Understanding Disgust Based OCD: Symptoms, Examples, and How ERP Can Help
Do you feel overwhelmed when you encounter something gross? Maybe it’s getting sticky food on your hands or smelling something bad. For some, the feeling of disgust comes and goes. For those with OCD, it can last a long time, leading to compulsions and avoidance. Feeling disgust is common in many subtypes of OCD. It can also be a subtype on its own. Though disgust is a challenging feeling to face, proper treatment can help you manage uncomfortable situations.
What is Disgust-based OCD?
Disgust-based OCD is a type of Obsessive Compulsive Disorder. It centers on obsessions about items or situations that could lead to feelings of disgust. Avoidance is a common compulsion with OCD, aiming to remove contact with things that are gross. Feelings can be physical, but can also be internalized. For example, being contaminated can make you feel like a gross person. Disgust triggers a different part of the brain than fear does, so symptoms may be managed a bit differently. If you have this subtype here are some things you may experience:
Signs & Symptoms
Preoccupation with things that are gross, sticky, or icky
Intrusive thoughts or images about triggers
Avoidance of situations that bring up feelings of disgust
Difficulty eating certain foods
Avoiding certain textures or substances
Symptoms make it difficult to function daily
Ruminating about where items have been
With the possibility of getting hit by unexpected triggers, life can be overwhelming. It might feel like the sensation of being contaminated won’t go away. Things that are already gross may lead to new fears. Public restrooms, bodily fluids, or sticky substances can feel dangerous, creating avoidance. Remember, this subtype of OCD follows a similar cycle as many others.
What is Obsessive Compulsive Disorder?
When understanding disgust-based OCD, it can be helpful to have an idea of OCD in general. Those with OCD experience a cycle of obsessions, uncomfortable emotions, and compulsions. Let’s look into each of these categories further:
Obsessions
Obsessions are a central part of OCD. They include intrusive images, thoughts, or urges. They are unwanted by the person who experiences them. Some examples are: “What if I just touched something that’s going to make me sick?”, “Am I really in love with my partner?”, “What if I secretly want to harm someone?”. They can also show up as images of something uncomfortable or bad happening. You might get flashes of triggering situations in your head. These intrusions lead to a sense of urgency, needing to do something about it. They also create a lot of uncomfortable emotions.
Anxiety and Distress
Understandably, obsessions cause intense distress. This might show up as anxiety, fear, disgust, overwhelm, or panic. There are often feelings of guilt, confusion, or shame attached. These feelings can go on for a long time, as intrusive thoughts come up often. Sitting with tough emotions is challenging. You might try to do anything you can to find relief. This is what fuels compulsions.
Compulsions
Compulsions are behaviors that temporarily reduce distress. They can show up as mental or physical actions. Though they provide relief in the moment, this feeling is brief. When obsessions keep coming up, you’ll feel discomfort and the urge to do compulsions again. Some examples of physical compulsions are asking for reassurance, handwashing, or researching. Examples of mental compulsions are replaying, planning, or figuring out answers in your head. Many with OCD experience a mix of both physical and mental compulsions.
How is disgust OCD different from contamination OCD?
When many think of Obsessive Compulsive Disorder, they think about contamination fears. They might be picturing the stereotype of someone washing their hands or sanitizing to avoid illness. While this is absolutely the case for many with OCD, others have different triggers. In fact, someone with Disgust-based OCD may avoid contaminants because of how they feel, not because of getting sick.
Let’s look at an example of using a public restroom and how that might trigger someone with either subtype:
With disgust-based OCD, a public restroom may be overwhelming. There are many substances or objects that are gross. It might be certain smells, finding a dirty toilet, or the thought of other people’s bodily fluids. When they walk in, they might be hit with a strong feeling of disgust. Either they will avoid public restrooms, or go through the motions with discomfort. They might feel this sensation of disgust stays with them throughout the day. Maybe they shower when they get home because they feel gross.
With contamination OCD, a public restroom can also trigger disgust. Their brain may take in the same information, making them feel grossed-out. However, there is another process. They also feel fear about what will happen when they become contaminated. Maybe someone who used the toilet before them had a severe illness. Maybe they worry about getting a sexually-transmitted disease from the toilet seat. These possibilities, while based on fear, feel intense. This person might go home and shower to prevent illness or infection.
Disgust and contamination fears can happen together or be separate. One of the biggest differences is that disgust involves a different part of the brain than fear does. Disgust has to do with the insula, a region that holds information about gross things we should avoid. This process may be more sensitive in those with OCD. Fear has to do with the amygdala, a region that sets off alarm when we face things that are scary. This can also be overactive in those with OCD. Disgust can make you avoid contamination because of how it feels. Fear can make you avoid contamination because of what will happen after.
Disgust-based Obsessions
There are many ways that disgust-based OCD can impact you. One is experiencing intrusive thoughts or images related to disgust. These are some examples of obsessions and feelings you might have:
“I will feel contaminated forever”
“I won’t be able to get rid of this feeling”
“What if this sticky stuff on my hands won’t come off?”
“I don’t feel clean enough after using the restroom”
“If I clean the house, will I come across something gross?”
“I can’t get a dog because I won’t be able to pick up after them”
“What if I can’t be in a relationship because kissing or intimacy feels gross?”
