International Society for Traumatic Stress Studies

The Uniqueness of Disgust as a Reaction to Trauma

Posted 28 May 2013 in StressPoints by Shannon M. Reynolds, MA

The ability to regulate one’s emotion after a traumatic event is considered a resiliency factor (Badour & Feldner, 2013; Bardeen, Kumpula, & Orcutt, 2013). This skill is so imperative and well recognized that essentially all trauma treatments, including Cognitive Processing Therapy (CPT), Prolonged Exposure, Acceptance and Commitment Therapy, and Dialectical Behavioral Therapy incorporate an emotion regulation component to assist clients in being able to manage these intense experiences.

Posttraumatic Stress Disorder (PTSD) is a psychological disorder that involves extreme emotion dysregulation. The client vacillates between under regulation of emotion (re-experiencing and hyperarousal) and over regulation of it (avoidance; Herman, 1997). Many clinicians/researchers think of fear and anger as being emotions experienced during trauma. Other reactions can include shame, sadness, and, the less recognized emotion, disgust (Hathaway, Boals, & Banks, 2010).

Compared to the other basic emotions, disgust has been relatively neglected in general research (Ekman, 2007; Rozin, Haidt, & McCauley, 2008), and even more so within the trauma literature. Yet disgust triggers are commonly experienced during trauma and include bodily fluids, wounds, death, and diseases (Ekman, 2003; Rozin, Haidt, & McCauley, 2008). Disgust motivates the person to create distance between him/herself and the triggering stimulus. It even primes cognition (Izard & Cohen, 1989) to be aware of things that could cause sickness if taken into the body through the nose or mouth. Disgust is a highly adaptive emotion that involves both the oral/nasal rejection (Rozin & Fallon, 1987) and hygiene systems (Curtis, Aunger, & Rabie, 2004; Kelly, 2011). However, similar to other emotions, extreme levels of disgust can create maladaptive responses and even psychological challenges (Reynolds, 2012; Rozin, Haidt, & McCauley, 2008).

Previous literature has linked dysregulated disgust to phobias (Davey & Marzillier, 2009) and obsessive-compulsive disorder (Olatunji, Ebesutani, David, Fan & McGrath, 2011). More recently, researchers are beginning to realize the impact disgust can have on someone who has experienced a trauma. The extant literature shows that disgust experienced during the trauma is related to later PTSD symptoms (Engelhard, Olatunji, & de Jong, 2010). Additionally, elevated disgust levels were related to more intrusive thoughts after viewing medical videos of severe burns, even when controlling for anxiety and depression (Bomyea & Amir, 2012). Clients with borderline personality disorder and/or PTSD, a population with high prevalence rates of trauma exposure, had higher levels of disgust and rated themselves as more disgusting than non-clinical controls (Rüsch, Schulz, Valerius, Steil, Bohus, & Schmahl, 2011). Conversely, low levels of disgust may be a protective factor against developing PTSD in military samples (Olatunji, Armstrong, Fan, & Zhao, 2012).

While the research on disgust and trauma is relatively new, I believe preliminary treatment and research considerations are warranted. First, disgust is a unique emotion that differs from other basic emotions, which may influence how a client responds to trauma treatments. Emotions such as anger and fear can be reduced when a person uses reason and logic to suggest those reactions are unwarranted. However, disgust is less flexible to being reduced even when mitigating factors are considered (Russell & Giner-Sorolla, 2011a). Similarly, people generally give more tautological reasons (e.g., “I’m disgusted because he is gross.”) to justify their disgust as compared to other emotions (e.g., “I’m angry because he took my possession;” Russell & Giner-Sorolla, 2011b). This research suggests it may be harder to verbalize reasons why one is experiencing disgust.

The experience of disgust may have less of a cognitive component than other emotions, which could influence how our current cognitive behavioral treatments affect it. Many treatments focus on the meaning of the trauma and attempt to change cognitions to influence the meaning and subsequently the emotions related to it. Disgust may need more pure exposure rather than cognitive strategies to be reduced.

The second issue related to disgust is that therapists may not know to assess for it or be less comfortable discussing disgust reactions. Since disgust has not generated as much attention or research as other basic emotions (Rozin, Haidt, & McCauley, 2008), therapists may not think instinctively remember to evaluate if the client is struggling with it. Additionally, even if the therapist does assess for it, most people have a natural tendency to want to mentally and physically avoid disgust and its triggers (Haidt, Rozin, McCauley, & Imada, 1997). Just hearing about the smell of rotting flesh in the desert sun, feces exiting a body, or disfiguring assault can cause some practitioners to cringe. Probing clients to discuss these reactions and emotions may be unnatural to clinicians. Additionally, the client may be less likely to discuss these topics because society has instructed him/her that disgusting things are to be avoided (Sawchuk, 2009). Clinicians should stay mindful of their own emotional reactions and remember to question if disgust is a part of their client’s emotional experience during or after a trauma.

Research is beginning to outline the relationship between disgust and PTSD. As psychology moves forward to a deeper understanding of this emotion, I urge researchers and clinicians to remember to assess clients who have experienced trauma for all of their emotional reactions, including disgust. Additionally, if disgust appears to be less influenced by cognitive methods, then more exposure may be necessary to decrease the client’s distress. In general, it is important to keep disgust in mind when conceptualizing reactions to trauma.

