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The Role of Disgust in Eating Disorders

  • EATING DISORDERS (S WONDERLICH and S ENGEL, SECTION EDITORS)
  • Published:
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Abstract

Purpose of Review

In current review, we evaluate the current literature examining the role of disgust in eating disorders (EDs), and provide a theoretical model designed to inform the study and treatment of disgust-based symptoms in EDs.

Recent Findings

Findings from this review suggest that aberrant disgust-conditioning processes represent promising but understudied mechanisms that may contribute to the risk and maintenance of core eating disorder (ED) psychopathology. In addition, preliminary evidence supports the use of interventions designed to target aversive disgust cues and disrupt maladaptive disgust-based conditioning that may maintain eating pathology. However, experimental studies designed to elucidate the role of disgust and aversive learning processes remain limited.

Summary

Disgust is a promising risk and maintenance factor in EDs. Future systematic investigation is needed to examine disgust-based processes at a mechanistic level in order to better understand the links between disgust, avoidance behaviors, and EDs. Further investigation of the mechanistic role of disgust in EDs is warranted.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Arch Gen Psychiatry. 2011;68(7):724–31.

    PubMed  Google Scholar 

  2. Mitchell JE, Crow S. Medical complications of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry. 2006;19(4):438–43.

    PubMed  Google Scholar 

  3. Winkler LA, Christiansen E, Lichtenstein MB, Hansen NB, Bilenberg N, Støving RK. Quality of life in eating disorders: a meta-analysis. Psychiatry Res. 2014;219(1):1–9.

    PubMed  Google Scholar 

  4. Culbert KM, Racine SE, Klump KL. Research review: what we have learned about the causes of eating disorders–a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry. 2015;56(11):1141–64.

    PubMed  Google Scholar 

  5. Hay P. A systematic review of evidence for psychological treatments in eating disorders: 2005–2012. Int J Eat Disord. 2013;46(5):462–9.

    PubMed  Google Scholar 

  6. Butler RM, Heimberg RG. Exposure therapy for eating disorders: a systematic review. Clin Psychol Rev. 2020. https://doi.org/10.1016/j.cpr.2020.101851.

  7. Cardi V, Leppanen J, Mataix-Cols D, Campbell IC, Treasure J. A case series to investigate food-related fear learning and extinction using in vivo food exposure in anorexia nervosa: a clinical application of the inhibitory learning framework. Eur Eat Disord Rev. 2019;27(2):173–81.

    PubMed  Google Scholar 

  8. Guarda AS, Schreyer CC, Boersma GJ, Tamashiro KL, Moran TH. Anorexia nervosa as a motivated behavior: relevance of anxiety, stress, fear and learning. Physiol Behav. 2015;152:466–72.

    CAS  PubMed  Google Scholar 

  9. Murray SB, Strober M, Craske MG, Griffiths S, Levinson CA, Strigo IA. Fear as a translational mechanism in the psychopathology of anorexia nervosa. Neurosci Biobehav Rev. 2018;95:383–95.

    PubMed  Google Scholar 

  10. Strober M. Pathologic fear conditioning and anorexia nervosa: on the search for novel paradigms. Int J Eat Disord. 2004;35(4):504–8.

    PubMed  Google Scholar 

  11. Swinbourne JM, Touyz SW. The co-morbidity of eating disorders and anxiety disorders: a review. Eur Eat Disord Rev. 2007;15(4):253–74.

    PubMed  Google Scholar 

  12. Swinbourne J, Hunt C, Abbott M, Russell J, St Clare T, Touyz S. The comorbidity between eating disorders and anxiety disorders: prevalence in an eating disorder sample and anxiety disorder sample. Aust N Z J Psychiatry. 2012;46(2):118–31.

    PubMed  Google Scholar 

  13. Duits P, Cath DC, Lissek S, Hox JJ, Hamm AO, Engelhard IM, et al. Updated meta-analysis of classical fear conditioning in the anxiety disorders. Depress Anxiety. 2015;32(4):239–53.

    PubMed  Google Scholar 

  14. Knowles KA, Jessup SC, Olatunji BO. Disgust in anxiety and obsessive-compulsive disorders: recent findings and future directions. Curr Psychiatry Rep. 2018;20(9):68.

