Elsevier

Psychiatry Research

Volume 178, Issue 1, 30 June 2010, Pages 126-131
Psychiatry Research

Perception bias of disgust in ambiguous facial expressions in obsessive–compulsive disorder

https://doi.org/10.1016/j.psychres.2009.11.023Get rights and content

Abstract

Impaired recognition of facial expressions of disgust has been suggested for patients with obsessive–compulsive disorder (OCD). This study aimed to compare the perception of negative emotions by OCD patients and controls using both non-ambiguous and ambiguous facial expressions. Forty-one OCD patients and thirty-seven controls performed the computerised emotion perception task. There were no differences between OCD patients and controls in the frequency of correct identification of non-ambiguous facial expressions. However, OCD patients were more likely to perceive disgust and less likely to perceive anger in response to ambiguous facial expressions when controlling for covariates. In OCD patients, a higher cleaning dimension was associated with a lower perception of anger and a higher perception of disgust when presented with ambiguous facial expressions. The domains of core disgust and contamination-based disgust domains of disgust sensitivity were positively correlated with the perception of ambiguous facial expressions as disgust, as well as cleaning symptom dimension scores. Our findings suggest that OCD patients, particularly those with higher washing/contamination symptoms, are more likely to perceive disgust in ambiguous facial expressions.

Introduction

Disgust is thought to underlie various psychiatric illnesses. Initially defined as a revulsion response to distasteful foods (Darwin and Ekman, 1998), the current concept of disgust now also includes responses to a wide range of stimuli, such as poor hygiene, potential for disease and violations of the normal body envelope (Rozin and Fallon, 1987).

At its core, disgust functions to prevent contamination and disease (Darwin and Ekman, 1998) by the characteristic behavioural dimension of avoidance (Rozin and Fallon, 1987). Disgust also has specific physiological manifestations, such as nausea and a distinct facial expression of narrowed nostrils, wrinkling of the brow and raising of the upper lip (Phillips et al., 1998, Rozin et al., 1994). From a developmental perspective, perception of disgust is thought to be absent at birth and to develop during childhood (Rozin and Fallon, 1987). The learning process is thought to occur through experience with other peoples' disgust, and to involve the identification of disgust-eliciting stimuli, the recognition of other peoples' facial expressions of disgust, and the correlation between the two (Sprengelmeyer et al., 1996). If there is a dysfunction in this appraisal process, the stimuli that elicit disgust in those with a dysfunction may be dissimilar from the stimuli that elicit disgust in others (Sprengelmeyer et al., 1996).

Impairment in this disgust appraisal process has been suggested to be closely related to obsessive–compulsive disorder (OCD). OCD is a relatively common disorder, characterised by persistent and unwanted thoughts and ritualistic behaviour. Among the heterogeneous symptoms of OCD, concerns with contamination are commonly involved. OCD patients often exhibit heightened appraisals of vulnerability to infection and spread of contamination in response to offensive objects, which elicit washing compulsions (Olatunji and McKay, 2007). Because the situations in which OCD patients experience disgust are different from those in which normal individuals experience disgust, it has been hypothesised that the learned association between the emotion of disgust and the facial expressions of disgust may have failed to develop (Sprengelmeyer et al., 1997).

Experimental support for this theory of disgust perception in OCD, however, has been mixed. Sprengelmeyer et al. (1997) reported that all OCD patients examined showed a distinct and significant impairment in recognising facial expressions of disgust. However, subsequent studies have not revealed a clear association between OCD and the failure to recognise facial expressions of disgust. Parker et al., 2004, Buhlmann et al., 2004 both reported no significant differences between OCD patients and normal controls with respect to facial expression recognition. In a more recent study, the results of Sprengelmeyer et al. (1997) were replicated, but the magnitude of the effect was much smaller — only about a third of OCD subjects showed the impairment (Corcoran et al., 2008). These previous studies used non-ambiguous facial expressions to assess the responses of OCD patients, which could result in other important aspects of disgust perception being missed.

Ambiguous facial expressions may further our understanding of emotion perception (Kee et al., 2006, Pollak and Kistler, 2002). Whereas non-ambiguous facial expressions are helpful in assessing facial emotion recognition, ambiguous facial expressions reveal whether individuals have a perception bias towards a certain emotion.

Furthermore, due to the heterogeneity of OCD, some researchers have hypothesised that only a subset of OCD patients may have altered disgust perception, particularly those with contamination/washing symptoms (Power and Dalgleish, 2008). Several studies have reported an association between contamination fear and disgust sensitivity (Mancini et al., 2001, Olatunji et al., 2004, Woody and Tolin, 2002), but the association between contamination fear and disgust perception has not been previously investigated.

In the present study, we recruited OCD patients and healthy controls for the following purposes: (1) to compare their emotion recognition of non-ambiguous facial expressions, (2) to test if there are any perception biases in the classification of ambiguous facial expressions, especially the emotion of disgust, (3) to determine if the particular OCD symptom dimension of cleaning is associated with disgust perception and (4) to evaluate the domains of disgust sensitivity associated with disgust perception and the cleaning dimension of OCD.

Section snippets

Participants

Forty-one primary OCD patients were recruited from the psychiatric outpatient clinic of Severance Hospital, Yonsei University Medical Center. Patients were interviewed and diagnosed by experienced psychiatrists on the basis of the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (SCID-CV) (First et al., 1997). Those with co-morbid diagnoses were included under

Demographics and clinical variables

No significant differences in demographic variables were found between groups. OCD patients scored higher on scales measuring disgust sensitivity and depression than the controls (Table 1).

Types of OCD symptoms

As is typically the case, the majority of OCD patients had more than one type of OC symptom. The frequencies (%) of symptom dimensions, using the factor-analysed symptom dimensions identified by Bloch et al. (2008), were symmetry = 32 (78.0%), forbidden thoughts = 31 (75.6%), cleaning = 26 (63.4%) and hoarding = 18

Discussion

In this study, we examined whether OCD patients show a bias in perceiving ambiguous facial expressions as expressions of disgust relative to healthy controls, especially in relation to contamination/washing symptoms.

One of the interesting findings in this study is that OCD subjects were significantly more likely to perceive disgust and less likely to perceive anger in ambiguous facial expressions when adjusting for sex, age and depression severity, but no differences were found in non-ambiguous

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