The emotion of disgust is associated with pediatric OCD depending on the level of harm avoidance

Abstract

Objectives: The emotion of disgust is a risk factor for obsessive-compulsive symptoms and traits. The role of the temperamental trait of harm avoidance, which predisposes to heightened anxiety, in mediating this relationship has not been studied in youth. This study examines the role harm avoidance in modulating the association of disgust with OCD. Methods: A pediatric OCD registry enrolled 59 youth with OCD, Tourette’s disorder, ADHD, or anxiety disorders. Disgust was measured using the Children’s Disgust Scale (CDS), an 18-item normed quantitative scale divided into affective disgust and avoidance disgust. The Leyton Obsessional Inventory Child Version (LOI-CV), a 20-item self-report measure, assessed obsessive-compulsive symptoms/traits. Median-split high-low LOI-CV groups and LOI-CV subscales (LOI-obsessions, LOI-contamination, LOI-numbers, LOI-perfectionism) were created. Harm avoidance was derived from the Junior Temperament and Character Inventory (JTCI), a 108-item parent self-report assay. Student t tests compared disgust total, affective, and avoidance scores in high-low LOI-CV groups and subscales. High-low harm avoidance groups were used to repeat the analyses, to determine if harm avoidance levels influence results. Results: A total of 59 youth ages 7 to 17 years (12.9 ± 2.8), 44% female, and 79% White formed low LOI-CV (n = 31) and high LOI-CV (n = 28) groups. Affective disgust ( p = .01), avoidance disgust ( p = .06), and total disgust scores ( p = .009) are significantly higher in the high LOI-CV stratum. Three subscales are also higher in the high LOI-CV group: LOI-obsessions ( p = .03), LOI-contamination ( p = .002), and LOI-perfectionism ( p = .02). When divided into harm avoidance strata, the high harm avoidance stratum had significant LOI-CV total ( p = .06) and LOI-contamination ( p = .001), while the low harm avoidance stratum had significant LOI-contamination ( p = .01) and LOI-perfectionism ( p = .03). Conclusions: Disgust measures are associated with LOI-CV obsessive-compulsive symptoms/traits across all LOI-CV subscales. However, high harm avoidance is more strongly associated with LOI-contamination (symptom), whereas low harm avoidance is associated with perfectionism (trait). Harm avoidance modulates the relationship between disgust and OCD symptoms/traits.