[Encyclios]

Types of avoidance and therapy

From a therapeutic point of view, detecting, and distinguishing, which avoidance the patient enacts is crucial: on the one hand through the extinction of those behaviors learned in terms of Pavlovian conditioning, suitable for those symptoms generated by anxiety, but not very useful for the fear of contamination mediated by disgust, treatable in terms of counterconditioning (Ludvick, Boshen & Neuman, 2015).

In fact, it has been hypothesized that disgust reactions might be maintained through evaluative conditioning, i.e., the change in valence of a stimulus, given by pairing it with another stimulus, through an abstract, hence thinking, relationship. Such abstract relations could be magic-sympathetic laws, disgust-based reasoning, and mental contamination (Ludvick, Boshen & Neuman, 2015).

If we think about the last one, the generation of high disgust propensity could be given by a referential type of learning, where the unconditioned stimulus does not go to predict the conditioned one, but is only its reference, i.e., the mere presence of the unconditioned stimulus generates an evaluation of the conditioned one, without it actually being present (Ludvick, Boshen & Neuman, 2015). Thus, treatment will not rely on extinction, but on counterconditioning: the pairing of the old unconditioned stimulus with a new conditioned stimulus with positive valence, to break the previous link (Ludvick, Boshen & Neuman, 2015).

Thus, although there is evied evidence of a relationship between disgust propensity and Obsessive-Compulsive Disorder, it should be further investigated:

• whether the propensity to disgust belongs only to the fear of contagion, or whether, in part, to other symptoms as well;
• what could be other cognitive distortions that reinforce the link, besides mental contamination and reasoning based on disgust;
• what might be the eliciting contexts, i.e., whether neutral non-disgusting situations can activate the propensity to disgust in patients with Obsessive-Compulsive Disorder;
• and whether there is a direct link between these distortions and compulsive acts to resolve them. Indeed, clarifying the relationship may provide insight into what treatment may be most effective for disgust (Melli et al., 2014), for example, if we interpret treatment in terms of counterconditioning evaluative learning (Ludvick, Boshen & Neuman, 2015).

In addition, there has been more focus in the literature on the central disgust dimension in Obsessive-Compulsive Disorder, a key logical step if we take into account the model of disgust, and the evidence reported on OCD.

Although it may be interesting to investigate another component of disgust, the interpersonal one. That is, interpersonal disgust would be about creating a distance of who is potentially, or is, considered disgusting (Rozin & Haidt, 2000). If we think about the stimuli that normally generate it, it could be plusible that the evaluation of interpersonal disgust in Obsessive-Compulsive Disorder is generated in terms of self-referentiality: it is the envy itself that is the disgusting stimulus, as well as others. The stimuli that normally elicit interpersonal disgust can be divided into four domains: strangeness (refers to contact with something unfamiliar or whose origin is unknown), moral stigma (rejection of those individuals who have unacceptable conducts), disease (aversive reactions towards the sick that remind us of our vulnerability), misfortune (repulsion for those individuals who have suffered a misfortune), and in these cases the contagion concerns the rejection of the acquisition of the characteristics of those individuals to be rejected (Rozin & Haidt, 2000).

Thus, it is conceivable that individuals with Obsessive-Compulsive Disorder may also have a high propensity for interpersonal disgust, given in turn by a likely mechanism of mental contagion or self-referral, which generates avoidance, or attempted control, of disgust.

However, these latter speculations go beyond what was presented in this article, proposed to investigate factors that may increase vulnerability in experiencing disgust. The analysis reported evidence in favor of a link between disgust and Obsessive-Compulsive Disorder, and highlighted its peculiarity, which is important for the use of new treatments, to complement standard ones.