    PubMed  PubMed Central  Google Scholar 

  15. Pittig A, Treanor M, LeBeau RT, Craske MG. The role of associative fear and avoidance learning in anxiety disorders: gaps and directions for future research. Neurosci Biobehav Rev. 2018;88:117–40.

    PubMed  Google Scholar 

  16. Pallister E, Waller G. Anxiety in the eating disorders: understanding the overlap. Clin Psychol Rev. 2008;28(3):366–86.

    PubMed  Google Scholar 

  17. Brown M, Robinson L, Campione GC, Wuensch K, Hildebrandt T, Micali N. Intolerance of uncertainty in eating disorders: a systematic review and meta-analysis. Eur Eat Disord Rev. 2017;25(5):329–43.

    PubMed  Google Scholar 

  18. Bar-Haim Y, Lamy D, Pergamin L, Bakermans-Kranenburg MJ, Van Ijzendoorn MH. Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychol Bull. 2007;133(1):1–24.

    PubMed  Google Scholar 

  19. Carleton RN, Mulvogue MK, Thibodeau MA, McCabe RE, Antony MM, Asmundson GJ. Increasingly certain about uncertainty: intolerance of uncertainty across anxiety and depression. J Anxiety Disord. 2012;26(3):468–79.

    PubMed  Google Scholar 

  20. Smith KE, Mason TB, Lavender JM. Rumination and eating disorder psychopathology: a meta-analysis. Clin Psychol Rev. 2018;61:9–23.

    PubMed  PubMed Central  Google Scholar 

  21. Olatunji BO, Forsyth JP, Cherian A. Evaluative differential conditioning of disgust: a sticky form of relational learning that is resistant to extinction. J Anxiety Disord. 2007;21(6):820–34. https://doi.org/10.1016/j.janxdis.2006.11.004.

    Article  PubMed  Google Scholar 

  22. Engelhard IM, Leer A, Lange E, Olatunji BO. Shaking that icky feeling: effects of extinction and counterconditioning on disgust-related evaluative learning. Behav Ther. 2014;45(5):708–19. https://doi.org/10.1016/j.beth.2014.04.003.

    Article  PubMed  Google Scholar 

  23. Harris AA, Romer AL, Hanna EK, et al. The central role of disgust in disorders of food avoidance. Int J Eat Disord. 2019;52(5):543–53. https://doi.org/10.1002/eat.23047This exploratory, cross-sectional study examined the associations between disgust, anxiety, sensory sensitivity, and picky eating in a large sample of adults (N = 1644); evidence indicates that disgust is more strongly related to severity of ARFID and maladaptive picky eating than anxiety, and that disgust may drive the link between anxiety and food aversion.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hildebrandt T, Grotzinger A, Reddan M, Greif R, Levy I, Goodman W, et al. Testing the disgust conditioning theory of food-avoidance in adolescents with recent onset anorexia nervosa. Behav Res Ther. 2015;71:131–8.

    PubMed  Google Scholar 

  25. Olatunji BO. Linking Pavlovian disgust conditioning and eating disorder symptoms: an analogue study. Behav Ther. 2020;51(1):178–89 Findings from this clinical analogue study indicate that individuals with elevated eating disorder symptom severity demonstrate enhanced food disgust during a food-disgust conditioning paradigm, and that rate of disgust acquisition was negatively associated with caloric consumption over the 24-h period following disgust conditioning, as compared to individuals with low eating disorder symptoms.

    PubMed  Google Scholar 

  26. Bell K, Coulthard H, Wildbur D. Self-disgust within eating disordered groups: associations with anxiety, disgust sensitivity and sensory processing. Eur Eat Disord Rev. 2017;25(5):373–80 This cross-sectional online survey study assessed self-reported anxiety, disgust sensitivity, disgust propensity, self-disgust, and sensory processing variables among women with eating disorder diagnoses (n = 270 AN, 104 BN) or no eating disorder diagnosis (n = 217); findings suggest that self-disgust is elevated in individuals with eating disorders and is positively associated with altered sensory traits (e.g., sensory sensitivity, sensory avoidance, low responsiveness to sensory cues).

    PubMed  Google Scholar 

  27. Kaye WH, Fudge JL, Paulus M. New insights into symptoms and neurocircuit function of anorexia nervosa. Nat Rev Neurosci. 2009;10(8):573–84.

