Abstract
All human emotions can be seen as having evolutionary roots related to facilitating adaptation to recurrent challenges or opportunities. Given that disgust may be the only emotion which has evolved for the primary goal of protecting against health threats, it has particular relevance to chronic health conditions. Extant literature strongly implicates its presence in, and association with, screening and diagnosis, treatment and associated decision-making, and long-term adaption related to chronic health conditions. Conditions that have had particular attention in the context of disgust in the last decade include cancer, obesity, bowel conditions, and skin problems. In focusing on this particular cluster of conditions, the literature has consistently overlooked several promising avenues for future research. For instance, conditions where disfigurement is clearly visible to others or has altered bodily function seem to be particularly strong candidates for further work. This chapter discusses the relevant research and clinical implications in this area and presents a mandate to address notable gaps in the literature.
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Given its evolved purpose to protect against health threats (Curtis et al. 2011), disgust has particular relevance to chronic health conditions. In this chapter, we consider the primary reasons why disgust (or the “ick factor”) is pertinent in the context of chronic conditions and discuss how, alongside some benefits, this emotion can be problematic. More specifically, this chapter highlights the research that has been conducted in the last decade on disgust and chronic conditions. Screening and diagnosis, treatment and decision-making, and long term adaptation to chronic health problems are used as a framework. The chapter closes with a discussion about clinical implications, gaps in the literature, and presents a proposed agenda for future research.
Disgust Evolved to Protect
All human emotions can be seen as having evolutionary roots related to facilitating adaptation to recurrent challenges or opportunities for survival and thus reproduction (Consedine et al. 2002; Nesse and Ellsworth 2009; Plutchik 2001; Tooby and Cosmides 2008). In contrast to the more general construct of “emotions”, discrete emotions can be defined as, “episodic, relatively short-term, biologically-based patterns of perception, experience, physiology, action, and communication that occur in response to specific physical and social challenges and opportunities” (Keltner and Gross 1999, p. 468). Arguably, every discrete emotion has a different purpose in response to such challenges or opportunities. Some emotions, such as happiness, facilitate progress towards a goal; some, including fear, promote self-preservation (Curtis and Biran 2001); and others, such as anger, support the removal of goal blockages (Johnson-Laird and Oatley 1992). This is especially true of discrete, as opposed to complex self-conscious, emotions. However, disgust—which functions as a protective, avoidance-promoting mechanism to minimise health threats—may be the only emotion whose purpose specifically relates to physical health (Curtis et al. 2004, 2011; Oaten et al. 2011).
As covered elsewhere in this volume (see Bradshaw and Gassen, Chap. 3, this volume), arguably, evolution has designed disgust to probabilistically reduce exposure to pathogens, especially through the body’s entry points: mouth, skin, anus, and genitals (Tybur et al. 2013). The disgust experience is one of revulsion that occurs at the thought of incorporating a potentially contaminating object (Rozin and Fallon 1987), and is recognised by a cluster of established responses. Physiologically, disgust is characterised by lowered blood pressure, lowered galvanic skin response, and nausea (Curtis and Biran 2001). Behaviourally, the disgust response involves avoidance, withdrawal, spitting or ejection of noxious substances, and the emotion is universally recognised through a cluster of facial expressions, including constriction of nostrils, gape and tongue extension, furrowing of the eyebrows, raising of upper lip, and wrinkling of the nose (Consedine et al. 2007; Olatunji and Sawchuk 2005; Rozin et al. 2000, 2009). This cluster of avoidance tendencies and behavioural, physiological, and cognitive responses has important implications in the context of physical health and is the basis for our discussion below.