When you have OCD sometimes you can have intrusive images about triggers. Maybe the objects or substances that are disgusting to you pop in at random times. It can be hard to focus when you’re hit with uncomfortable feelings. Your obsessions may cause you to avoid things that might bring you joy, like friendships, relationships, or having a pet. The thought of feeling disgusted or contaminated forever is overwhelming. Some people experience moral disgust. They may have intrusive thoughts about becoming a disgusting or immoral person.
Disgust-based Compulsions
To combat these obsessions, you likely do compulsions. These behaviors might look a bit different for everyone. Here are some common compulsions you might do:
Avoiding objects, places, or situations that trigger disgust
Handwashing or cleaning surfaces
Restricting certain foods
Mentally reviewing places you have been contaminated in the past
Throwing away contaminated items
Extra wiping or washing after using the restroom
Avoiding pets or other animals
Avoiding relationships or intimacy because of disgust fears
With OCD, compulsions like these can take up a lot of energy. Rumination is a compulsion that is present with most forms of OCD. You may spend a bulk of your time avoiding triggers, but end up feeling uncomfortable anyways. It can feel like your life is shrinking as you avoid more and more. Having to be careful about what you touch or who you are around can impact your quality of life. Even when you feel relief, obsessions come back stronger. This can make you add to compulsions you already do, or spend more time doing them.
Why do people develop disgust-based OCD?
There are many reasons why someone might develop this subtype. OCD is thought to be from genetics and learned behavior. So if your parent has OCD or anxiety, you may be more likely to have it. Learned behavior can also be a factor. If you saw someone have a strong reaction to something gross, you could learn to react similarly. Maybe you had a challenging experience in the past yourself. Often, our brains want us to avoid things that are disgusting to protect us. Your brain might be on overdrive, urging you to not just avoid that thing, but anything gross. If you already have OCD or anxiety, a new subtype can be more likely to develop. Sometimes people with sensory sensitivities have comorbid OCD. This can make certain textures, tastes, or smells overwhelming.
What does treatment for disgust OCD look like?
Living with disgust-based OCD can be really hard when you do it alone. Effective treatment exists, and you can get better! Getting proper therapy can help you manage discomfort and re-engage with things you avoid. Exposure and Response Prevention (ERP) is the gold-standard treatment for Obsessive Compulsive Disorder. Well, there has not been a lot of research, but there have been people with lived experience in writing who have a better understanding of this process. Richard Gallagher, LMFT, wrote an article about discussing OCD and helped us understand it a little more. We do ERP, but we also use a lot of mastery skills and the approach might be just a bit different. While, we're still waiting for more research on this. We do see clients responding very well to this process. This process can guide you in responding differently to triggers. You will work with a therapist to get an understanding of OCD and how it impacts you. Slowly, you will begin facing situations that cause discomfort. Instead of relying on compulsions, you’ll learn to sit with distress and engage in things that hold meaning to you. This process will be at your pace, starting with exposures that are easier and working up to harder ones.
Since disgust is not experienced in the same way as fear, exposures may look a little different. This is because our goal in therapy is habituation. Habituation means getting used to something. For example, facing a fear, over and over, can lead to fearing it less. However, this type of OCD doesn’t just involve fear, but disgust. Disgust habituates slower than fear does. This can mean that seeing something gross will still feel gross. Our goal in therapy is to help you sit with this feeling instead of avoiding it. For exposures, you might be engaging in daily activities, even if disgust comes up. You might imagine yourself feeling contaminated, but be able to move through it. Instead of disgust as something you can’t experience, experience it as a normal part of life. Eventually, you will put yourself in situations where disgust comes up. This might be holding something sticky, eating a certain food, or using a public restroom. You will learn that you can manage something, even if it feels uncomfortable. Avoidance makes things overwhelming while facing them builds confidence.
Engaging with things you enjoy is an important part of treatment. Maybe OCD has caused you to shy away from things that interest you. Or maybe things you used to like don’t feel the same anymore. When you have OCD, getting involved in activities or tasks can add meaning to your life. As you make progress in ERP, you might find it easier to engage in them.
Disgust OCD Treatment in San Diego, CA
At Resilience Counseling, we understand the unique challenges of disgust-based OCD. Our team of OCD therapists are dedicated to supporting you through these struggles using evidence-based treatments. We specialize in treating OCD using Exposure and Response Prevention (ERP) and Cognitive Behavioral Therapy (CBT). We help clients regain control of their lives, building tools they can use in and out of session. We take a collaborative approach, creating a treatment plan that is specific to you. It can be hard to reach out for support. Our therapists value having a judgement-free space, where you can work through things at your pace.
We have helped countless kids, teens, and adults overcome OCD. No matter the subtype, we take time to understand your experience. By reducing avoidance and engaging to take small steps to push against OCD, you will build resilience. Learning to sit with challenging emotions can build inner strength. We help you build skills that you can use when you face triggers. Getting the right support can make all the difference. You don’t have to figure this out by yourself. If you feel ready to take the first step, contact us to hear more about how we can support you. Our team will figure out the best approach towards your path of building confidence, calm, and clarity. Schedule a free consultation today!
Katherine Pica OCD Therapist - San Diego, CA
Katherine Pica, LCSW, Founder and Clinical Director of Resilience Counseling. She has been practicing since 2007 with more than 19 years of clinical experience. She provides supervision and training to the practice’s OCD therapists with a focus on Exposure and Response Prevention (ERP) and EMDR for trauma. Katherine brings extensive experience treating OCD to both her clients and the clinicians she mentors.
Katherine also serves as a board member for OCD SoCal, where she is involved in increasing OCD awareness, education, and community support throughout San Diego, CA and Southern California.
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