Bethany G. Ciesielski

Fear and loathing: a meta-analytic review of the specificity of anger in PTSD.

The available empirical literature suggests that anger may be characteristic of posttraumatic stress disorder (PTSD). Meta-analytic strategies were used to evaluate the extent to which the experience of anger is specific to PTSD rather than anxiety disorders in general. Thirty-four anxiety disorder patient samples (n=2,169) from 28 separate studies were included in the analysis. Results yielded a large effect size indicating greater anger difficulties among anxiety disorder patients versus controls. Compared to control samples, a diagnosis of PTSD was associated with significantly greater difficulties with anger than was any other anxiety disorder diagnosis. Other anxiety disorder diagnoses did not differ significantly from each other. However, the specific association between PTSD and anger did vary depending on the anger domain assessed. Difficulties with anger control, anger in, and anger out significantly differentiated PTSD from non-PTSD anxiety disorder samples, whereas difficulties with anger expression, state anger, and trait anger did not. These findings are discussed in the context of future research on the role of anger in PTSD.

The effects of safety behaviors on health anxiety: An experimental investigation

The present study examined the extent to which safety behaviors exacerbate symptoms of hypochondriasis (severe health anxiety). Participants were randomized into a safety behavior (n=30) or control condition (n=30). After a baseline period, participants in the safety behavior condition spent one week actively engaging in a clinically representative array of health-related safety behaviors on a daily basis, followed by a second week-long baseline period. Participants in the control condition monitored their normal use of safety behaviors. Compared to control participants, those in the safety behavior condition reported significantly greater increases in health anxiety, hypochondriacal beliefs, contamination fear, and avoidant responses to health-related behavioral tasks after the safety behavior manipulation. In contrast, general anxiety symptoms did not significantly differ between the two groups as a function of the manipulation. Mediational analyses were consistent with the hypothesis that changes in the frequency of health-related thoughts mediated the effects of the experimental manipulation on health anxiety. These findings suggest that safety behaviors are associated with increases in health anxiety, perhaps by fostering catastrophic thoughts about health. The implications of these findings for the conceptualization of hypochondriasis as an anxiety disorder are discussed.

Specificity of disgust vulnerability in the distinction and treatment of OCD

A growing body of research has implicated disgust as a potential risk factor for the development and maintenance of obsessive-compulsive disorder (OCD). The first aim of the present study was to determine whether related, yet distinct, disgust vulnerabilities are endorsed more strongly by individuals with OCD than by those with another anxiety disorder. The second aim was to examine the unique contributions of changes in disgust to symptom improvement observed with exposure-based treatment for OCD. In study 1, individuals with OCD, generalized anxiety disorder (GAD), and nonclinical controls (NCCs) completed a measure of disgust propensity and disgust sensitivity. Compared to NCCs and individuals with GAD, those with OCD more strongly endorsed disgust propensity. However, individuals with OCD did not significantly differ from individuals with GAD in disgust sensitivity, although both groups reported significantly higher disgust sensitivity levels compared to NCCs. Study 2 comprised mediation analyses of symptom improvement among individuals with OCD and revealed that decreases in disgust propensity over time mediated improvement in OCD symptoms, even after controlling for improvements in negative affect. The implications of these findings for conceptualizing the role of disgust in the nature and treatment of OCD are discussed.

The Three Domains of Disgust Scale: Factor Structure, Psychometric Properties, and Conceptual Limitations.

This investigation examined the measurement properties of the Three Domains of Disgust Scale (TDDS). Principal components analysis in Study 1 (n = 206) revealed three factors of Pathogen, Sexual, and Moral Disgust that demonstrated excellent reliability, including test–retest over 12 weeks. Confirmatory factor analyses in Study 2 (n = 406) supported the three factors. Supportive evidence for the validity of the Pathogen and Sexual Disgust subscales was found in Study 1 and Study 2 with strong associations with disgust/contamination and weak associations with negative affect. However, the validity of the Moral Disgust subscale was limited. Study 3 (n = 200) showed that the TDDS subscales differentially related to personality traits. Study 4 (n = 47) provided evidence for the validity of the TDDS subscales in relation to multiple indices of disgust/contamination aversion in a select sample. Study 5 (n = 70) further highlighted limitations of the Moral Disgust subscale given the lack of a theoretically consistent association with moral attitudes. Lastly, Study 6 (n = 178) showed that responses on the Moral Disgust scale were more intense when anger was the response option compared with when disgust was the response option. The implications of these findings for the assessment of disgust are discussed.

Disgust vulnerability and symptoms of contamination-based OCD: descriptive tests of incremental specificity.

The present investigation examines the incremental association between disgust propensity and sensitivity and contamination-based obsessive-compulsive disorder (OCD) symptoms. Structural equation modeling in Study 1 indicated that general disgust was related to contamination fear even when controlling for negative affect in a nonclinical sample. Evidence was also found for a model in which the effect of negative affect on contamination fear is mediated by general disgust. Study 1 also showed that both disgust sensitivity and disgust propensity uniquely predicted contamination fear when controlling for negative affect. Growth curve analyses in Study 2 indicated that higher baseline contamination fear is associated with less reduction in contamination fear over a 6-week period as disgust sensitivity increases even when controlling for negative affect. Lastly, disgust propensity was associated with concurrent levels of excessive washing symptoms among patients with OCD in Study 3 when controlling for depression. Implications of these findings from nonclinical, analogue, and clinical samples for future research on the specificity of disgust-related vulnerabilities in the etiology of contamination concerns in OCD are discussed.

