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The psychobiology of obsessive-compulsive disorder: How important is the role of disgust?

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Abstract

Psychobiologic models of obsessive-compulsive disorder (OCD) have focused on cortico-striatal-thalamic-cortical (CTSC) circuits, noting normal function in cognitive and motoric procedural strategies. Such models have relied on the classification of OCD as an anxiety disorder, seldom exploring other relevant emotions. Based on the hypothesis that a central emotion in OCD is disgust, the authors review the literature on its psychobiology and its relevance to current models of OCD. There are important parallels between the psychobiology of OCD and that of disgust. Obsessivecompulsive disorder may be conceptualized in terms of a false contamination alarm in which disgust plays a crucial organizing or embodying role, not only at a basic brain level, but also in terms of the psychosocial aspects of the disorder. Just as psychobiologic models of panic disorder and posttraumatic stress disorder have been strengthened by the inclusion of preclinical work on amygdala-mediated fear conditioning, so findings on disgust and its mediating CSTC circuits may generate useful hypotheses for OCD research.

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References and Recommended Reading

  1. Fineberg N, Marrazitti D, Stein DJ: Obsessive-Compulsive Disorder: A Practical Guide to Management. London: Martin Dunitz; 2001.

    Google Scholar 

  2. Stein DJ, Goodman WK, Rauch SL: The cognitive-affective neuroscience of obsessive-compulsive disorder. Curr Psychiatry Rep 2000, 2:341–346.

    PubMed  CAS  Google Scholar 

  3. Montgomery SA: Obsessive compulsive disorder is not an anxiety disorder. Int Clin Psychopharmacol 1993, 8(suppl):57–62.

    Article  PubMed  Google Scholar 

  4. Phillips ML, Senior C, Fahy T, David AS: Disgust — the forgotten emotion of psychiatry. Br J Psychiatry 1998, 172:373–375. This article reviews research on disgust and cogently makes the argument that, given its importance to a range of psychiatric disorders, disgust has received insufficient study and attention.

    PubMed  CAS  Google Scholar 

  5. Rozin P, Fallon A: A perspective on disgust. Psychological Rev 1987, 94:23–41.

    Article  CAS  Google Scholar 

  6. Miller WI: The Anatomy of Disgust. Cambridge: Harvard University Press; 1997.

    Google Scholar 

  7. Darwin CR: The Expression of Emotions in Man and Animals. Chicago: University of Chicago Press; 1965.

    Google Scholar 

  8. Ekman P, Freisen WV: Unmasking the Face. Englewood Cliffs, NJ: Prentice-Hall; 1975.

    Google Scholar 

  9. Izard CE: Intersystem connections, In The Nature of Emotion. Edited by Ekman P, Davidson RJ. New York: Oxford University Press;1994:356–360.

    Google Scholar 

  10. Anygal A: Disgust and related aversions. J Abnorm Soc Psychol 1941, 36:393–412.

    Article  Google Scholar 

  11. Rozin P, Lowery L, Ebert RJ: Varieties of disgust faces and the structure of disgust. Pers Soc Psychol 1994, 66:870–881.

    Article  CAS  Google Scholar 

  12. Vrana SR: The psychophysiology of disgust: differentiating negative emotional context with facial EMG. Psychophysiology 1993, 30:279–286.

    Article  PubMed  CAS  Google Scholar 

  13. Haidt J, McCauley C, Rozin P: Individual differences in sensitivity to disgust: a scale sampling seven domains of disgust elicitors. Person Individ Diff 1994, 17:701–713.

    Article  Google Scholar 

  14. Rozin P, Lowery L, Imada S, Haidt J: The CAD triad hypothesis: a mapping between three moral emotions (contempt, anger, disgust) and three moral codes (community, autonomy, divinity). J Pers Soc Psychol 1999, 76:574–586.

    Article  PubMed  CAS  Google Scholar 

  15. Lakoff G: Women, Fire, and Dangerous Things: What Categories Reveal about the Mind. Chicago: University of Chicago Press; 1987.

