How to Manage Disgust--With or Without OCD

Disgust may be one of the most powerful emotions we feel. It’s also the most misunderstood. In today’s podcast, we’ll explore what disgust is, how it helps us and how it harms us. Specifically, let’s address how to manage disgust if it’s part of the OCD picture—or part of your life even if you don’t have OCD. 

Let’s kick it off with a story about disgust. Trigger alert. If you don’t want to hear it, fast forward about 20 seconds. 

One of my favorite scenes in the Barbie movie unfolds when Barbie confesses to her friends that her heels touch the ground. Dr. Barbie says, “Show me,” Then exclaims, “Flat Feet!” You see the disgust of Dr. Barbie, the other Barbies and even Ken as they start to retch.

I saw that expression of disgust among a different group in real life. A group of surgeons  were sharing stories after an evening of dining and drinking a medical meeting. A surgeon told us about a patient he treated while he was volunteering on a medical mission. A patient came to the make-shift hospital with a leg injury. As this surgeon cut away the dressing, he saw something moving in the open leg wound. He looked more closely and saw the wound was crawling with  maggots. These seasoned male surgeons who had seen it all, said almost in unison said, = “EWWEE.” One surgeon kept his calm and said, “I bet the wound wasn’t infected. Maggots keep wounds clean.” 

You know disgust when you feel it or see it. Disgust is a feeling of revulsion or profound disapproval when you encounter something offensive, poisonous or contaminating. 

Disgust is the most universal emotion on the planet. You one easily recognize the expression of someone who is disgusted.

Yet, it’s the most poorly understood emotion we have. 

Charles Darwin was the world’s first disgustologist—a scientist who studies and writes  about disgust. Darwin was curious about the role emotions play in evolution. 

He wrote his colleagues from all corners of the world, and asked about how local natives expressed disgust. He found that the expression of disgust was near-universal.

In his book The Expressions of Emotions in Man and Animals, he described the face of disgust. The eyes squint, the tongue sticks out and the nose crinkles as if to prevent toxins from getting into the body. The “Eww” my surgeon colleagues expressed force air out of the lungs. 

Disgust presents with varying intensities from mild dislike to intense loathing. 

Why would we have disgust?

Think of feelings as warning lights on the car dashboard. Emotions offer us information about what’s happening around and inside of ourselves.

The most power emotions that grab our attention most effectively offer information about threats to our safety.

When we face live and death circumstances, our body activates the danger response. Fear triggers the fight-flee -freeze response to get us back to safety.  In fact, our very survival is predicated on our ability to escape predators. 

What’s the biggest threat to life after predators? It’s disease. While most predators picks off individuals, communicable diseases can wipe out entire tribes. 

Think of disgust as a feeling that helps us avoid circumstances that increase the risk of disease. Steven Pinker describes disgust as intuitive microbiology. 

We can feel disgusted by something we perceive with our physical senses, including sight, smell, touch, sound, taste. Disgust causes us to keep our distance from expelled body fluids like feces, vomit, urine, mucus and blood that could carry disease.

The triggers that evoke disgust may be the most diverse of any human emotion, ranging from dirty bathrooms to unappetizing food to someone with poor hygiene. Have you ever noticed that cleaning products and diapers are in their own isles in the center of the store that don’t have food. People don’t buy food right next to products intended to manage contamination. It’s as if the food itself becomes contaminated. 

Disgust compels us to keep our distance from people with signs of illness, places infested by insects or rodents, or rotten food. Realtors talk about the challenges of selling houses that smell funny.

Some triggers for disgust are universal whereas other triggers are much more culturally and individually influenced .

Next time you’re in Sweden, you can visit the Museum of Disgusting Foods. I once bought Durian fruit into the house . Once I cut into it, there were screams, “That’s disgusting. Get it out of here.” 

Intimacy lowers the threshold for what we consider disgusting. In a pinch, you might be willing to share your toothbrush to your partner; however it’s unlikely you would share it to a stranger. This intimacy disgust reset  helps us change a baby’s diapers or care for a sick loved one. This suspension of disgust establishes intimacy and may even strengthen love and community.