Emotion modulation of visual attention: categorical and temporal characteristics.

Background Experimental research has shown that emotional stimuli can either enhance or impair attentional performance. However, the relative effects of specific emotional stimuli and the specific time course of these differential effects are unclear. Methodology/Principal Findings In the present study, participants (n = 50) searched for a single target within a rapid serial visual presentation of images. Irrelevant fear, disgust, erotic or neutral images preceded the target by two, four, six, or eight items. At lag 2, erotic images induced the greatest deficits in subsequent target processing compared to other images, consistent with a large emotional attentional blink. Fear and disgust images also produced a larger attentional blinks at lag 2 than neutral images. Erotic, fear, and disgust images continued to induce greater deficits than neutral images at lag 4 and 6. However, target processing deficits induced by erotic, fear, and disgust images at intermediate lags (lag 4 and 6) did not consistently differ from each other. In contrast to performance at lag 2, 4, and 6, enhancement in target processing for emotional stimuli was observed in comparison to neutral stimuli at lag 8. Conclusions/Significance These findings suggest that task-irrelevant emotion information, particularly erotica, impairs intentional allocation of attention at early temporal stages, but at later temporal stages, emotional stimuli can have an enhancing effect on directed attention. These data suggest that the effects of emotional stimuli on attention can be both positive and negative depending upon temporal factors.

Incremental specificity of disgust sensitivity in the prediction of obsessive-compulsive disorder symptoms: Cross-sectional and prospective approaches ☆

The present study examines the association between disgust sensitivity (DS) and obsessive-compulsive disorder (OCD) symptoms in two non-clinical samples. Findings from Study 1 (n=270) revealed a significant association between DS and OCD symptoms even after controlling for negative affect and anxiety sensitivity. Subsequent analysis also revealed a specific association between DS and the washing subtype of OCD symptoms when controlling for other OCD symptom dimensions. DS did not significantly predict residual change in total symptoms of OCD over a 12-week period (n=300) when controlling for risk factors for anxiety disorder symptoms in general (e.g., negative affect, anxiety sensitivity) and OCD specifically (e.g., obsessive beliefs) in Study 2. However, exploratory analyses suggest that DS may be predictive of residual change in some OCD symptom subtypes but not others. Implications of these findings for future research on the role of disgust in OCD are discussed.

Making something out of nothing: neutral content modulates attention in generalized anxiety disorder

Background: Although an attentional bias for threat has been implicated in generalized anxiety disorder (GAD), evidence supporting such a bias has been inconsistent. This study examines whether exposure to different emotional content modulates attention disengagement and impairs the perception of subsequently presented nonemotional targets in GAD. Methods: Patients with GAD (n = 30) and controls (n = 30) searched for a target embedded within a series of rapidly presented images. Critically, an erotic, fear, disgust, or neutral distracter image appeared 200 msec or 800 msec before the target. Results: Impaired target detection was observed among GAD patients relative to controls following only fear and neutral distractors. However, this effect did not significantly vary as a function of distractor stimulus duration before the target. Furthermore, group differences in target detection after fear distractors were no longer significant when controlling target detection after neutral distractors. Subsequent analysis also revealed that the impaired target detection among those with GAD relative to controls following neutral (but not fear) distractors was mediated by deficits in attentional control. Conclusions: The implications of these findings for further delineating the function of attentional biases in GAD are discussed. Depression and Anxiety, 2011.

A taxometric investigation of the latent structure of eating disorders

The present study examined the latent structure of eating disorder symptoms in a large sample of patients with a diagnosis of anorexia nervosa restricting type, anorexia nervosa binge eating/purging type, and bulimia nervosa (n=3747). Three taxometric procedures (MAXimum EIGenvalue (MAXEIG), Mean Above Minus Below A (MAMBAC), and Latent-Mode Factor Analysis (L-Mode)) were applied to self-reported symptoms of bulimia, drive for thinness, body dissatisfaction, as well as body mass index. Taxometric analysis among patients with the restricting and binge eating/purging subtype of anorexia and those with bulimia nervosa supported a dimensional latent structure of eating disorder symptoms. Taxometric analysis also revealed a dimensional latent structure of eating disorder symptoms among patients with the restricting and binge eating/purging subtype of anorexia suggesting that the two anorexia subtypes may not represent discrete categories. These findings suggest that the diagnosis and assessment of eating disorder symptoms should be conceptualized from a dimensional framework.

Disgust, anxiety, and vasovagal syncope sensations: A comparison of injection-fearful and nonfearful blood donors

Although research has implicated disgust in the fainting response observed in blood-injection-injury (BII) phobia, this finding has not been consistently observed in the literature. The present study further examines the relationship between disgust and fainting symptoms among injection-fearful (n=108) and nonfearful (n=338) blood donors. Volunteers from community blood drives provided pre-donation levels of anxiety and disgust towards giving blood and completed a standardized measure of vasovagal reactions (fainting) to blood donation after giving blood. As predicted, injection-fearful participants reported significantly more pre-donation anxiety and disgust compared to nonfearful participants. Injection-fearful donors also reported experiencing more fainting symptoms during blood donation and found the donation experience more unpleasant than did nonfearful participants. Although pre-donation disgust and anxiety levels each uniquely predicted fainting symptoms among nonfearful donors, only pre-donation anxiety uniquely predicted fainting symptoms among injection-fearful donors. Implications of these findings for conceptualizing the disgust-faint relationship in BII phobia are discussed.