Given the potential costs of missing a health threat (i.e., getting sick), the disgust response errs on the side of conservativism (Oaten et al. 2011; Rozin et al. 1986). This conservative process means that the avoidance-promoting response can be activated in the absence of objective threat via laws of similarity and contagion beliefs (i.e., simply because aspects of a context seem similar to one associated with a genuine threat; Eskine et al. 2013; Stavrova et al. 2016). For example, disgust-generated withdrawal effects have been demonstrated in experimental studies where people stand at a greater distance to a confederate who displays an entirely non-infectious skin condition (birthmark) compared to when they do not (Newell 1999; Rumsey et al. 2004) and having a greater propensity to disgust has been causally implicated in stigmatisation of people with a non-contageous condition such as cancer (Azlan et al. 2020). This is an important consideration in the context of chronic health conditions, where individuals who might be non-infectious can become socially isolated despite posing no actual health threat.
Also of relevance in the context of chronic conditions, is the distinction between the propensity to experience disgust (i.e., the tendency/frequency in responding with disgust to a given situation) and disgust sensitivity (i.e., the extent that disgust is experienced as aversive or unpleasant; van Overveld et al. 2006). Although related, these two constructs are distinct from one another and independently predict behavioural avoidance in health contexts (van Overveld et al. 2010). People with smelling distortions exhibit an increased propensity (but not sensitivity) in experiencing disgust towards poor hygiene (Ille et al. 2016) and disgust sensitivity, but not propensity, predicts decisions to delay medical help seeking for bowel symptoms (Reynolds et al. 2018a). In a recent study, disgust propensity and sensitivity were actually shown to predict chemotherapy-related consequences in different and opposing ways (Dev et al. 2020). Thus, it is useful to make a distinction between a person’s propensity to experience disgust and how sensitive (or aversive) their experience is.
Although the primary purpose of disgust has generalised to domains other than those that pose a threat to our physical health (Chapman and Anderson 2012), including moral judgements (Pizarro et al. 2011; see also Giner-Sorolla, Chap. 8, this volume), sexual function (de Jong et al. 2010; see also Borg and de Jong, Chap. 9, this volume), and career choices (Consedine et al. 2013), given the focus of our current discussion, below, we concentrate primarily on the domains most relevant to chronic health conditions: (1) Pathogen disgust —pathogen disgust is specific to health threats and is elicited in response to cues that indicate the potential presence of such a threat (Tybur et al. 2013). Pathogen cues are commonly found in chronic health contexts and include poor hygiene (e.g., pungent body odour); bodily fluids and products (e.g., blood, faeces, urine); violations of the body envelope (e.g., medical procedures, surgery, wounds); and death (Consedine 2008; Tybur et al. 2013). (2) Self-disgust —self-disgust is manifest in response to appraising aspects of oneself as “disgusting” (Powell et al. 2014). Much of the self-disgust literature has focused on mental health and psychopathology (e.g., depression; see Davey, Chap. 11, this volume); however, there is a growing body of work that argues that chronic health conditions which, by definition, often require ongoing, long term exposure to disgust elicitors, such as bodily products, disfigurement and the like, is also of relevance to the manifestation of self-disgust (Reynolds et al. 2018b).
Relevance to Chronic Health Conditions
Empirical work implicates pathogen and self-disgust in a range of chronic health conditions. Of particular relevance to this discussion are health conditions that have regular and/or sustained exposure to established disgust elicitors such as cancers (Dev et al. 2020), bowel-related conditions (Reynolds et al. 2014a), obesity (Lieberman et al. 2012), and skin-related conditions (Pereira et al. 2019). Most cancers and their treatments involve exposure to various elicitors including medical procedures and surgery (i.e., invasion of the body envelope); side-effects (e.g., vomit, diarrhoea); bodily changes (e.g., amputation, hair loss, radiotherapy burns); and existential elicitors, such as being confronted by the prospect of one’s own death. Similarly, bowel conditions like inflammatory bowel disease or faecal incontinence inevitably involve close proximity to faecal matter (Reynolds et al. 2014a); excess body fat associated with obesity can signal the presence of pathogens (Lieberman et al. 2012); and chronic skin conditions can involve exposure to well-established elicitors, such as peeling skin and raw lesions, which may signal infiltration of the body envelope by pathogens (Pereira et al. 2019). In addition to considering the types of conditions where disgust is relevant, it is also useful to categorise the typical points along an illness trajectory where disgust has particular influence. These include screening and diagnosis, treatment and decision-making, and long term adaptation to a chronic health problem.