    Google Scholar 

  16. Davidson RJ, Ekman P, Saron DC, et al.: Approach-withdrawal and cerebral asymmetry: emotional expression and brain physiology I. J Pers Soc Psychol 1990, 58:330–341.

    Article  PubMed  CAS  Google Scholar 

  17. Jones NA, Fox NA: Electroencephalogram asymmetry during emotionally evocative films and its relation to positive and negative affectivity. Brain Cogn 1992, 20:280–299.

    Article  PubMed  CAS  Google Scholar 

  18. Fox NA, Davidson RJ: Taste-elicited changes in facial signs of emotion and the asymmetry of brain electrical activity in human newborns. Neuropsychologia 1986;24:417–422.

    Article  PubMed  CAS  Google Scholar 

  19. Hiyoshi T, Seino M, Mihara T, et al.: Emotional facial expressions at the onset of temporal lobe seizures: observations on scalp and intracranial EEG recordings. Jpn J Psychiatry Neurol 1989, 43:419–426.

    PubMed  CAS  Google Scholar 

  20. Collet C, Vernet-Maury E, Delhomme G, Dittmar A: Autonomic nervous system response patterns specificity to basic emotions. J Auton Nerv Syst 1997, 62:45–57.

    Article  PubMed  CAS  Google Scholar 

  21. Boiten FA: The effects of emotional behaviour on components of the respiratory cycle. Biol Psychol 1998, 49:29–51.

    Article  PubMed  CAS  Google Scholar 

  22. Prkachin K, Williams-Avery RM, Zwaal C, Mills DE: Cardiovascular changes during induced emotion: an application of Lang’s theory of emotional imagery. J Psychosom Res 1999, 3:255–267.

    Article  Google Scholar 

  23. Vernet-Maury E, Alaoui-Ismaili-O, Dittmar A, et al.: Basic emotions induced by odorants: a new approach based on autonomic pattern results. J Auton Nerv Syst 1999, 75:176–183.

    Article  PubMed  CAS  Google Scholar 

  24. Lane RD, Reiman EM, Bradley MM, et al.: Neuroanatomical correlates of pleasant and unpleasant emotion. Neuropsychologia 1997, 35:1437–144.

    Article  PubMed  CAS  Google Scholar 

  25. Reiman EM: The application of positron emission tomography to the study of normal and pathologic emotions. J Clin Psychiatry 1997, 58(suppl):4–12.

    PubMed  Google Scholar 

  26. Paradiso S, Robinson RG, Andreasen NC, et al.: Emotional activation of limbic circuitry in elderly normal subjects in a PET study. Am J Psychiatry 1997, 154:384–389.

    PubMed  CAS  Google Scholar 

  27. Young AW, Newcombe F, de Haan EHF, et al.: Face perception after brain injury: selective impairments affecting identity and expression. Brain 1993, 116:941–959.

    Article  PubMed  Google Scholar 

  28. Adolphs R, Tranel D, Damasio H, et al.: Cortical systems for the recognition of emotion in facial expressions. Neurosci 1996, 315:7678–7687.

    Google Scholar 

  29. Mandal MK, Tandon SC, Asthana HS: Right brain damage impairs recognition of negative emotions. Cortex 1991, 27:247–253.

    PubMed  CAS  Google Scholar 

  30. Adolphs R, Tranel D, Damasio H, Damasio A: Impaired recognition of emotion in facial expressions following bilateral damage to the human amygdala. Nature 1994, 372:613–614.

    Article  Google Scholar 

  31. Adolphs R, Tranel D, Damasio H, Damasio AR: Fear and the human amygdala. J Neurosci 1995, 15:5879–5891.

    PubMed  CAS  Google Scholar 

  32. Calder AJ, Young AW, Rowland D, et al.: Facial emotional recognition after bilateral amygdala damage: differentially sever impairment of fear. Cogn Neuropsychol 1996, 13:699–675.

