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. Author manuscript; available in PMC: 2019 Oct 1.
Published in final edited form as: J Obsessive Compuls Relat Disord. 2018 Aug 7;19:72–76. doi: 10.1016/j.jocrd.2018.08.002

Disgust sensitivity mediates the effects of race on contamination aversion

Jamilah R George a, Christopher Pittenger a, Benjamin Kelmendi a,c, Jeffrey M Lohr b, Thomas G Adams a,b,c
PMCID: PMC6656395  NIHMSID: NIHMS1506247  PMID: 31341759

Abstract

African Americans report greater contamination aversion than European Americans. Few studies have attempted to identify potential causes for this elevated contamination aversion, though existing research and theory suggests this may be partly due to concomitant heightened disgust sensitivity. The present study examined the relations between race, disgust sensitivity, and contamination aversion among African and European Americans. A convenience sample of fourhundred and twenty-nine participants completed the Disgust Scale – Revised (DS-R) and the Padua Inventory – Revised (PI-R). African Americans endorsed greater disgust sensitivity (DS-R total) – particularly on the core and contamination subscales of the DS-R – and scored higher on the contamination subscale of the PI-R (but not on other subscales) than European Americans. Mediational analyses revealed a significant total effect of race on contamination aversion and a significant indirect effect of race on contamination aversion through disgust sensitivity; the direct effect of race on contamination aversion remained significant even after controlling for race. These findings suggest that elevated contamination aversions among African Americans may be partly due to elevated disgust sensitivity. If confirmed with larger and clinical samples, and more robust experimental methods, this relationship may prove to have implications for the treatment of contamination-based obsessive-compulsive disorder (OCD) among African Americans.

Keywords: race, African American, obsessive-compulsive disorder, contamination, disgust

1. Introduction

Obsessive Compulsive Disorder (OCD) is defined as the presence of obsessions (recurrent, persistent, and unwanted thoughts, images, impulses, or urges that are typically anxiety-provoking), compulsions (excessive and repetitive behaviors or mental acts often performed to prevent or reduce negative affect or perceived harm), or both, which cause substantial impairment or distress (American Psychiatric Association, 2013). OCD has a modest prevalence – lifetime prevalence of OCD is approximately 2.5% (Karno, Golding, Sorenson, & Burnam, 1988) – and has been found to significantly impair functionality in multiple daily living settings such as work, home, and social life (Ruscio, Stein, Chiu, & Kessler, 2010).

OCD is heterogeneous, but symptoms generally fall into four dimensions: contamination obsessions and cleaning compulsions, symmetry obsessions and compulsions, forbidden thoughts and checking compulsions, and hoarding (although this is now considered a distinct disorder) (Bloch, Landeros-Weisenberger, Rosariom, Pittenger, & Leckman, 2008). Contamination obsessions are usually related to fears or aversion to dirt, germs, illness, or environmental contaminants. Accompanying cleaning or washing compulsions are aimed at ameliorating contamination-based obsessions, preventing harm from perceived contamination, and mitigating the emotional distress that often results from contact with contaminants. Patients with contamination-based OCD often avoid stimuli that may generally be considered contaminants (e.g. bodily secretions; certain foods; chemicals). The avoidance and cleaning behaviors of OCD patients may differ in degree but rarely in kind from those seen in the general population, though some avoid stimuli that may otherwise be considered innocuous by most people (Brady, Adams, & Lohr, 2010).

Contamination aversion – avoidance of intense feelings of having been in contact with someone or something thought to be infectious or harmful (Rachman, 2004) – is a common obsessional theme, accounting for approximately 55–57.7% of obsessional concerns reported by treatment-seeking OCD patients (Rasmussen & Tsuang, 1986). Contamination aversion has also been reported among nonclinical individuals (Purdon & Clark, 1993). A number of factors have been shown to predict the severity of contamination aversion and contamination-based obsessions and compulsions; one of the most robust is disgust sensitivity (Olatunji, Sawchuk, Lohr, & Jong, 2004; Thorpe, Patel, & Simonds, 2003; Cisler, Reardon, Williams, & Lohr, 2007).

Disgust sensitivity is the strength of disgust response to a range of stimuli that may be indicative of uncleanliness, contamination, or the potential for disease (Rozin, Haidt, & McCauley, 2008). According to the most commonly used measure of disgust sensitivity, the revised disgust sensitivity scale (DS-R), disgust sensitivity consists of multiple subconstructs: core, animal reminder, and contamination-based disgust (Olatunji, Williams et al., 2007). Core disgust is often triggered by rotten food, body products, rodents, or other infectious pests; this presumably functions to trigger avoidance and thereby protect the body from disease or infection (Petrowski, et al, 2010). Animal reminder disgust represents an aversion to stimuli that are reminders of the animal origins of humans, such as blood, veins, tissue, and death (Olatunji, Sawchuk, Lohr, & Jong, 2004). Finally, contamination-based disgust relates to feelings of discomfort or being disgusted by a potentially contaminated person or object (Olatunji et al., 2004).