    CAS  PubMed  Google Scholar 

  28. Steinglass JE, Sysko R, Glasofer D, Albano AM, Simpson HB, Walsh BT. Rationale for the application of exposure and response prevention to the treatment of anorexia nervosa. Int J Eat Disord. 2011;44(2):134–41.

    PubMed  PubMed Central  Google Scholar 

  29. Hildebrandt T, Bacow T, Markella M, Loeb KL. Anxiety in anorexia nervosa and its management using family-based treatment. Eur Eat Disord Rev. 2012;20(1):e1–e16.

    PubMed  Google Scholar 

  30. Menzel JE, Reilly EE, Luo TJ, Kaye WH. Conceptualizing the role of disgust in avoidant/restrictive food intake disorder: implications for the etiology and treatment of selective eating. Int J Eat Disord. 2019;52(4):462–5 This manuscript reviews current findings supporting the role of disgust as a central factor for pathological selective eating patterns characteristic of avoidant/restrictive feeding and eating disorder (ARFID), and introduces future clinical and research directions that may inform our understanding of selective eating and food avoidance in ARFID.

    PubMed  Google Scholar 

  31. Cisler JM, Olatunji BO, Lohr JM. Disgust, fear, and the anxiety disorders: a critical review. Clin Psychol Rev. 2009;29(1):34–46.

    PubMed  Google Scholar 

  32. Mason EC, Richardson R. Looking beyond fear: the extinction of other emotions implicated in anxiety disorders. J Anxiety Disord. 2010;24(1):63–70.

    PubMed  Google Scholar 

  33. Olatunji BO, Smits JA, Connolly K, Willems J, Lohr JM. Examination of the decline in fear and disgust during exposure to threat-relevant stimuli in blood-injection-injury phobia. J Anxiety Disord. 2007;21(3):445–55.

    PubMed  Google Scholar 

  34. Olatunji BO, Wolitzky-Taylor KB, Willems J, Lohr JM, Armstrong T. Differential habituation of fear and disgust during repeated exposure to threat-relevant stimuli in contamination-based OCD: an analogue study. J Anxiety Disord. 2009;23(1):118–23.

    PubMed  Google Scholar 

  35. Smits JA, Telch MJ, Randall PK. An examination of the decline in fear and disgust during exposure-based treatment. Behav Res Ther. 2002;40(11):1243–53.

    CAS  PubMed  Google Scholar 

  36. Wierenga CE, Bischoff-Grethe A, Berner LA, Simmons AN, Bailer U, Paulus MP, et al. Increased anticipatory brain response to pleasant touch in women remitted from bulimia nervosa. Transl Psychiatry. 2020;10(1):236.

    PubMed  PubMed Central  Google Scholar 

  37. Khalsa SS, Hassanpour MS, Strober M, Craske MG, Arevian AC, Feusner JD. Interoceptive anxiety and body representation in anorexia nervosa. Front Psychiatry. 2018;9:444.

    PubMed  PubMed Central  Google Scholar 

  38. Boswell JF, Anderson LM, Oswald JM, Reilly EE, Gorrell S, Anderson DA. A preliminary naturalistic clinical case series study of the feasibility and impact of interoceptive exposure for eating disorders. Behav Res Ther. 2019;117:54–64.

    PubMed  PubMed Central  Google Scholar 

  39. Plasencia M, Sysko R, Fink K, Hildebrandt T. Applying the disgust conditioning model of food avoidance: a case study of acceptance-based interoceptive exposure. Int J Eat Disord. 2019;52(4):473–7 This paper presents findings from a single case study supporting the initial efficacy of adjunctive interoceptive exposure, a treatment that targets interoceptive aversive disgust cues, in an adolescent with anorexia nervosa.

    PubMed  PubMed Central  Google Scholar 

  40. Brown M, Hildebrandt T. Parent-facilitated behavioral treatment for avoidant/restrictive food intake disorder: a case report. Cogn Behav Pract. 2020;27:231–51 This paper presents findings from a single case report examining a novel behavioral intervention that utilizes a counter-conditioning approach to target anxiety- and disgust-based food avoidance behaviors in youth with avoidant/restrictive food intake disorder.

    Google Scholar 

  41. Stasik-O’Brien SM, Schmidt J. The role of disgust in body image disturbance: incremental predictive power of self-disgust. Body Image. 2018;27:128–37 Findings from this study suggest that self-disgust may be a particularly important predictor of body image disturbances, above and beyond global negative affect, anxiety sensitivity, disgust propensity, and disgust sensitivity.