Screening and Diagnosis
Disgust has been strongly implicated in the screening and diagnosis of chronic health conditions. Given that many screening and diagnostic procedures involve exposure to elicitors such as testing bio-markers for disease (e.g., in blood, urine, and faeces) or inserting medical devices into body cavities that are ordinarily meant as exit rather than entry points (e.g., colonoscopies through the anus), it is unsurprising that dispositional disgust (both sensitivity and propensity) and state disgust (i.e., a persons current emotional state) might lead to screening avoidance and delays in attending healthcare services (Davis et al. 2017; Klasko-Foster et al. 2020; Reynolds et al. 2013, 2018a).
Avoidance of healthcare has particular significance in contexts such as screening, where early identification of disease enables timely management and prevention of disease progression (Garcia-Vidal et al. 2009; Provincial Health Services Authority 2019; World Health Organisation 2019). An emerging body of work has linked disgust with screening-related avoidance . Bowel cancer screening, which typically involves exposure to faeces and invasive rectal procedures, is of particular relevance here (e.g., Chambers et al. 2016b; Kotzur et al. 2016). Some recent work investigating bowel cancer screening behaviours and intentions has shown that both state disgust and the dispositional tendency to experience disgust is associated with less engagement with screening (Chambers et al. 2016a; Klasko-Foster et al. 2020). Likewise, another study revealed that greater insertion-related disgust predicted a lower likelihood of invasive bowel screening (such as colonoscopies) in the previous 5 years (Reynolds et al. 2018a). Other studies have also implicated disgust in this context with greater faecal disgust predicting greater screening-related avoidance behaviours over and above screening intentions (Davis et al. 2017; O’Carroll et al. 2015). The fact that disgust can predict screening behaviours above stated intentions demonstrates the additive potency of affect over cognitions in predicting health behaviours. Given the importance of screening in facilitating early intervention in a range of diseases, the robust association between greater disgust sensitivities and lower screening behaviours is one of considerable clinical importance.
Whilst screening programmes facilitate early detection of non-symptomatic disease, seeking timely medical advice is generally recommended in the presence of suspicious symptoms. However, as with screening avoidance, experimental studies have shown that people may delay seeking healthcare when symptoms are disgusting. For instance, disgust has been found to predict anticipated delay to sexual health services where disgust elicitors are involved (i.e., collecting genital discharge; McCambridge and Consedine 2014), and other experimental work has shown that people will delay seeking medical consultation in response to a scenario where they have suspicious bowel symptoms (diarrhoea and blood in stool; Reynolds et al. 2014b). Whilst these experimental studies provide an early indication that disgust is implicated in delayed presentation to healthcare, there is scant research that investigates this possibility with patient populations and further investigation of this possibility in clinical contexts is warranted.
Treatment and Decision-Making
Disgust can also negatively impact various aspects of treatment, including treatment uptake (Oppfeldt et al. 2016; Reynolds et al. 2013; Turner et al. 2018). Contemporary healthcare systems emphasise the importance of patient informed decision-making and, whilst the provision of detailed information can benefit patient understanding, it can also generate emotion. Where emotions are avoidance-promoting (as with disgust), treatment uptake has the potential to be disrupted. As noted above, symptoms that elicit disgust can influence decisions to delay help-seeking (McCambridge and Consedine 2014; Reynolds et al. 2014b). Similarly, experimental work indicates that disgust can impact intentions to undertake surgery. In a recent study, participants randomised to a condition where they received detailed information and pictures about construction and self-management of a stoma (a surgically created hole in the abdomen that excretes faeces) reported significantly higher disgust and lower intentions to undergo colorectal cancer surgery than controls (Turner et al. 2018). Furthermore, state disgust mediated memory recall such that disgusted participants were less able to remember pre-operative instructions. It is unclear why this might have been the case; however, one possibility is that the experience of state disgust uses valuable cognitive resources that are required in the process of laying down memories . Thus, overall, the experience of disgust appears to influence intentions and cognitive processes critical to rational decision-making.