Disgust sensitivity is a reliable predictor of contamination-based obsessive-compulsive (OC) symptoms and contamination aversion (Deacon & Olatunji, 2007; Muris et al., 2000). In fact, Olatunji and colleagues (2004) showed that 44% of the variance in contamination aversion scores – as measured by the Padua Inventory Revised scale (PI-R; Burns, Keortge, Formea, & Sternberger, 1996)– was explained by the three DS-R subscales. Several investigators have also reported a positive correlation between disgust sensitivity and the washing subscale of the Maudsley Obsessive-Compulsive Inventory (MOCI; Hodgson & Rachman, 1997) (Muris et al., 2000; Mancini et al., 2001). Mancini and colleagues (2001) showed that disgust sensitivity was the strongest predictor of the MOCI washing subscale even after controlling for anxiety and depression measures, in a non-clinical sample. Similarly, in a clinical sample, Woody and Tolin (2002) showed that OCD patients with contamination-based symptoms reported significantly higher disgust sensitivity scores than did non-anxious controls (as measured by the original Disgust Scale), and marginally higher disgust sensitivity scores than OCD patients without contamination-based symptoms.

Although research in this area is limited, studies suggest that clinical (Williams, Einstein, Buckner, Abelson, & Himle, 2012) and non-clinical (Haidt, McCauley, & Rozin, 1994) samples of African Americans endorse greater contamination-based OC symptoms and contamination aversion when contrasted with European Americans. It has been proposed that among African Americans with OCD, contamination aversion is the most common obsession (Lewis-Hall, 1994). Williams, Turkheimer, Magee, and Guterbock (2008) showed that African Americans with OCD scored significantly higher than European Americans with OCD on the contamination and washing scales of the Padua Inventory (PI; Sanavio, 1988) and the Obsessive-Compulsive Inventory (OCI; Foa, Huppert, Leiberg, Langer, & Hajcak, 2002). Thomas and colleagues (2000) showed that African Americans scored almost one standard deviation higher than their European American counterparts on the MOCI washing subscale; however, African Americans did not endorse more severe OC symptoms when interviewed individually. Williams, Turkheimer, Schmidt, and Oltmanns (2005) found a similar trend in which nonclinical African Americans (and Hispanics) endorsed contamination aversion scores as high as participants with an OCD diagnosis. In this study, Williams and colleagues (2005) performed a differential item functioning (DIF) analysis of Padua Inventory (Sanavio, 1988) scores between African and European Americans and found that African Americans endorsed an item from the Padua Contamination subscale 1.55 times more often than European Americans.

A variety of factors may explain why African Americans report greater contamination aversions; though there is scant research on this topic matter (Litman, Williams, Rosen, Weinberger-Leitman, & Robinson, 2017). The heightened endorsement of contamination aversion among African Americans found in multiple studies may be attributed to a variety of socio-cultural factors (Williams, Turkheimer et al., 2008). For example, it has been proposed that African Americans may over-endorse cleaning behaviors to counteract negatively attributed stereotypes (Williams & Turkheimer, 2008). This idea is supported by earlier work showing that Black-White differences in contamination concerns between groups disappear after controlling for cultural attitudes (William & Turkheimer, 2007). Cultural differences regarding contamination and washing may also be affected by the legacy of racism and segregation in the US, wherein European Americans feared becoming contaminated as a result of close contact with African Americans (Williams & Turkheimer, 2007).

Several studies suggest that African Americans may also report heightened disgust sensitivity. Haidt and colleagues (1994) were the first to report that African Americans scored higher on the Disgust Sensitivity scale than European American participants. Tolin and colleagues (2006) also found that non-European Americans (a sample comprised mostly of African Americans) scored significantly higher on the Disgust Scale than did European Americans. In contrast, at least one study failed to detect significant differences in disgust sensitivity between African and European Americans (Williams, Abramowitz, & Olatunji, 2012). It is worth noting that the latter study did not include the DS-R and instead used the revised Disgust Propensity and Sensitivity Scale (DPSS-R; Olatunji et al., 2007) to assess disgust sensitivity. Whereas the DS-R assesses severity of self-reported disgust in reaction to a range of stimuli and situations, the DPSS-R assesses sensitivity to or fear of feelings of disgust. As such, it could be that African Americans simply report more disgust in reaction to a range of stimuli but are not more sensitive to those feelings than European Americans.