    PubMed  Google Scholar 

  42. Shafran R, Fairburn CG, Robinson P, Lask B. Body checking and its avoidance in eating disorders. Int J Eat Disord. 2004;35(1):93–101.

    PubMed  Google Scholar 

  43. Griffen TC, Naumann E, Hildebrandt T. Mirror exposure therapy for body image disturbances and eating disorders: a review. Clin Psychol Rev. 2018;65:163–74.

    PubMed  Google Scholar 

  44. Johnson WG, Schlundt DG, Jarrell MP. Exposure with response prevention, training in energy balance, and problem solving therapy for bulimia nervosa. Int J Eat Disord. 1988;5(1):35–45.

    Google Scholar 

  45. Rosen JC, Litenberg H. The anxiety model of bulimia nervosa and treatment with exposure plus response prevention. In: The psychobiology of bulimia nervosa. Berlin: Springer; 1988. p. 146–51.

    Google Scholar 

  46. Berg KC, Crosby RD, Cao L, Peterson CB, Engel SG, Mitchell JE, et al. Facets of negative affect prior to and following binge-only, purge-only, and binge/purge events in women with bulimia nervosa. J Abnorm Psychol. 2013;122(1):111–8.

    PubMed  Google Scholar 

  47. Schaefer LM, Smith KE, Anderson LM, Cao L, Crosby RD, Engel SG, et al. The role of affect in the maintenance of binge-eating disorder: evidence from an ecological momentary assessment study. J Abnorm Psychol. 2020;129(4):387–96.

    PubMed  PubMed Central  Google Scholar 

  48. Krypotos AM, Effting M, Kindt M, Beckers T. Avoidance learning: a review of theoretical models and recent developments. Front Behav Neurosci. 2015;9:189.

    PubMed  PubMed Central  Google Scholar 

  49. Arnaudova I, Kindt M, Fanselow M, Beckers T. Pathways towards the proliferation of avoidance in anxiety and implications for treatment. Behav Res Ther. 2017;96:3–13.

    PubMed  Google Scholar 

  50. Scheveneels S, Boddez Y, Vervliet B, Hermans D. The validity of laboratory-based treatment research: bridging the gap between fear extinction and exposure treatment. Behav Res Ther. 2016;86:87–94.

    PubMed  Google Scholar 

  51. Vervliet B, Raes F. Criteria of validity in experimental psychopathology: application to models of anxiety and depression. Psychol Med. 2013;43(11):2241–4.

    CAS  PubMed  Google Scholar 

  52. Lissek S, Powers AS, McClure EB, et al. Classical fear conditioning in the anxiety disorders: a meta-analysis. Behav Res Ther. 2005;43(11):1391–424.

    PubMed  Google Scholar 

  53. Foa EB, McLean CP. The efficacy of exposure therapy for anxiety-related disorders and its underlying mechanisms: the case of OCD and PTSD. Annu Rev Clin Psychol. 2016;12:1–28.

    PubMed  Google Scholar 

  54. Ougrin D. Efficacy of exposure versus cognitive therapy in anxiety disorders: systematic review and meta-analysis. BMC Psychiatry. 2011;11:200.

    PubMed  PubMed Central  Google Scholar 

  55. Booth DA. Culturally corralled into food abuse: the eating disorders as physiologically reinforced excessive appetites. In: Pirke KM, Vandereycken W, Ploog D, editors. The psychobiology of bulimia nervosa: Springer; 1988;18–32.

  56. Jansen A. A learning model of binge eating: cue reactivity and cue exposure. Behav Res Ther. 1998;36(3):257–72.

    CAS  PubMed  Google Scholar 

  57. Steinglass J, Walsh BT. Habit learning and anorexia nervosa: a cognitive neuroscience hypothesis. Int J Eat Disord. 2006;39(4):267–75.

    PubMed  Google Scholar 

  58. Leehr EJ, Schag K, Brinkmann A, Ehlis AC, Fallgatter AJ, Zipfel S, et al. Alleged approach-avoidance conflict for food stimuli in binge eating disorder. PLoS One. 2016;11(4):e0152271.

    PubMed  PubMed Central  Google Scholar 

  59. Fricke K, Vogel S. How interindividual differences shape approach-avoidance behavior: relating self-report and diagnostic measures of interindividual differences to behavioral measurements of approach and avoidance. Neurosci Biobehav Rev. 2020;111:30–56.