Disgust compels us to stay away from,  block off, or eliminate something offensive, toxic or contaminating. This helps keep people safe and healthy.

We can also experience what’s been called  “social disgust” or “moral disgust”.  We can feel disgust by another person’s appearance, actions, ideas or social standing.

You may have disgust as you hear about pedophiles, or clergy who perpetrate scams against senior parishoners or police officers who choke suspects in their custody.

Some call social or moral disgust ways of preventing contamination of the soul. 

We can understand social disgust from an evolutionary standpoint. In the Paleolythic era, our survival was tied to our ability to  collaborate when we hunted. We depended on each other.

To live together, we have to define as a group what was and what was not allowed. Disgust helps you identify behaviors that unacceptable and bring the threat of expulsion. 

Everyone may have disgust reactions to a “morally tainted” person, but what is considered “morally tainted” might vary across cultures.

There is an ongoing debate within the scientific community as to whether certain forms of social disgust— like being disgusted by another person’s appearance, actions, ideas or social standing—are learned and culture-specific or whether they exist in some form across all cultures.

OCD and Disgust

In a sense people with OCD are safety-driven beings. OCD themes reflect different ways of describing how the world is unsafe. 

People with OCD may be more sensitive to danger. They respond to potential danger more robustly.

A neuropsychologist did an experiment. He swished a pencil around a toilet, then touched one pencil to another and then another and then another. He went to a maximum of 12 pencils. People without OCD said that the 6th pencil was no longer contaminated. People with OCD said that there were not enough pencils to make them clean. 

When he repeated the experiment with the pencil touching candy, there was no contamination concern. 

Just as a reminder of how OCD works, a circumstance can trigger an obsessive thought that is deeply disturbing. The obsession creates intense feelings. Then the person performs compulsions to get relief from the feeling.

The feelings associated with the cycle of obsessions and compulsions are usually fear and anxiety.

Disgust can be part of the robust safety response. Let me show you how.

Over half of people with OCD wrestle with contamination themes. They may see contamination differently than someone without OCD. Did you have the 10 second rule with your children If dropped food is on the floor for less than ten seconds, it’s safe to eat. Not so for someone with OCD.  

When we think of people with contamination themes, we know they can respond with fear or anxiety. They think, “I’ll get sick and die!”

However, other people can respond with disgust. They think,  “I’ll never feel clean enough and will obsess about this forever!”

OCD compulsions can serve to either avoid harm or avoid disgust.

People with other OCD themes beyond contamination can experience disgust. 

For people with symmetry/ordering symptoms, feelings of disgust may be associated with perceived messiness or disorganization. Think of how you feel when you watch the TV show Hoarders.

Individuals with sexual obsessions may experience  disgust in response to unwanted sexual thoughts or images. Part of this could be contamination-related disgust. The exchange of bodily fluids themselves can be seen as disgusting. 

A person who has sex increases their risk of sexually transmitted diseases. They exchange body secretions. In fact one third of people with untreated OCD are either virgins or have not had sex in many years. 

However, other people with sexual OCD themes talk feel disgust. They judge their sexual thoughts as immoral or wrong. 

Disgust appears to be a predictor of religious obsessions. How is disgust-related OCD treated

The evidence-based gold standard treatment for OCD is called Exposure and Response Prevention or ERP. You help the brain understand that neither anxiety nor the trigger for the anxiety are dangerous through intentional exposures. You allow anxiety or fear to take its course. 

You can certainly take disgust to your therapist for ERP. 

However, if you’ve tried, you might find that you don’t get the same great results that you see with anxiety or fear. You might find that it takes many more exposures, and the result unfold much more slowly.   

One study reported that about half of all-comers with disgust don’t respond, drop out or refuse ERP intervention. About 75% of patients who do complete treatment exhibit residual symptoms.