The influence of disgust on treatment decision-making is also reflected in qualitative literature. For instance, people who have Chronic Obstructive Pulmonary Disease (COPD)—an inflammatory lung disease that causes obstructed airflow from the lungs and involves production and expulsion of excessive mucous (Miravitlles et al. 2014)—report concern about unpalatable symptoms in discussing intentions to undergo rehabilitation (Harrison et al. 2015). Other qualitative research implicates disgust in lower intentions of patients with Crohn’s disease (an inflammatory bowel condition) to undergo recommended faecal microbiota transplantation (Oppfeldt et al. 2016). The act of transporting faeces, which harbours trillions of bacteria (Khoruts and Sadowsky 2016), from one person’s colon to another is directly relevant to disgust in that it almost certainly triggers concerns about contamination and invasion of the body envelope (i.e., inserting foreign matter into the rectum). The barrier to uptake this innovative, potentially life changing (sometimes life-saving) procedure due to the “ick factor” has been a regular feature in media reporting (Chuong et al. 2015). Collectively, these studies indicate that disgust has the potential to influence important aspects of decision-making processes and treatment uptake. In the context of contemporary healthcare systems that increasingly emphasise patient informed decision-making, the influence of this avoidance-promoting emotion warrants further investigation.
Other research shows that heightened disgust sensitivities are associated with symptoms and wellbeing in patients as they undertake their treatment. For example, a recent unpublished study has shown that greater disgust sensitivity in a heterogenous sample of cancer patients predicted greater taste and smell-related changes during chemotherapy (Dev et al. 2020). Maintaining weight during treatment is an important factor in the health status of cancer patients (Deans et al. 2009), and changes to the taste and smell of food can negatively impact this process (Bernhardson et al. 2009). Similarly, other work has investigated cancer patients undergoing chemotherapy and found that greater disgust predicted increases in social, cognitive, and emotional avoidance (Reynolds et al. 2016) and that greater disgust-related side-effects, including bowel or bladder problems and nausea, were associated with greater depression and anxiety (Powell et al. 2016). The latter finding was mediated by self-disgust and partially moderated by disgust propensity (Powell et al. 2016). However, more research is required to determine the extent to which the anticipated impact of treatment might be influenced by either pathogen disgust or self-disgust. Whilst early indication suggests an association between disgust and lower psychological wellbeing in the context of cancer treatment, there is very little research that considers its role in other health conditions where disgust elicitors are prevalent.
Long Term Adaptation to a Chronic Health Problem
Beyond screening, diagnosis and treatment, disgust has also been implicated in the experience of long-term adaptation to various chronic health conditions. It has been noted in particular regarding health conditions which exhibit visible signs of poor health (Palmeira et al. 2019; Rosman 2004), involve exposure to established disgust elicitors (Dibley et al. 2019; Hunt 2019), and in certain neurological conditions (Ille et al. 2015; Trinkler et al. 2017; Verstaen et al. 2016; see also Overton et al., Chap. 12, this volume).
Recent research indicates that individuals living with visible signs of poor health can have high levels of disgust, including feelings of aversion and repugnance towards the self (Palmeira et al. 2019; Rosman 2004). Greater levels of disgust are reported by individuals with visible conditions such as alopecia (Rosman 2004; van Beugen et al. 2016), chronic leg ulcers (Nagaratnam et al. 2018), skin conditions (Narayanan et al. 2014), and obesity (Palmeira et al. 2019). Patients with psoriasis—dry, itchy, red raw, and scaly skin patches (Menter et al. 2008)—commonly describe their appearance with disgust and self-loathing (Narayanan et al. 2014). Even the brain scans of patients with psoriasis reveal pronounced reactions to criticism and facial signs of disgust (Schmidt 2015). In a study comparing psoriasis patients with healthy controls, skin-related disgust and shame were significantly higher in the psoriasis patients (Lahousen et al. 2016).