    CAS  PubMed  Google Scholar 

  60. Armstrong T, Olatunji BO. Pavlovian disgust conditioning as a model for contamination-based OCD: evidence from an analogue study. Behav Res Ther. 2017;93:78–87.

    PubMed  PubMed Central  Google Scholar 

  61. Olatunji BO, McKay D. Disgust and its disorders: theory, assessment, and treatment implications. Washington, DC: American Psychological Association; 2009;9–292.

  62. Spreckelsen PV, Glashouwer KA, Bennik EC, Wessel I, de Jong PJ. Negative body image: relationships with heightened disgust propensity, disgust sensitivity, and self-directed disgust. PLoS One. 2018;13(6):e0198532.

    PubMed  Google Scholar 

  63. Houben K, Havermans RC. A delicious fly in the soup. The relationship between disgust, obesity, and restraint. Appetite. 2012;58(3):827–30.

    PubMed  Google Scholar 

  64. Anderson LM, Reilly EE, Thomas JJ, Eddy KT, Franko DL, Hormes JM, et al. Associations among fear, disgust, and eating pathology in undergraduate men and women. Appetite. 2018;125:445–53.

    PubMed  PubMed Central  Google Scholar 

  65. Harvey T, Troop NA, Treasure JL, Murphy T. Fear, disgust, and abnormal eating attitudes: a preliminary study. Int J Eat Disord. 2002;32(2):213–8.

    PubMed  Google Scholar 

  66. Troop N, Baker A. Food, body, and soul: the role of disgust in eating disorders. In: Olatunji BO, McKay D, editors. Disgust and its disorders: theory, assessment, and treatment implications. Washington, DC: American Psychological Association; 2009. p. 229–51.

    Google Scholar 

  67. McLaughlin KA, Lambert HK. Child trauma exposure and psychopathology: mechanisms of risk and resilience. Curr Opin Psychol. 2017;14:29–34.

    PubMed  PubMed Central  Google Scholar 

  68. McLaughlin KA, DeCross SN, Jovanovic T, Tottenham N. Mechanisms linking childhood adversity with psychopathology: learning as an intervention target. Behav Res Ther. 2019;118:101–9.

    PubMed  PubMed Central  Google Scholar 

  69. Hildebrandt T (2019) Disgust conditioning as a model for food avoidance among adolescents with low-weight eating disorders. Paper presented at: Association for Behavioral and Cognitive Therapies 53rd Annual Convention; Atlanta, GA.

  70. Berg H, Cooper SE, Ross JP, Lissek S (2019) Generalization of conditioned disgust: individual differences and temporal dynamics. Paper presented at: Association for Behavioral and Cognitive Therapies 53rd Annual Convention; Atlanta, GA.

  71. Kaczkurkin AN, Burton PC, Chazin SM, Manbeck AB, Espensen-Sturges T, Cooper SE, et al. Neural substrates of overgeneralized conditioned fear in PTSD. Am J Psychiatry. 2017;174(2):125–34.

    PubMed  Google Scholar 

  72. Lissek S, Rabin S, Heller RE, Lukenbaugh D, Geraci M, Pine DS, et al. Overgeneralization of conditioned fear as a pathogenic marker of panic disorder [published correction appears in Am J Psychiatry. 2010 Jan;167(1):106]. Am J Psychiatry. 2010;167(1):47–55.

    PubMed  Google Scholar 

  73. Lissek S, Kaczkurkin AN, Rabin S, Geraci M, Pine DS, Grillon C. Generalized anxiety disorder is associated with overgeneralization of classically conditioned fear. Biol Psychiatry. 2014;75(11):909–15.

    PubMed  Google Scholar 

  74. Hunt C, Cooper SE, Hartnell MP, Lissek S. Anxiety sensitivity and intolerance of uncertainty facilitate associations between generalized Pavlovian fear and maladaptive avoidance decisions. J Abnorm Psychol. 2019;128(4):315–26.

    PubMed  Google Scholar 

  75. Pittig A, Wong AHK, Glück VM, Boschet JM. Avoidance and its bi-directional relationship with conditioned fear: mechanisms, moderators, and clinical implications. Behav Res Ther. 2020;126:103550.