If, indeed, African Americans experience greater disgust sensitivity and contamination aversion, then theory would suggest that elevated disgust sensitivity could be predictive of stronger contamination aversion. The present cross-sectional study aimed to provide preliminary findings in support of this theory by examining the role of race and disgust sensitivity in contamination aversion among a convenience sample of Africans Americans and European Americans. We hypothesized that African Americans would endorse elevated disgust sensitivity and contamination aversion relative to their European American counterparts, and that disgust sensitivity would mediate the effects of race on contamination aversion – that is, that differences in contamination aversion between African American and European American participants could be largely explained by disgust sensitivity.

2. Methods

2.1. Participants

A sample of 429 undergraduate students were recruited to participate in this study. A majority of participants self-identified as European American (n = 399) while a small percentage self-identified as African American (n = 30). Participants were not provided their country of heritage or origin, therefore we are unsure whether or not members of other Black groups (such as African or Caribbean) were represented. The mean age of the sample was 19.44 (SD = 2.93) and 69% (n = 298) identified as women. There were no significant differences in age or gender between African American and European American participant groups (all ps > .10).

2.2. Procedures

Participants were recruited from introductory psychology courses at a large Southern university. After completing IRB-approved informed consent, participants completed a series of self-report measures. All data were collected electronically via surveymonkey.com, which is as reliable as data collected in person (The Digital Future, 2008). Participants were awarded course credit for their participation.

2.3. Measures

Disgust Scale – Revised (DS-R; Olatunji, et al, 2007). Disgust sensitivity was assessed using the 25-item version of the DS-R. The DS-R measures individual differences in the propensity to experience disgust in three domains: core, animal reminder, and contamination disgust sensitivity. Participants were asked to rate each item on a 5-point Likert-type scale (0–4) based on the degree to which the statement applied to them, or how disgusting they found the item. The DS-R has strong construct validity, discriminant validity, and test-retest reliability (van Overveld et al., 2006; Rozin, Haidt, & McCauley, 2008; Olatunji et al., 2007). Internal consistency was strong in the entire sample (α = .91), among European Americans (α = .90), and among African Americans (α = .89).

Padua Inventory - Revised (PI-R; Burns, Keortge, Formea, & Sternberger, 1996). The Padua Inventory consists of 39 statements about thoughts and behaviors, (e.g., “I feel my hands are dirty when I touch money”) that were designed to measure the degree of disturbance caused by intrusive thoughts and compulsive behaviors. Items are rated using a 5-point scale. The PI-R is composed of five subscales: thoughts of harm to self or others; impulses of harm to self or others; contamination and washing; checking; and dressing rituals. It has adequate internal consistency and test-retest reliability (Burns et al, 1996). Internal consistency of the total score and contamination subscale were strong in the present sample, α = .92 and .84, respectively. Alphas for the PI-R total score and contamination subscale were also strong among European Americans (α = .93 and .88, respectively) and Among African Americans (α = .92 and .87, respectively) in the present study.

3. Results

African Americans scored higher than European Americans on overall DS-R [t (427) = 4.16, p < .01] and on the core [t (427) = 4.02, p < .01] and contamination [t (427) = 7.48, p < .01] subscales. There were no significant between-group differences on the animal reminder subscale [t (427) = .78, p = .44]. African Americans scored higher on the contamination subscale of the PI-R [t (427) = 4.18, p < .01], but there were no significant differences between African Americans and European Americans on any other OC symptom dimension or on overall OCD severity (all ps > .10; Table 1).

Table 1.

Descriptive statistics and t-tests for both racial groups: European American (n = 30) and African American (n = 399).

Race M (SD) t-test [df = (427)] Cohen’s d
PI-Contamination European Am 9.67 (7.22)
African Am 15.50 (9.16) 4.18, p < .01 .71
DS-R Total European Am 52.84 (17.16)
African Am 66.42 (18.06) 4.16, p < 01 .78
DS-R Contamination European Am 6.59 (4.04)
African Am 12.36 (4.52) 7.48, p <.01 1.35
DS-R Animal Reminder European Am 18.50 (6.96)
African Am 19.53 (6.84) .78, p = .44 .15
DS-R Core European Am 27.75 (8.84)
African Am 34.53 (9.70) 4.02, p < .01 .73
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Note. DS-R = Disgust Sensitivity - Revises, PI-R = Padua Inventory – Revised

Consistent with previous research, disgust sensitivity was significantly correlated with contamination aversion within the entire sample (r = .58, p < .01) and among African Americans (r = .57, p < .01) and European Americans (r = .56, p < .01). All DS-R subscales were significantly correlated with contamination aversion within the entire sample and each racial group (all ps < .05, see Table 2). A series of r to z-tests revealed that, save for one association (DS-R total and the DS-R contamination subscale), there were no significant differences in the magnitude of correlation coefficients between the two racial groups (all ps > .10), including between DS-R total and the contamination subscale of the Padua.

