients experienced elevated death-related
disgust.disgust.

64.  Ille and colleagues say the elevated food-relatedIlle and colleagues say the elevated food-related
disgust propensity in patients with schizophreniadisgust propensity in patients with schizophrenia
may be linked to their tendency to overestimatemay be linked to their tendency to overestimate
contagious effects of disgust elicitors.contagious effects of disgust elicitors.
““They are susceptible to magical beliefs aboutThey are susceptible to magical beliefs about
contamination (e.g., laws such as you are whatcontamination (e.g., laws such as you are what
you eat or once in contact always in contact),you eat or once in contact always in contact),
implying that disgust elicitors are able to intrudeimplying that disgust elicitors are able to intrude
into the body and soul with long-lasting negativeinto the body and soul with long-lasting negative
consequences,” they commentconsequences,” they comment..

65. Likewise touching another person might beLikewise touching another person might be
experienced as a threat of incorporation of thisexperienced as a threat of incorporation of this
person’s properties, which, again, relates to theperson’s properties, which, again, relates to the
disgust laws of sympathetic magic.disgust laws of sympathetic magic.
““Elevated interpersonal disgust might lead toElevated interpersonal disgust might lead to
problems concerning intimate relationships,problems concerning intimate relationships,
which are typically seen in patients sufferingwhich are typically seen in patients suffering
from schizophrenia,” Ille and colleaguesfrom schizophrenia,” Ille and colleagues
commentcomment

66. DISGUST AND CIGARETTEDISGUST AND CIGARETTE
SMOKINGSMOKING
Cigarette smoking provides one exemplar in whichCigarette smoking provides one exemplar in which
disgust has transformed a once social preferencedisgust has transformed a once social preference
intointo a moral valuea moral value..
Approximately 50 years ago, cigarette smoking wasApproximately 50 years ago, cigarette smoking was
a natural part of our social culture, and wasa natural part of our social culture, and was
treated as a matter of personal preferencetreated as a matter of personal preference..
More recently, cigarette smoking has transformedMore recently, cigarette smoking has transformed
from a mere preference intofrom a mere preference into a moral violationa moral violation
among manyamong many..

67. The connection between disgust and the moralizationThe connection between disgust and the moralization
of cigarette smoking is supported by theof cigarette smoking is supported by the
observation that many people readily experienceobservation that many people readily experience
significant aversion tosignificant aversion to even minuteeven minute (i.e., odors)(i.e., odors)
contact with the “offensive” substancecontact with the “offensive” substance..
The link between disgust and the internalization of theThe link between disgust and the internalization of the
moral and religious implicationsmoral and religious implications of cigaretteof cigarette
smoking can be found in the potential for cigarettessmoking can be found in the potential for cigarettes
to result in heart disease and lung cancer and theto result in heart disease and lung cancer and the
observation that smoking is harmful to otherobservation that smoking is harmful to other
peoplepeople..

68. Furthermore, disgust measures correlated moreFurthermore, disgust measures correlated more
strongly and positively with moral judgments ofstrongly and positively with moral judgments of
smoking than did smoking–related health concernssmoking than did smoking–related health concerns..
In efforts to decrease smoking behavior, mediaIn efforts to decrease smoking behavior, media
advertisements have recognized that a very effectiveadvertisements have recognized that a very effective
way to enforce the prohibition of cigarette smokingway to enforce the prohibition of cigarette smoking
is by linking it to disgustis by linking it to disgust

70. PSYCHOMETRIC ASSESSMENTPSYCHOMETRIC ASSESSMENT
OF DISGUSTOF DISGUST
The Disgust QuestionnaireThe Disgust Questionnaire
))DQ; Rozin, Fallon,& Mandell, 1984). The DQ has beenDQ; Rozin, Fallon,& Mandell, 1984). The DQ has been
used as a measure of “disgust sensitivityused as a measure of “disgust sensitivity””
or one’s “proneness” toward being disgustedor one’s “proneness” toward being disgusted..
The Disgust ScaleThe Disgust Scale
))DS; Haidt et al., 1994),which assesses the intensity ofDS; Haidt et al., 1994),which assesses the intensity of
disgust reactions across several domainsdisgust reactions across several domains::
Animals, Body Products, Death, Food, hygiene, Sex, andAnimals, Body Products, Death, Food, hygiene, Sex, and
Sympathetic Magic (improbable contaminationSympathetic Magic (improbable contamination(.(.

71. the Disgust Emotion Scalethe Disgust Emotion Scale::
))DES; Kleinknecht, Kleinknecht, &DES; Kleinknecht, Kleinknecht, & Thorndike, 1997)Thorndike, 1997)
has been introduced as an alternative measure ofhas been introduced as an alternative measure of
disgust across multiple domainsdisgust across multiple domains::
Animals, Injections and Blood Draws, Mutilation andAnimals, Injections and Blood Draws, Mutilation and
Death, Rotting Foods, and OdorsDeath, Rotting Foods, and Odors..
The Questionnaire for the AssessmentThe Questionnaire for the Assessment
of Disgust Sensitivity, QADSof Disgust Sensitivity, QADS
Self Disgust Scale, SDSSelf Disgust Scale, SDS

72. ConclusionConclusion
Disgust is a basic emotion that was initially describedDisgust is a basic emotion that was initially described
as the oral incorporation of contaminated foods. Anas the oral incorporation of contaminated foods. An
evolved understanding of disgust has more recentlyevolved understanding of disgust has more recently
begun to implicate this emotion in other socio–begun to implicate this emotion in other socio–
moral, interpersonal, and clinical domainsmoral, interpersonal, and clinical domains..
further systematic examination of this emotion bothfurther systematic examination of this emotion both
alone and in combination with other affective statesalone and in combination with other affective states
may ultimately help improve our understanding ofmay ultimately help improve our understanding of
human behaviorhuman behavior..

73. future studies must be conducted in light of evidencefuture studies must be conducted in light of evidence
regarding the physiology (parasympatheticregarding the physiology (parasympathetic
activation) and neurocircuitry (increased activationactivation) and neurocircuitry (increased activation
of the insula) of disgustof the insula) of disgust..
Such approach will provide grounds for making moreSuch approach will provide grounds for making more
definitive inferences regarding the role of disgust indefinitive inferences regarding the role of disgust in
psychiatric illnesspsychiatric illness..