    PubMed  Google Scholar 

  76. Abramowitz JS, Blakey SM. Overestimation of threat. In: Abramowitz JS, Blakey SM, editors. Clinical handbook of fear and anxiety: maintenance processes and treatment mechanisms: American Psychological Association; 2020. p. 7–25.

  77. Ottaviani C, Watson DR, Meeten F, Makovac E, Garfinkel SN, Critchley HD. Neurobiological substrates of cognitive rigidity and autonomic inflexibility in generalized anxiety disorder. Biol Psychol. 2016;119:31–41.

    PubMed  Google Scholar 

  78. Roberts ME, Tchanturia K, Stahl D, Southgate L, Treasure J. A systematic review and meta-analysis of set-shifting ability in eating disorders. Psychol Med. 2007;37(8):1075–84.

    PubMed  Google Scholar 

  79. Prefit AB, Cândea DM, Szentagotai-Tătar A. Emotion regulation across eating pathology: a meta-analysis. Appetite. 2019;143:104438.

    PubMed  Google Scholar 

  80. Sloan E, Hall K, Moulding R, Bryce S, Mildred H, Staiger PK. Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: a systematic review. Clin Psychol Rev. 2017;57:141–63.

    PubMed  Google Scholar 

  81. Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry. 2004;161(12):2215–21.

    PubMed  Google Scholar 

  82. Aharoni R, Hertz MM. Disgust sensitivity and anorexia nervosa. Eur Eat Disord Rev. 2012;20(2):106–10.

    PubMed  Google Scholar 

  83. Anestis MD, Holm-Denoma JM, Gordon KH, Schmidt NB, Joiner TE. The role of anxiety sensitivity in eating pathology. Cogn Ther Res. 2014;32(3):370–85.

    Google Scholar 

  84. Davey GC, Buckland G, Tantow B, Dallos R. Disgust and eating disorders. Eur Eat Disord Rev. 1998;6(3):201–11.

    Google Scholar 

  85. Harrison A, O’Brien N, Lopez C, Treasure J. Sensitivity to reward and punishment in eating disorders. Psychiatry Res. 2010;177(1–2):1–11.

    PubMed  Google Scholar 

  86. Jappe LM, Frank GK, Shott ME, et al. Heightened sensitivity to reward and punishment in anorexia nervosa. Int J Eat Disord. 2011;44(4):317–24.

    PubMed  PubMed Central  Google Scholar 

  87. Monteleone AM, Cardi V, Volpe U, Fico G, Ruzzi V, Pellegrino F, et al. Attachment and motivational systems: relevance of sensitivity to punishment for eating disorder psychopathology. Psychiatry Res. 2018;260:353–9.

    PubMed  Google Scholar 

  88. Troop NA, Treasure JL, Serpell L. A further exploration of disgust in eating disorders. Eur Eat Disord Rev. 2002;10(3):218–26.

    Google Scholar 

  89. Klabunde M, Acheson DT, Boutelle KN, Matthews SC, Kaye WH. Interoceptive sensitivity deficits in women recovered from bulimia nervosa. Eat Behav. 2013;14(4):488–92.

    PubMed  Google Scholar 

  90. Jenkinson PM, Taylor L, Laws KR. Self-reported interoceptive deficits in eating disorders: a meta-analysis of studies using the eating disorder inventory. J Psychosom Res. 2018;110:38–45.

    PubMed  Google Scholar 

  91. Brown TA, Berner LA, Jones MD, Reilly EE, Cusack A, Anderson LK, et al. Psychometric evaluation and norms for the Multidimensional Assessment of Interoceptive Awareness (MAIA) in a clinical eating disorders sample. Eur Eat Disord Rev. 2017;25(5):411–6.

    PubMed  Google Scholar 

  92. Khalsa SS, Craske MG, Li W, Vangala S, Strober M, Feusner JD. Altered interoceptive awareness in anorexia nervosa: effects of meal anticipation, consumption and bodily arousal. Int J Eat Disord. 2015;48(7):889–97.

    PubMed  PubMed Central  Google Scholar 

  93. Berner LA, Simmons AN, Wierenga CE, Bischoff-Grethe A, Paulus MP, Bailer UF, et al. Altered interoceptive activation before, during, and after aversive breathing load in women remitted from anorexia nervosa. Psychol Med. 2018;48(1):142–54.