Table 2.

Correlation matrix for European Americans (top diagonal) and African Americans (bottom diagonal) are displayed.

PI-R Cont DS-R Total DS-R Cont DS-R AR DS-R Core
PI-R Cont -- .558** .560** .392** .518**
DS-R Total .574** -- .743** .854** .928**
DS-R Cont .490** .877** -- .466** .618**
DS-R AR .454* .793** .647** -- .657**
DS-R Core .520** .893** .710** .469** --
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Zero-order Correlations.

**

p ≤ 0.01

*

p ≤ 0.05.

European Americans on the top diagonal and African-American on the bottom diagonal. “PI-Cont” = Padua Contamination Subscale, “DS-R Core” = DS-R Core subscale, “DS-R AR” = DS-R Animal Reminder subscale, “DS-R Cont” = DS-R Contamination subscale, “DS-R Total” = DS-R Total score

The PROCESS Macro in SPSS (Hayes, 2012) was used to examine the total, direct, and indirect effects of race and disgust sensitivity on contamination aversions. Bias corrected bootstrapped confidence intervals were estimated using 5000 samples. The total effect of race on contamination aversion was significant [B = 5.83, 95% CI = 3.09 – 8.57, t = 4.18, p < .01]. The effect of race on disgust sensitivity was significant [B = 13.58, 95% CI = 7.17 – 19.99, t = 4.16, p < .01], as was the effect of disgust sensitivity on contamination aversion while controlling for the effects of race [B = .24, 95% CI = 0.21 – 0.27, t = 13.90, p < .01]. The direct effect of race on contamination aversion while controlling for disgust sensitivity was also significant [B = .2.58, 95% CI = 0.26 – 4.91, t = 2.18, p < .05]. Lastly, the indirect effect of race on contamination aversion through disgust sensitivity was significant [B = 3.25, 95% CI = 1.69 – 4.96]. Bootstrapped estimates of the ratio of the indirect effect relative to the total effect suggests a majority of the effect of race on contamination aversion was likely explained by disgust sensitivity, PM = 0.56, 95% CI = 0.33 – 1.11. A series of separate regression were carried out to estimate unique R2 of the total, direct, and indirect effects of race on contamination aversion. Race accounted for 3.9% of the variance in contamination aversion. This effect was reduced to 0.7% after controlling for disgust sensitivity, which suggests that the indirect effect accounted for approximately 82% of the total effect of race on contamination aversion (see Figure 1).

Figure 1.

Figure 1.

Open in a new tab

Direct and indirect effects of race on contamination aversion through disgust sensitivity.

Note: **p ≤ 0.01, *p ≤ 0.05.

Total effect of X on Y [B = 5.83, p < 0.01, 95% CI = 3.09 – 8.57], direct effect of X on Y [B = 2.58, p < 0.05, 95% CI = .26 – 4.91], indirect effect of X on Y [B = 3.25, p <0.01, 95% CI = 1.69 – 4.89], relative (to total) indirect effect [PM = 0.5].

4. Discussion

The present study was conducted to investigate the relations between race, disgust sensitivity, and contamination aversion among Africans Americans and European Americans. We found that African Americans endorsed significantly higher scores on measures of disgust sensitivity and contamination aversion. Mediational analyses revealed that race had significant total, direct, and indirect (via disgust sensitivity) effects on contamination aversion. That is, while race and disgust sensitivity both predicted contamination aversion, a significant indirect effect suggested that most of the effect of race on contamination aversion was explained by disgust sensitivity. While the term mediation is often used to infer causality, the present study’s cross-sectional design precludes any strong causal inference (Kraemer et al., 2002). Rather, the present findings are useful for hypothesis development. Future research using longitudinal or experimental designs will be required to determine if disgust sensitivity exerts a causal influence on contamination aversion or if disgust sensitivity causally influences the relations between race and contamination aversion.