    Article  Google Scholar 

  33. Broks P, Young AW, Maratos EJ, et al.: Face processing impairments after encephalitis: amygdala damage and recognition of fear. Neuropsychologia 1998, 36:59–70.

    Article  PubMed  CAS  Google Scholar 

  34. Gur RC, Skolnick BE, Gur RE: Effects of emotional discrimination tasks on cerebral blood flow regional activation. Brain Cogn 1994, 25:271–286.

    Article  PubMed  CAS  Google Scholar 

  35. Morris JS, Frith CD, Perret DI, et al.: A differential neural response in the human amygdala to fearful and happy facial expressions. Nature 1996, 383:812–815.

    Article  PubMed  CAS  Google Scholar 

  36. Breiter HC, Etcoff NL, Whalen PJ, et al.: Response and habituation of the human amygdala during visual processing of facial expression. Neuron 1996, 17:875–887.

    Article  PubMed  CAS  Google Scholar 

  37. Sprengelmeyer R, Young AW, Calder AJ, et al.: Loss of disgust: perception of faces and emotions in Huntington’s disease. Brain 1996, 119:1647–1665.

    Article  PubMed  Google Scholar 

  38. Gray JM, Young AW, Barker WA, et al.: Impaired recognition of disgust in Huntington’s disease gene carriers. Brain 1997, 120:2029–2038.

    Article  PubMed  Google Scholar 

  39. Calder AJ, Keane J, Manes F, et al.: Impaired recognition and experience of disgust following brain injury. Nat Neurosci 2000, 3:1077–1078.

    Article  PubMed  CAS  Google Scholar 

  40. Lavenu I, Pasquier F, Lebert F, et al.: Perception of emotion in frontotemporal dementia and Alzheimer disease. Alzheimer Dis Assoc Disord 1999, 13:96–101.

    Article  PubMed  CAS  Google Scholar 

  41. Phillips ML, Williams L, Senior C, et al.: A differential neural response to threatening and non-threatening negative facial expressions in paranoid and non-paranoid schizophrenics. Psychiatry Res 1999, 92:11–31.

    Article  PubMed  CAS  Google Scholar 

  42. Phillips ML, Young AW, Senior C, et al.: A specific neural substrate for perceiving facial expressions of disgust. Nature 1997, 389:495–498.

    Article  PubMed  CAS  Google Scholar 

  43. Sprengelmeyer R, Rausch M, Eysel UT, Przuntek H: Neural structures associated with recognition of facial expressions of basic emotions. Proc R Soc Lond B Biol Sci 1998, 265:1927–1931. A number of fMRI studies found that the recognition of different facial emotional expressions is mediated by distinctive neurocircuits. In this study, perception of disgusted expressions activated the left insula cortex and right putamen, and various expressions, including disgust, activated the inferior part of the left frontal cortex.

    Article  CAS  Google Scholar 

  44. Phillips ML, Young AW, Scott SK, et al.: Neural responses to facial and vocal expressions of fear and disgust. Proc R Soc Lond B Biol Sci 1998, 1408:1809–1817. This study elaborated the group’s seminal earlier work on the neurocircuitry mediating recognition of different facial expressionsby studying differences in facial and vocal expressions. Whereas facial expressions of disgust activated the anterior insula as well as the caudate and putamen, vocal expressions of disgust did not, indicating that activation of this neurocircuitry is specifically dependent on the modality of expressed disgust. Both facial and vocal expressions of disgust and of fear activated the superior temporal gyrus.

    Article  Google Scholar 

  45. Rolls ET: Central taste anatomy and physiology. In Handbook of Clinical Olfaction and Gustation. Edited by Doty RL. New York: Marcel Dekker; 1994.

    Google Scholar 

  46. Kinomura S: Functional anatomy of taste perception in the human brain studies with positron emission tomography. Brain Res 1994, 659:263–266.

    Article  PubMed  CAS  Google Scholar 

  47. Fullbright RK, Skudlarski P, Lacadie CM, et al.: Functional MR imaging of regional brain responses to pleasant and unpleasant odors. Am J Neuroradiol 1998, 19:1721–1726.

