The Uniqueness of Disgust as a Reaction to Trauma
May 28, 2013
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).
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