Elsevier

Biological Psychiatry

Volume 54, Issue 7, 1 October 2003, Pages 751-756
Biological Psychiatry

Brain activation by disgust-inducing pictures in obsessive-compulsive disorder

https://doi.org/10.1016/S0006-3223(03)00003-9Get rights and content

Abstract

Background

There is growing interest in the role of disgust in the pathogenesis of obsessive-compulsive disorder (OCD).

Methods

Eight OCD subjects with contamination preoccupations and eight gender- and age-matched healthy volunteers viewed pictures from the International Affective Picture System during functional magnetic resonance imaging scans.

Results

A different distribution of brain activations was found during disgust-inducing visual stimulation in several areas, most notably the insula, compared with neutral stimulation in both OCD subjects and healthy volunteers. Furthermore, whereas activation during the threat-inducing task in OCD subjects showed a pattern similar to that in healthy volunteers, the pattern of activation during the disgust-inducing task was significantly different, including greater increases in the right insula, parahippocampal region, and inferior frontal sites.

Conclusions

This pilot study supports the relevance of disgust in the neurocircuitry of OCD with contamination-preoccupation symptoms; future studies looking at non-OCD individuals with high disgust ratings, non–contamination-preoccupied OCD individuals, and individuals with other anxiety disorders are needed.

Introduction

The emotion of disgust may have an important role in the psychobiology of obsessive-compulsive disorder (OCD) (for a review, see Stein et al 2001). Recent studies have identified several regions of the brain that are involved in the facial recognition of “disgust” (e.g., the insula and putamen) Sprengelmeyer et al 1997, Sprengelmeyer et al 1998. Sprengelmeyer et al (1997) have noted that OCD patients have deficits when asked to identify facial representations of disgust, in comparison with other anxiety disorders. Furthermore, Phillips et al (2000) have shown that OCD individuals respond to “disgusting” stimuli differently from healthy volunteers—with functional magnetic resonance imaging (fMRI) activity in the insula. In this study, we used disgust-inducing pictures from the International Affective Picture System (IAPS)1Center for the Study of Emotion and Attention 2001, Lang et al 2001 to evaluate insula activation in OCD subjects compared with healthy volunteers. Activation patterns to disgust-inducing stimuli were compared, with activations prompted both by neutral pictures and by other arousing pictures (i.e., scenes of physical threat). As whole-brain data were collected, differences in all functionally active areas were similarly tested.

Section snippets

Subjects

Eight right-handed OCD subjects (five female/three male, age range 24–55, mean 41.8 years) with obsessions and compulsions predominantly focused on contamination (mean Yale-Brown Obsessive-Compulsive Scale [Y-BOCS] score of 25.13 ± 5.69) and eight right-handed healthy volunteers, gender- and age-matched (five female/three male, age range 34–44, mean 38 years), from a pool of 12 volunteers, participated. All participants signed written, informed consent as approved by the Health Science Center

Psychological and behavioral measures

On Haidt’s 32-item Disgust Scale (Haidt et al 1994), OCD subjects showed higher mean values than the healthy volunteers (73.5 ± 19.2 vs. 59.4 ± 13.6), with a near significant Mann–Whitney U test: [Z(7)= −1.84, p = .065]. The correlation between the level of disgust measured by the Haidt disgust scale and the level of OCD subject’s impairment measured by the Y-BOCS was positive (R = .55), but not significant for this small population.

Activation in healthy volunteers

Different patterns of brain activation were found during

Discussion

In this preliminary work, we aimed to identify the neural substrates recruited in the brains of individuals with OCD (concerned with cleaning and germs) and a matched group of healthy volunteers, when presented with pictures that are considered disgusting or that depict physical threat. The brain activation found for disgust included, most notably, the insula, part of the gustatory cortex that processes unpleasant tastes and smells, and a region reported to mediate the disgust response by

Acknowledgements

This work was supported by a National Alliance for Research on Schizophrenia and Depression Young Investigator Award to YL and by grants from the National Institute of Mental Health: MH37757, MH43975, and P50-MH523384.

The authors thank Dean Sabatinelli, Jin Tong Mao, Jeffrey Fitzsimmons, and Lewis Baxter for their technical assistance during the conception and design of this project.

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