    Google Scholar 

  48. Casey K, et al.: Positron emission tomography analysis of cerebral structures activated specifically by repetitive noxious heat stimuli. J Neurophysiol 1994, 71:802–807.

    PubMed  CAS  Google Scholar 

  49. Douglas M: Purity and Danger: An Analysis of the Concepts of Pollution and Taboo. London: Routledge and Kegan Paul; 1966.

    Google Scholar 

  50. Fallon AE, Rozin P, Pliner P: The child’s conception of food: the development of food rejections with special reference to disgust and contamination sensitivity. Child Dev 1984, 55:566–575.

    Article  PubMed  CAS  Google Scholar 

  51. Sprengelmeyer R, Young AW, Pundt I, et al.: Disgust implicated in obsessive-compulsive disorder. Proc R Soc Lond B Biol Sci 1997, 264:1767–1773. This group reported that those patients with Huntington’s, a basal ganglia disorder, demonstrated selective impairment in recognition of facial expressions of disgust. In this study, they reported that patients with OCD, but not Tourette’s disorder patients without OCD (or anxiety disorder control patients), also had impaired recognition of facial expressions of disgust. OCD subjects had no difficulties in assigning words to basic emotional categories; the problem was rather one of perception.

    Article  CAS  Google Scholar 

  52. Rozin P, Nemeroff CJ: The laws of sympathetic magic: a psychological analysis of similarity and contagion. In Cultural Psychology: Essays on Comparative Human Development. Edited by Stigler J, Herdt G, Shweder RA. Cambridge, England: Cambridge University Press; 205-232.

  53. Rozin P, Millman L, Nemeroff C: Operation of the laws of sympathetic magic in disgust and other domains. J Pers Soc Psychol 1986, 50:703–712.

    Article  Google Scholar 

  54. Tylor EB: Primative Culture: Researches in the Development of Mythology, Philosophy, Religion, Art and Custom. New York: Gordon Press; 1871.

    Google Scholar 

  55. Frazer JG: The Golden Bough: A Study in Magic and Religion. New York: Macmillan; 1890.

    Google Scholar 

  56. Mauss M: A General Theory of Magic. New York: Norton; 1971.

    Google Scholar 

  57. Rachman S: Pollution of the mind. Behav Res Ther 1994, 32:311–314.

    Article  PubMed  CAS  Google Scholar 

  58. Power M, Dalgleish T: Cognition and Emotion: From Order to Disorder. Hove, UK: Psychology Press; 1997.

    Google Scholar 

  59. Rolls ET: A theory of emotion and consciousness, and its application to understanding the neural basis of emotion. In The Cognitive Neurosciences. Edited by Gazzaniga MS. Cambridge, MA: MIT Press; 1995:1091–1106.

    Google Scholar 

  60. Phillips MJ, Marks I, Senior C, et al.: A differential neural response in obsessive-compulsive disorder patients with washing compared with checking symptoms to disgust. Psychol Med 2000, 30:1037–1050.

    Article  PubMed  CAS  Google Scholar 

  61. Quigley JF, Sherman MF, Sherman NC: Personality disorder symptoms, gender, and age as predictors of adolescent disgust sensitivity. Person Individ Differences 1997, 22:661–667.

    Article  Google Scholar 

  62. Oltmanns TF, Gibbs NA: Emotional responsiveness and obsessive-compulsive behavior. Cogn Emotion 1995, 9:563–578.

    Google Scholar 

  63. Nesse RM, Williams GC: Why We Get Sick: The New Science of Darwinian Medicine. New York: Vintage Books; 1995.

    Google Scholar 

  64. Stein DJ, Bouwer C: A neuro-evolutionary approach to the anxiety disorders. J Anxiety Disord 1997, 11:409–429.

    Article  PubMed  CAS  Google Scholar 

  65. Ames D, Cummings JL, Wirshing WC, et al.: Repetitive and compulsive behavior in frontal lobe degenerations. J Neuropsychiatry Clin Neurosci 1994, 6:100–113.