In such situations, individuals commonly engage in avoidance behaviours, including avoiding touching themselves, looking in mirrors, and masking the offending aspects of themselves (Burden et al. 2018; Palmeira et al. 2019; Powell et al. 2014). Women in particular appear to experience greater self-disgust than men (Palmeira et al. 2019; Rosman 2004) and are more likely to use disguises (e.g., wigs) to mask their bodily difference (Rosman 2004). Recent research reinforces the impact of self-disgust on psychological well-being; higher levels of self-disgust are implicated in depression (Powell et al. 2013), eating psychopathology in people who are overweight and obese (Palmeira et al. 2019), non-suicidal self-harm (Smith et al. 2015), and psychoticism (Ille et al. 2014). As such, the link between self-disgust and adaptation to chronic physical conditions is clinically important, with the construct itself being psychometrically validated and qualitatively consistent across the literature (Clarke et al. 2019).
Disgust is also reported where elicitors are less visible to others (Dibley et al. 2019; Hunt 2019). Bowel disease , which commonly involves increased exposure to one’s own faeces, is of particular relevance and qualitative work notes that people with bowel disease are often disgusted by their condition (Brooks et al. 2015; Dibley et al. 2018, 2019; Woodward et al. 2016). In one study, a patient reported, “…it’s disgusting and I think it’s horrible and smelly and going to the toilet all the time and seeing all this gunk and blood and mucus”, whilst another said, “I don’t think I’ll ever change my mind about that, I’ve got it and it is disgusting” (Woodward et al. 2016, p. 654). These observations are consistent with results of another qualitative study where patients with Irritable Bowel Syndrome identified that disgust was a primary feature of unfavourable body image and feeling different from others (Mohebbi et al. 2017). Importantly, adaptation to a chronic bowel condition has been shown to be worse in people who have greater sensitivity to disgust. For instance, stoma patients with higher disgust sensitivity (i.e., “range and intensity” as opposed to frequency) report lower life satisfaction, poorer adjustment to their colostomy, and are more likely to feel stigmatised (Smith et al. 2007). Of note, women are more likely to report disgust towards their stoma than their male counterparts (Juan et al. 2017). More broadly, this probably reflects the underlying gender differences in disgust (sensitivity and propensity; Clarke et al. 2016; Giel et al. 2016) and self-disgust (Palmeira et al. 2019).
As noted earlier, much of the literature investigating disgust in the context of chronic physical health conditions focuses on cancer . Not only do cancer patients tend to have greater levels of disgust sensitivity and self-disgust in comparison to matched controls, but disgust also tends to be a significant predictor of depressive symptoms in such individuals (Azlan et al. 2017a). In another study, greater disgust sensitivity amongst the partners of cancer patients was found to be associated with greater self-disgust, disgust propensity, and depression in those patients (Azlan et al. 2017b). Furthermore, results in this study indicated that patients’ self-disgust had a mediating role in allowing disgust sensitivity of their partners to negatively influence their own psychological wellbeing (Azlan et al. 2017b). The association between patients’ self-disgust and their partners’ disgust may be explained by the partners’ emotional (in this case, disgust-based) responses contributing to the emerging self-disgust schema in the patients (see Powell et al. 2014).
The experiences of patients with health conditions that comprise aversive symptoms or features are presumably made more debilitating when disgust-based reactions are observed in others. The following quote from a patient illustrates the detrimental impact of noting disgust in another person: “I got a feeling of disgust from her. . . . It was hurtful and caused me a lot of anxiety. It probably knocked my confidence for a very long time. Because, as it got worse, it became a much bigger part of my life that was disgusting and secret and hidden [sic]” (Dibley et al. 2019, p. 1201). Other work has observed that disgust sensitivity is a predictor of wanting less contact with colostomy patients (Smith et al. 2007). Similarly, this effect is demonstrated in a qualitative study that investigated social media responses to a selfie depicting a young woman in a bikini with an ostomy bag: “EWWW EWWWW EWWWWW… .my mother wore one when she had cancer, and nobody wants to look at S**t…I’m sorry, but this is something that should be covered up. If you don’t tell me you got one, I’ll never know [sic]” (Rademacher 2018, p. 3871). Similar themes are also observed in the context of amputees (Burden et al. 2018); however, the literature is limited in this context.
