Perception bias of disgust in ambiguous facial expressions in obsessive–compulsive disorder
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
References (52)
- et al.
Personality dimensions in obsessive–compulsive disorder: relation to clinical variables
Psychiatry Research
(2008) - et al.
Emotion recognition deficits in body dysmorphic disorder
Journal of Psychiatric Research
(2004) - et al.
Facial expression recognition across the adult life span
Neuropsychologia
(2003) - et al.
Patients with generalized social phobia direct their attention away from faces
Behaviour Research and Therapy
(2002) - et al.
Recognition of facial expressions in obsessive–compulsive disorder
Journal of Anxiety Disorders
(2008) - et al.
Harm avoidance in subjects with obsessive–compulsive disorder and their families
Journal of Affective Disorders
(2008) - et al.
The effects of social anxiety and depression on the evaluation of facial crowds
Behaviour Research and Therapy
(2005) - et al.
An analysis of categorical perception of facial emotion in schizophrenia
Schizophrenia Research
(2006) - et al.
Neural responses to facial expressions of disgust but not fear are modulated by washing symptoms in OCD
Biological Psychiatry
(2007) - et al.
The connection between disgust and obsessions and compulsions in a non-clinical sample
Personality and Individual Differences
(2001)
Abnormal recognition of facial expression of emotions in depressed patients with major depression disorder and schizotypal personality disorder
Biological Psychiatry
Frontal lobe networks for effective processing of ambiguously expressed emotions in humans
Neuroscience Letters
Disgust domains in the prediction of contamination fear
Behaviour Research and Therapy
No disgust recognition deficit in obsessive–compulsive disorder
Journal of Behavior Therapy and Experimental Psychiatry
Impaired recognition of affect in facial expression in depressed patients
Biological Psychiatry
Affective ambiguity for a group recruits ventromedial prefrontal cortex
Neuroimage
A meta-analysis of functional neuroimaging in obsessive–compulsive disorder
Psychiatry Research
The relationship between disgust sensitivity and avoidant behavior: studies of clinical and nonclinical samples
Journal of Anxiety Disorders
A Validation Study of the Korean-Version of the Montgomery–Asberg Depression Rating Scale
Journal of Korean Neuropsychiatric Association
Disgust and obsessive–compulsive disorder: an update
Psychiatry
Meta-analysis of the symptom structure of obsessive–compulsive disorder
American Journal of Psychiatry
Development of Korean Form of Children's Yale–Brown Obsessive–Compulsive Scale (CY-BOCS): a reliability and validity study
Korean Journal of Child and Adolescent Psychiatry
The Montgomery–Asberg Depression Scale: reliability and validity
Acta Psychiatrica Scandinavica
Recognition of facial affect in Borderline Personality Disorder
Journal of Personality Disorders
Pictures of Facial Affect. Consulting Psychologists Press
Cited by (22)
Social cognition and empathy in adults with obsessive compulsive disorder: A meta-analysis
2022, Psychiatry ResearchFacial emotion recognition difficulties may be specific to skin picking disorder, but could also be related to the presence of alexithymia in trichotillomania
2022, European Journal of PsychiatryCitation Excerpt :Similar to our study, studies are reporting that there are difficulties in the recognition of disgusted facial expressions in OCD.19–21,41,42, However, some studies detected no difficulty in recognizing disgusted facial expressions among patients with OCD when compared with controls.22–24 It has been reported that there may be a variation in recognizing disgusted facial expressions among patients with OCD according to the symptom severity,24 presence of the symptom dimension of dirtiness/contamination,23 and responsiveness to cognitive-behavioral therapy.42
Deactivation of anterior cingulate cortex during virtual social interaction in obsessive-compulsive disorder
2020, Psychiatry Research - NeuroimagingHoping for more: How cognitive science has and hasn't been helpful to the OCD clinician
2019, Clinical Psychology ReviewAltered olfactory processing and increased insula activity in patients with obsessive-compulsive disorder: An fMRI study
2017, Psychiatry Research - NeuroimagingCitation Excerpt :In addition, OCD patients reported experiencing unpleasant odors as subjectively more unpleasant and intense in relation to their increased anterior insula response, and they experienced pleasant odors as less pleasant (numerically), and less intense in the case of vanilla, than HC. It may be that, similar to patients with major depression (Watters and Williams, 2011), OCD patients have a negative cognitive bias and experience all stimuli, regardless of sensory domain, as being slightly more negative than HC, so even “pleasurable” stimuli are experienced as less pleasant (Jhung et al., 2010), although this hypothesis is speculative and requires further investigation. Patients’ increased insular reactivity to both pleasant and unpleasant odors might reflect their propensity to experience negative emotions, which might be a vulnerability factor for OCD (Schienle et al., 2005).
Effective behavioural strategies for reducing disgust in contamination-related OCD: A review
2015, Clinical Psychology Review