    CAS  PubMed  Google Scholar 

  94. Zucker NL, Bulik CM. On bells, saliva, and abdominal pain or discomfort: Early aversive visceral conditioning and vulnerability for anorexia nervosa. Int J Eat Disord. 2020;53(4):508–12 This article briefly reviews emerging evidence for conceptualizing aversive visceral conditioning, early gastrointestinal pain or discomfort, and altered interoceptive processes as key vulnerability factors for later onset and maintenance of anorexia nervosa.

    PubMed  PubMed Central  Google Scholar 

  95. Berner LA, Simmons AN, Wierenga CE, Bischoff-Grethe A, Paulus MP, Bailer UF, et al. Altered anticipation and processing of aversive interoceptive experience among women remitted from bulimia nervosa. Neuropsychopharmacology. 2019;44(7):1265–73.

    PubMed  PubMed Central  Google Scholar 

  96. Kambanis PE, Kuhnle MC, Wons OB, Jo JH, Keshishian AC, Hauser K, et al. Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant/restrictive food intake disorder. Int J Eat Disord. 2020;53(2):256–65.

    PubMed  Google Scholar 

  97. Zucker NL, Merwin RM, Bulik CM, Moskovich A, Wildes JE, Groh J. Subjective experience of sensation in anorexia nervosa. Behav Res Ther. 2013;51(6):256–65.

    PubMed  PubMed Central  Google Scholar 

  98. Vartanian LR, Herman CP, Polivy J. Consumption stereotypes and impression management: how you are what you eat. Appetite. 2007;48(3):265–77.

    PubMed  Google Scholar 

  99. Puhl RM, Moss-Racusin CA, Schwartz MB, Brownell KD. Weight stigmatization and bias reduction: perspectives of overweight and obese adults. Health Educ Res. 2008;23(2):347–58.

    PubMed  Google Scholar 

  100. Boswell JF, Anderson LM, Anderson DA. Integration of interoceptive exposure in eating disorder treatment. Clin Psychol Sci Pract. 2015;22(2):194–210.

    Google Scholar 

  101. McIntosh VV, Carter FA, Bulik CM, Frampton CM, Joyce PR. Five-year outcome of cognitive behavioral therapy and exposure with response prevention for bulimia nervosa. Psychol Med. 2011;41(5):1061–71.

    CAS  PubMed  Google Scholar 

  102. Steinglass J, Albano AM, Simpson HB, Carpenter K, Schebendach J, Attia E. Fear of food as a treatment target: exposure and response prevention for anorexia nervosa in an open series. Int J Eat Disord. 2012;45(4):615–21.

    PubMed  Google Scholar 

  103. Schmidt U, Marks I. Cue exposure to food plus response prevention of binges for bulimia: a pilot study. Int J Eat Disord. 1988;7(5):663–72.

    Google Scholar 

  104. Hildebrandt T. Mirror exposure therapy for body image disturbances and eating disorders: a review. Clin Psychol Rev. 2018;65:163–74.

    PubMed  Google Scholar 

  105. Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B. Maximizing exposure therapy: an inhibitory learning approach. Behav Res Ther. 2014;58:10–23.

    PubMed  PubMed Central  Google Scholar 

  106. Bosman RC, Borg C, de Jong PJ. Optimising extinction of conditioned disgust. PLoS One. 2016;11(2):e0148626.

    PubMed  PubMed Central  Google Scholar 

  107. van’t Wout M, Faucher C, Garnaat S, Philip N, Burwell R. Learning not to avoid: effects of transcranial direct current stimulation on reversal learning. In: Neuropsychopharmacology, vol. 44, no. Suppl 1. London: Nature Publishing Group; 2019. p. 87–8.

    Google Scholar 

  108. van’t Wout-Frank M, Shea MT, Larson VC, Greenberg BD, Philip NS. Combined transcranial direct current stimulation with virtual reality exposure for posttraumatic stress disorder: feasibility and pilot results. Brain Stimul. 2019;12(1):41–3.

    Google Scholar 

  109. Krypotos AM, Engelhard IM. Pavlovian-to-instrumental transfer in subclinical obsessive–compulsive disorder. J Exp Psychopathol. 2020;11(3):2043808720925244.

    Google Scholar 

  110. van Meurs B, Wiggert N, Wicker I, Lissek S. Maladaptive behavioral consequences of conditioned fear-generalization: a pronounced, yet sparsely studied, feature of anxiety pathology. Behav Res Ther. 2014;57:29–37.