It is important to note that these findings do not imply a genetic predisposition towards elevated disgust sensitivity or contamination aversion among African Americans. As reviewed above, others have proposed that a variety of socio-cultural factors are implicated in heightened contamination aversion (Williams & Turkheimer, 2007; 2008) – an idea that has some empirical support (William & Turkheimer, 2007). Given the strong associations between contamination aversion and disgust sensitivity, it is likely that the same socio-cultural determinants that are implicated in contamination aversion are also relevant to disgust sensitivity. Future research should aim to identify socio-cultural factors that are unique to the development of disgust sensitivity. Further, it should attempt to identify how extant cultural beliefs, values, traditions, and geographic factors might explain differences in disgust sensitivity and contamination aversion within and between the races. This is particularly important given that “race” in and of itself lacks a consistent scientific meaning and therefore should not be considered a cause of group differences (Helms, Jerniga, & Mascher, 2005).

Our use of a non-clinical convenience sample limits external validity. The present findings may not generalize beyond the nonclinical student sample that was used. Though the findings of this study provide insight into OCD symptoms among African Americans and may eventually prove to be relevant to their treatment, future research will require replication of results with a racially diverse clinical sample of OCD patients. This is particularly true in light of research demonstrating that differences in contamination fears between black and white community members are largely eliminated when controlling for more casual concerns about cleanliness, animals, and grooming (Williams & Turkheimer, 2007).

A sizeable majority of our sample was European American, with a much smaller African American sample. This points to a larger challenge of minority recruitment and representation in research more generally (Erves et al, 2017; Bonevski, et al, 2014; Kauffman et al, 2013). Ideally, future research should aim to collect data that equally (or at least proportionally) represents each demographic population(s) of interest. Additionally, this study simply assessed race and did not account for the origin or heritage of participants (e.g., Caribbean Blacks, African immigrants, or first-generation African Americans). Since African American cultural history has been suspected to be a factor in the reported differences in contamination scores among African Americans, (Williams & Turkheimer, 2007), accounting for individual differences in origin or heritage might explain some variation in attitudes and perspectives on contamination.

Lastly, none of the selected scales were originally normed on African Americans. While there is a plethora of measures used to assess OCD symptoms, few have been validated in African Americans (Williams, Sawyer, & Wetterneck, 2015). Similarly, psychometric properties of the DS-R are largely unknown among adult African Americans. Existing research with adult Ghanaian and adolescent African American participants suggests there may be some important differences in DS-R factor structure across the races (Skolnick & Dzokoto, 2013; Kim, Ebesutani, Young, & Olatunji, 2013). It is worth noting, however, that internal consistency of the PI-R and DS-R were adequate to strong with both racial groups in the present study, suggesting acceptable internal reliability. Nonetheless, the lack of psychometric data on the PI-R and DS-R among adult African Americans is a limitation of the present study. Future research should aim to assess the psychometric properties of the PI-R and DS-R among adult African Americans.

The current study indicates that African Americans endorsed significantly higher scores on measures of disgust sensitivity and contamination aversion, and mediational analyses revealed that race had significant total, direct, and indirect effects on contamination aversion. The significant indirect effect suggests that most of the effect of race on contamination aversion was accounted for by disgust sensitivity. This may prove to have implications for the etiology of contamination-based OCD among African Americans, but additional research will be required to determine if disgust sensitivity exerts a causal influence on contamination aversion or if disgust sensitivity causally influences the relations between race and contamination aversion.

Supplementary Material

1

Note: **p ≤ 0.01, *p ≤ 0.05.

Total effect of X on Y [B = 13.58, p < 0.01, 95% CI = 7.17 – 19.99], direct effect of X on Y [B = 5.97, p < 0.05, 95% CI = 0.54 – 11.40], indirect effect of X on Y [B = 7.61, p <0.01, 95% CI = 3.38 – 12.55], relative (to total) indirect effect [PM = 0.56, 95% CI = 0.29 – 0.97] 6, 95% CI = 0.33 – 1.11]. Bold lines represent the total and direct effects. Dashed line represents the indirect effect.

Highlights.

  • African Americans (N=30) reported greater disgust sensitivity

  • African Americans (N=30) reported greater contamination aversion than European

  • Americans (N = 399)

  • Disgust sensitivity mediated the effect of race on contamination aversion

Footnotes

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

1

Note: **p ≤ 0.01, *p ≤ 0.05.

Total effect of X on Y [B = 13.58, p < 0.01, 95% CI = 7.17 – 19.99], direct effect of X on Y [B = 5.97, p < 0.05, 95% CI = 0.54 – 11.40], indirect effect of X on Y [B = 7.61, p <0.01, 95% CI = 3.38 – 12.55], relative (to total) indirect effect [PM = 0.56, 95% CI = 0.29 – 0.97] 6, 95% CI = 0.33 – 1.11]. Bold lines represent the total and direct effects. Dashed line represents the indirect effect.

NIHMS1506247-supplement-1.tif (28.3KB, tif)

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