Disgust also appears to be an important component of bias towards people who have visible signs of poor health, including being overweight (Vartanian 2010) and having skin conditions (Green-Armytage et al. 2019; Halioua et al. 2016; Pereira et al. 2019; see also Vartanian et al., Chap. 10, this volume). Images of obese individuals have reliably elicited disgust responses in others (Lieberman et al. 2012) and, specifically, increased pathogen disgust proneness predicts more negative attitudes towards such individuals, ostensibly via implicit signals that excess body fat is an indicator of the potential presence of pathogens (Lieberman et al. 2012). Attitudes that obese individuals are lazy, unintelligent, and lacking in control are common (De Brún et al. 2014) and may provide a rationalisation for withdrawal and avoidance of such persons. Similarly, disgust is reported in response to people who have obvious signs of psoriasis and eczema (Green-Armytage et al. 2019; Halioua et al. 2016; Pereira et al. 2019), and laypersons and medical students both report not wanting to date, shake hands, or share a car with people who have enlarged psoriatic hand lesions (Pearl et al. 2019).
Clearly, disgust responses such as these have the capacity to impact on the psychological well-being of people with chronic conditions and can lead to people feeling isolated and stigmatised. However, there may also be situations where a person, who has feelings of self-directed disgust, may incorrectly assume that others feel similarly. In such situations, withdrawal from social connections may occur as a protective mechanism (Powell et al. 2014; Reynolds et al. 2018b). Although withdrawal from others appears likely in this context, apart from one study that demonstrated that disgust proneness in chemotherapy patients predicted social avoidance (Reynolds et al. 2016), there is little research investigating the extent of this possibility in chronic health and more work in the area is required.
Of note, disgust has also been implicated as having a causal role in certain health problems (Hildebrandt et al. 2015; Watkins et al. 2016). It has been argued that defects in the propensity to experience disgust can contribute to obesity by allowing over-consumption of food (Watkins et al. 2016). This effect has been shown to be especially true for females (Giel et al. 2016). Conversely, greater sensitivity to disgust may lead to under-consumption of food, which may be reflective of, or contribute towards, eating disorders (Anderson et al. 2018; Egolf et al. 2018; Hildebrandt et al. 2015). This is consistent with research that shows greater disgust (especially self-disgust) is associated with greater insulin restriction and more rigid, punitive approaches to diabetes management amongst patients with Type 1 diabetes (Merwin et al. 2015). It might be the case that feelings of disgust trigger vulnerable individuals to restrict insulin in the hope of losing weight and promoting feelings of well-being (Merwin et al. 2015).
Importantly, there is evidence to suggest that people might habituate to disgust elicitors over time (Olatunji et al. 2011; Rozin 2008), suggesting that problematic responses related to health conditions may lessen as time passes. However, one study found that while disgust lessened over time in response to one stimuli (i.e., a cold dead body) it did not reduce in response to another similar elicitor (i.e., a warm dead body; Rozin 2008) and other work has found disgust relatively rigid to change compared to other emotions (Olatunji et al. 2009). Thus, the impact of disgust may lessen over time in particular situations, but this may not translate to new situations. It is also possible that self-disgust elicitors might operate differently to pathogen elicitors, perhaps leading to sensitisation over time. Further research is required in this area to understand the extent to which characteristics of disgust are static versus dynamic.
Moving Forward
An escalating number of studies in the past decade have focussed on disgust in the context of chronic health conditions. Despite this recent activity, work investigating disgust in physical health has tended to cluster around the conditions that have the most obvious link to disgust elicitors including cancer, obesity, bowel conditions, and skin problems. However, there are other conditions that appear to be obvious candidates for future focus. Conditions where disfigurement is clearly visible to others or has altered bodily function (speaking, eating, drinking, excreting, etc.) seem like particularly strong candidates for further work. Such research could include faecal and urinary stoma patients, people who have experienced invasive burns, those who suffer dental problems, and/or those with obvious scarring or wounds. Considering the ways in which the avoidance-promoting disgust response might impact on such populations are worthy avenues for future research.