    PubMed  PubMed Central  Google Scholar 

  111. Flores A, López FJ, Vervliet B, Cobos PL. Intolerance of uncertainty as a vulnerability factor for excessive and inflexible avoidance behavior. Behav Res Ther. 2018;104:34–43.

    PubMed  Google Scholar 

  112. Olatunji BO, Sawchuk CN. Disgust: characteristic features, social manifestations, and clinical implications. J Soc Clin Psychol. 2005;24(7):932–62.

    Google Scholar 

  113. Whitton AE, Henry JD, Grisham JR. Cognitive and psychophysiological correlates of disgust in obsessive-compulsive disorder. Br J Clin Psychol. 2015;54(1):16–33.

    PubMed  Google Scholar 

  114. Klucken T, Schweckendiek J, Koppe G, Merz CJ, Kagerer S, Walter B, et al. Neural correlates of disgust-and fear-conditioned responses. Neuroscience. 2012;201:209–18.

    CAS  PubMed  Google Scholar 

  115. Schweckendiek J, Klucken T, Merz CJ, Kagerer S, Walter B, Vaitl D, et al. Learning to like disgust: neuronal correlates of counterconditioning. Front Hum Neurosci. 2013;7:346.

    PubMed  PubMed Central  Google Scholar 

  116. Kerr KL, Moseman SE, Avery JA, Bodurka J, Zucker NL, Simmons WK. Altered insula activity during visceral interoception in weight-restored patients with anorexia nervosa. Neuropsychopharmacology. 2016;41(2):521–8.

    PubMed  Google Scholar 

  117. Woody SR, Teachman BA. Intersection of disgust and fear: normative and pathological views. Clin Psychol Sci Pract. 2000;7(3):291–311.

    Google Scholar 

  118. Lissek S, Pine DS, Grillon C. The strong situation: a potential impediment to studying the psychobiology and pharmacology of anxiety disorders. Biol Psychol. 2006;72(3):265–70.

    PubMed  Google Scholar 

  119. Elsey JW, Kindt M. Breaking boundaries: optimizing reconsolidation-based interventions for strong and old memories. Learn Mem. 2017;24(9):472–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  120. Fullana MA, Dunsmoor JE, Schruers KRJ, Savage HS, Bach DR, Harrison BJ. Human fear conditioning: from neuroscience to the clinic. Behav Res Ther. 2020;124:103528.

    CAS  PubMed  Google Scholar 

  121. Rozin P. Food and eating. In: Kitayama S, Cohen D, editors. Handbook of cultural psychology. New York: The Guilford Press. 2010 p. 391–416.

  122. Martins Y, Pliner P. Human food choices: an examination of the factors underlying acceptance/rejection of novel and familiar animal and nonanimal foods. Appetite. 2005;45(3):214–24.

    CAS  PubMed  Google Scholar 

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Funding

This research was supported by the National Institute of Mental Health of the National Institutes of Health under award numbers T32MH082761 and K23MH123910. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, 2450 Riverside Avenue South, F229, Minneapolis, MN, 55454, USA

    Lisa M. Anderson

  2. Department of Psychology, University of Minnesota, N218 Elliott Hall, 75 East River Road, Minneapolis, MN, 55455, USA

    Hannah Berg

  3. Department of Psychiatry, University of California – San Diego, 4510 Executive Drive, Suite 315, San Diego, CA, 92121, USA

    Tiffany A. Brown & Jessie Menzel

  4. Department of Psychology, Hofstra University, 210 Hauser Hall, Hempstead, NY, 11549, USA

    Erin E. Reilly

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  1. Lisa M. Anderson
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  2. Hannah Berg
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  4. Jessie Menzel
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  5. Erin E. Reilly
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Contributions

All authors made substantial contributions to the conception or design of the work. Initial conceptualization and material preparation was performed by Lisa M. Anderson. All authors, Lisa M. Anderson, Hannah Berg, Tiffany A. Brown, Jessie Menzel, and Erin E. Reilly, drafted the work and revised it critically for important intellectual content; read and approved the final manuscript submission.

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Correspondence to Lisa M. Anderson.

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Anderson, L.M., Berg, H., Brown, T.A. et al. The Role of Disgust in Eating Disorders. Curr Psychiatry Rep 23, 4 (2021). https://doi.org/10.1007/s11920-020-01217-5

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