Just as a reminder, I am not a therapist; I do not treat people with OCD. Instead my goal is to help you understand how your human brain works and point you to strategies that will help you be freed from OCD.

So let’s look at the brain.  

Different part of the brain are involved with disgust than anxiety and fear.

Disgust is processed in the part of the brain involved with long-term memory.

Disgust neural circuits are much slower to change. 

How then, do you manage disgust whether or not you have OCD? 

Here are a few steps.

First, recognize that disgust is a normal human emotion.

Disgust is there to serve us—to keep us safe from physical or social or moral contamination.

Disgust also has the potential to harm us. It can keep us from doing the things we want to do.

I can give you and example from my own personal experience. I have a very specific trigger for my own disgust. I get disgusted by the sight of blood being withdrawn from my body or the bodies of people I love. I can watch strangers get their blood drawn. In fact, I once worked at a blood bank.

To be clear, I didn’t have phobias around needles. I didn’t have worries about the temporary discomfort of a blood draw. I had a very specific sensation in my body at the sight of blood leaving my body. I would feel an urge to pull the needle out of my arm and run. When I needed multiple vials of blood, I would always say to the nurse, “Are you done yet?” 

I decided to become a doctor after I had a life-threatening emergency. I was bleeding internally.

When I told a friend that I was going to apply to medical school, she asked, “But what about this blood  thing?” 

Was I going to allow this blood draw thing get in the way of applying to medical school? I certainly could have. No one would even have to have known.

But I just decided that my desire to become a doctor was stronger than my fear of disgust. I would find a way of dealing with it. Feeling disgusted was something I could learn to deal with, and I did.

That did not mean the disgust would go away. After all these years being a surgeon, I can feel queasy when my own blood is drawn. 

It was not going to stop me, though.

So, if you feel disgust, you, too have a choice. You can decide whether disgust has control over you , or you have control over it.

Here are some specific steps to take. You can sign up below to get w worksheet to help you manage disgust.

Where do you feel disgust in your body? How do you know you’re having disgust and not fear or anxiety? 

What triggers your disgust? Can you offer some specific circumstances, like my disgust with blood coming out of my body? 

What triggers the disgust of those around you?

What actions do you take when you’re disgusted?

What actions do you take to avoid being disgusted?

How does disgust limit your life?

What are some strategies you can use to tolerate disgust and move forward?

1. Stop beating up on yourself for feeling disgust. You are not a bad person because you feel disgust. Have your own back.
2. Name it. “I’m having her sensation of disgust.”
3. Interpret it, ”My body is trying to protect me from dying of contamination. It does not understand that I am completely safe.” 
4. Reassure yourself, “I can live though this feeling for 45 seconds. Disgust will not kill me.” 
5. Prepare yourself. Let’s say your trigger for disgust is being in the presence of someone who is sick or dying. Your grandmother is in hospice, and you want to go and say goodbye. You also know that if you go, you might throw up. You’ll certainly want to run from the room. Your desire to say goodbye is stronger than your disgust, and you want to go. You can prepare. Maybe there’s something you can say to yourself. 
6. If you feel disgust, say, “I feel disgust. That’s just my body trying to keep me safe.”
7. You can also say, “If I throw up, it’s okay. I can live through that.”
8. You can say, “If I want to run out of the room, it’s okay. Even if I leave early, it’s okay.” I can do that. If you’re disgusted by being in the presence of people sho are sick, and you want to visit a relative with cancer.  

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Disgust does not need to control or ruin your life. When you feel disgust, think about Barbie’s flat feet. In her reinvented life, Barbie’s flat feet were not a problem. In fact, there weren’t even an issue. With some thought work, you can get there with disgust, too.

Let me leave you with a final thought.

Many families touched by OCD feel alone in their struggles. 

If you found this information helpful, please feel welcome to share it with friends and family and communities in which you participate. 

Let’s get the message out there that people struggling with OCD are not alone. There is is hope. 

Thank you again for your investment in your family and yourself. You got this!