Arguably, however, disgust is relevant to all health conditions given its evolutionary purpose. Wherever a person exhibits signs of illness, blood is drawn, invasive medical procedures are conducted, the body is medicalised or cut open, bodily function is altered, exposure to body product occurs (etc.), a disgust response is possible. Given the likely relevance of this response across all aspects of health, clinicians could be routinely screening their patients for disgust sensitivity and propensity. In doing so, patients (and their partners) who have a greater propensity or sensitivity to disgust can be pre-emptively identified and targeted for early interventions. Correspondingly, it is also important for researchers and clinicians to consider developing better disgust screening tools that can identify the kinds of elicitors likely to be problematic, and the behavioural, physiological, and emotional responses that might occur in response.
Importantly, research is required that informs interventions that might mitigate the deleterious impacts of disgust on patients, their close associates, and healthcare professionals. There remains a need for interventions to be developed and tested that specifically target clinical contexts and the self-management tasks that chronic health conditions require. Whilst research investigating disgust-focused interventions in the context of chronic health is scant, emerging experimental work offers promise (Reynolds et al. 2013). A recent study has demonstrated that disgust negatively impacts clinical engagement with patients who present with disgusting symptoms and suggests that compassion might offer potential in mitigating this impact (Reynolds et al. 2019). Other strategies found to be helpful include acknowledging the presence of disgust (Kircanski et al. 2012); challenging thoughts, re-framing, and re-appraisal (Feinberg et al. 2014; Fink et al. 2018; Goldin et al. 2008; Wilson et al. 2018); using a detached stance (Shiota and Levenson 2012); exposure-based habituation (Adams et al. 2011; Olatunji et al. 2009); and acceptance-based therapies (Wolgast et al. 2011). However, while there has been an escalating interest in this area, the majority of this work has been experimental research either conducted with healthy volunteers or clinical populations who have psychopathologies (OCD, spider phobias, etc.). Investigation of the utility of clinical interventions with physical health populations has been almost completely overlooked and strategies almost certainly need to be tailored to the specific elicitor and type of disgust (i.e., pathogen or self-disgust), as different contexts are likely to require different interventional approaches.
Where disgust is self-directed or associated with critical self-evaluation it may be that self-compassion is of benefit. Self-compassion is the ability to direct compassion to ones’ self and encapsulates components of self-kindness, common humanity, and mindfulness (Neff 2003). Cross-sectional work has found that higher levels of self-disgust are related to lower self-compassion (Palmeira et al. 2019), and recent clinical trials have shown that self-compassion training can lead to improved psychological and physiological outcomes amongst populations with chronic health conditions (Friis et al. 2016; Sherman et al. 2018). A study investigating the utility of a brief online self-compassion writing exercise with breast cancer patients found significant improvements post-intervention in body image distress and body appreciation (Sherman et al. 2018); and a replication of this study with stoma patients found that the intervention was effective in reducing body image distress in stoma patients with low disgust sensitivity (Harris 2019). Thus, there appears potential for further investigation of this interventional approach in other chronic health contexts.
Concluding Remarks
In sum, although there has been an escalating interest into the links between disgust and physical health in recent years, there remain vast areas of unexplored territories in this domain for interested researchers. Disgust appears relevant to any condition where health is threatened, and it is important to fully consider the interventional strategies that might be helpful for patients, caregivers, associates, and health professionals in this context.
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Reynolds, L.M., Dev, V. (2021). How the “Ick Factor” Matters in Chronic Health Conditions. In: Powell, P.A., Consedine, N.S. (eds) The Handbook of Disgust Research. Springer, Cham. https://doi.org/10.1007/978-3-030-84486-8_13
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