    PubMed  CAS  Google Scholar 

  66. Berthier ML, Kulisevsky J, Gironell A, et al.: Obsessivecompulsive disorder associated with brain lesions: clinical phenomenology, cognitive function, and anatomic correlates. Neurology 1996, 47:353–361.

    PubMed  CAS  Google Scholar 

  67. Rauch SL, Savage CR, Alpert NM, et al.: Probing striatal function in obsessive-compulsive disorder: a PET study of implicit sequence learning. J Neuropsychiatry Clin Neurosci 1997, 9:568–573.

    PubMed  CAS  Google Scholar 

  68. Leckman JF, Grice DE, Boardman J, et al.: Symptoms of obsessive-compulsive disorder. Am J Psychiatry 1997, 154:911–917.

    PubMed  CAS  Google Scholar 

  69. Rauch SL, Savage CR, Alpert NM, et al.: The functional neuroanatomy of anxiety: a study of three disorders using positron emission tomography and symptom provocation. Biol Psychiatry 1997, 42:446–452.

    Article  PubMed  CAS  Google Scholar 

  70. Lucey JV, Costa DC, Adshead G, et al.: Brain blood flow in anxiety disorders. OCD, panic disorder with agoraphobia, and post-traumatic stress disorder on 99mTcHMPAO single photon emission tomography (SPET). Br J Psychiatry 1997, 171:346–350.

    Article  PubMed  CAS  Google Scholar 

  71. Davey GC, McDonald AS, Hirisave U, et al.: A cross-cultural study of animal fears. Behav Res Ther 1998; 36:735–750.

    Article  PubMed  CAS  Google Scholar 

  72. Thorpe SJ, Salkovskis PM: Studies on the role of disgust in the acquisition and maintenance of specific phobias. Behav Res Ther 1998, 36:877–893.

    Article  PubMed  CAS  Google Scholar 

  73. Kleinknecht RA, Kleinknecht EE, Thorndike RM: The role of disgust and fear in blood and injection-related fainting symptoms: a structural equation model. Behav Res Ther 1997, 35:1075–1087.

    Article  PubMed  CAS  Google Scholar 

  74. Page AC: Blood-injury phobia. Clin Psychol Rev 1994, 14:443–461.

    Article  Google Scholar 

  75. Muris P, Merckelbach H, Schmidt H, et al.: Disgust sensitivity, trait anxiety and anxiety disorders symptoms in normal children. Behav Res Ther 1999, 37:953–961.

    Article  PubMed  CAS  Google Scholar 

  76. Steiner JE, Lidar-Lifschitz D, Perl E: Taste and odor: reactivity in depressive disorders, a multdisciplinary approach. Percept Mot Skills 1993, 77:1331–1346.

    PubMed  CAS  Google Scholar 

  77. Troop NA, Murphy F, Bramon E, Treasure JL: Disgust sensitivity in eating disorders: a preliminary investigation. Int J Eat Disord 2000, 27:446–451.

    Article  PubMed  CAS  Google Scholar 

  78. Benson PJ: A means of measuring facial expressions and a method for predicting emotion categories in clinical disorders of affect. J Affect Disord 1999, 55:179–185.

    Article  PubMed  CAS  Google Scholar 

  79. Blair RJ, Curran HV: Selective impairment in the recognition of anger induced by diazepam. Psychopharmacology 1999, 147:335–338.

    Article  PubMed  CAS  Google Scholar 

  80. Gross JJ: Antecedent- and response-focused emotion regulation: divergent consequences for experience, expression, and physiology. J Pers Soc Psychol 1998, 74:224–237.

    Article  PubMed  CAS  Google Scholar 

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Stein, D.J., Liu, Y., Shapira, N.A. et al. The psychobiology of obsessive-compulsive disorder: How important is the role of disgust?. Curr Psychiatry Rep 3, 281–287 (2001). https://doi.org/10.1007/s11920-001-0020-3

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