About the Author

Shannon Reynolds, MA, attended Auburn University for her bachelor’s degree and is currently at The University of Tulsa completing her Ph.D. in Clinical Psychology. Her dissertation involved the development of a comprehensive measure of disgust. She is currently completing internship at the Michael E. DeBakey VA Medical Center (MEDVAMC) in Houston, Texas. Shannon was also recently awarded a two-year postdoctoral fellowship at the South Central Mental Illness Research, Education, and Clinical Center (MIRECC).


References

Badour, C. L., & Feldner, M. T. (2013). Trauma-related reactivity and regulation of emotion:Associations with posttraumatic stress symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 44, 69-76.

Bardeen, J. R., Kumpula, M. J., & Orcutt, H. K. (2013). Emotion regulation difficulties as a prospective predictor of posttraumatic stress symptoms following a mass shooting. Journal of Anxiety Disorders, 27, 188-196.

Bomyea, J. & Amir, N. (2012) Disgust propensity as a predictor of intrusive cognitions following a distressing film. Cognitive Therapy and Research, 36, 190-1998.

Curtis, V., Aunger, R., & Rabie, T. (2004). Evidence that disgust evolved to protect from risk of disease. Proceedings. Biological Sciences / The Royal Society, 271 Suppl 4, S131-S133.

Davey, G. C. L., & Marzillier, S. (2009). Disgust and animal phobias. In B. O. Olatunji & D. McKay (Eds.), Disgust and its disorders: Theory, assessment, and treatment implications (pp. 169-190). Washington, DC: American Psychological Association.

Ekman, P. (2003). Telling lies: Clues to deceit in the marketplace, politics, and marriage. New York, NY: W.W. Norton & Company, Inc.

Ekman, P. (2007). Emotions revealed: Recognizing faces and feelings to improve communication and emotional life (2nd ed.). New York, NY: Owl Books.

Engelhard, I. M., Olatunji, B. O., & de Jong, P. J. (2010). Disgust and the development of posttraumatic stress among soldiers deployed to Afghanistan. Journal of Anxiety Disorders, 25, 58-63.

Haidt, J., Rozin, P., McCauley, C., & Imada, S. (1997). Body, psyche, and culture: The relationship between disgust and morality. Psychology and Developing Societies, 9(1), 107-131.

Hathaway, L. M., Boals, A., & Banks, J. B. (2010). PTSD symptoms and dominant emotional response to a traumatic event: An examination of DSM-IV criterion A2. Anxiety, Stress & Coping: An International Journal, 23(1), 119-126.

Herman, J. (1997). Trauma and recovery: The aftermath of violence – from domestic abuse to political terror. New York, NY: Basic Books.

Izard, C. E., & Cohen, I. S. (1989). The structure and functions of emotions: Implications for cognition, motivation, and personality. In The G. Stanley Hall lecture series (Vol. 9, pp. 39-73). Washington, DC: American Psychological Association.

Kelly, D. (2011). Yuck! The nature and moral significance of disgust. Cambridge, MA: MIT Press.

Olatunji, B. O., Armstrong, T., Fan, Q., & Zhao, M. (2012). Risk and resiliency in posttraumatic stress disorder: Distinct roles of anxiety and disgust sensitivity. Psychological Trauma: Theory, Research Practice, and Policy. No pagination specified.

Olatunji, B. O., Ebesutani, C., David, B., Fan, Q., & McGrath, P. B. (2011). Disgust proneness and obsessive-compulsive symptoms in a clinical sample: Structural differentiation from negative affect. Journal of Anxiety Disorders, 25(7), 932-938.

Reynolds, S. M. (2012). The development of a comprehensive disgust scale (Doctoral dissertation). The University of Tulsa, Tulsa, Oklahoma.

Rozin, P., & Fallon, A. E. (1987). A perspective on disgust. Psychological Review, 94(1), 23-41.

Rozin, P., Haidt, J., & McCauley, C. (2008). Disgust. In M. Lewis & J. M. Haviland-Jones (Eds.), Handbook of Emotions (3rd ed., pp. 757-776). New York, NY: The Guilford Press.

Rüsch, N., Schulz, D., Valerius, G., Steil, R., Bohus, M., & Schmahl, C. (2011). Disgust and implicit self-concept in women with borderline personality disorder and posttraumatic stress disorder. European Archives of Psychiatry and Clinical Neuroscience, 261(5), 369-376.

Russell, P. S., & Giner-Sorolla, R. (2011a). Moral anger is more flexible than moral disgust. Social Psychological and Personality Science, 2(4), 360-364.

Russell, P. S., & Giner-Sorolla, R. (2011b). Social justifications for moral emotions: When reasons for disgust are less elaborated than for anger. Emotion, 11, 637-46

Sawchuk, C. N. (2009). The acquisition and maintenance of disgust: Developmental and learning perspectives. In B.O. Olatunji, & D. McKay (Eds.), Disgust and its disorders: Theory, assessment, and treatment implications (pp. 77-97). Washington, DC: American Psychological Association.