Contamination OCD, Part 3: Enter Disgust, Stage Left
TL; DR
Contamination OCD can evoke feelings of disgust instead of anxiety, with disgust functioning as a protective emotional response evolved to keep us safe from contamination. Those with disgust-based OCD often feel overwhelmed by their triggers, which can include various contaminants, leading to compulsive behaviors like excessive cleaning for temporary relief. Exposure and Response Prevention (ERP) therapy is effective, particularly when using the inhibitory learning model, which focuses on tolerating feelings of disgust rather than simply habituating to anxiety. This approach encourages individuals to build new associations and disconfirm their fears while incorporating elements of Acceptance and Commitment Therapy (ACT) to help them live meaningfully despite their discomfort. Ultimately, OCD treatment is about accepting uncomfortable feelings as part of life while pursuing valued goals.
When OCD Causes Feelings of Disgust
When we talk about OCD, we typically discuss anxiety as the primary emotion involved. But for many folks, their OCD elicits disgust instead of or in addition to anxiety. The emotion of disgust functions differently from the emotion of anxiety. However, it is still responsive to exposure and response prevention (ERP) therapy, especially when therapy is focused on tolerance of the feeling.
Why Do People Feel Disgust?
The most likely answer is to keep us safe. Disgust is considered a universal emotion, meaning it is experienced and recognized across cultures. Evolutionary psychologists have proposed that disgust functions as a way to keep us safe from eating food contaminated by parasites, bacteria, etc. There are differences between cultures and individuals in how easily disgusted a person is and how sensitive a person is to disgust. By sensitive to disgust, I mean how unpleasant the feeling of disgust is to an individual. People with disgust-based OCD are typically more easily disgusted and experience disgust as more unpleasant.
The triggers in disgust-based contamination OCD are the same as classic contamination: triggers may be related to one contaminant, several distinct contaminants (e.g., poop and blood), or general contamination (e.g., germs). Often, when it comes to disgust-based contamination OCD, there is a core fear or concern that the individual will have that feeling of disgust, and it will never go away unless or until they are clean. There may also be a fear of germs and of getting sick, or it may simply be that the feeling will not go away. It makes sense, as I think most people would be concerned if they thought they would never be able to feel content again due to disgust. Due to that core concern, and due to the discomfort of feeling disgust, folks with OCD are driven to engage in compulsions such as cleaning and washing. The compulsions provide temporary relief. However, they make the problem worse in the long run. This is the OCD cycle.
How is Disgust-Based OCD Treated?
In ERP, people with OCD deliberately expose themselves to their triggers while resisting any form of avoidance or compulsive behavior. This disrupts the OCD cycle and allows people to learn something new. There are some nuances to how we go about ERP for disgust-based OCD that might be different from OCD symptoms focused on anxiety. For anxiety, there is often an expectation that folks will find their anxiety increases, peaks, and then decreases during the course of a single exposure. There is even more of an expectation that folks will find their peak anxiety begins to decrease after multiple exposure trials. This process is called habituation and is one model of how exposure therapy works.
However, in recent years, the inhibitory learning model has gained traction with a growing body of evidence for it. This model is more focused on tolerance of anxiety (and disgust!). It is called inhibitory learning because, instead of erasing an old association between two things (for example, an association between a spider and danger), we are building a new association (for example, between a spider and safety). We then have to build the new association stronger so that it overpowers or ‘inhibits’ the old association, which remains but may weaken over time. Think of a path dug in the ground for water to flow through. The water will keep flowing down that path unless another path is made, going in another direction. But the new path has to be dug deeper and wider in order to get most of the water to flow in that direction rather than the original direction.
There are several implications for how we might go about ERP depending on what model we are using. Here are some key differences:
Habituation model
Focus on the decrease of anxiety/distress
Expecting anxiety to decrease by half before ending exposure
Going up the exposure hierarchy from lowest to highest fear
Setting up exposure to learn that anxiety will reduce on its own
Doing an exposure to one trigger at a time
Inhibitory learning model
Focus on tolerance of anxiety/distress
Expecting to learn something new before ending exposure
Example: learning that you can cope with this feeling
Starting with an exposure with lower anxiety, but then varying the intensity of the exposure
Focus on willingness rather than anxiety level in choosing exposures
Setting up exposures to disconfirm expectations
Combining triggers in a single exposure, when appropriate
Variety: varying the place, time, etc., in which the exposure is done to generalize learning to different contexts
Final Thoughts From an OCD Therapist
When it comes to disgust, ERP for OCD usually leads to less habituation. Specifically, decreases in disgust are slower and rarely occur in a single exposure trial. Thus, using the inhibitory learning approach to ERP is highly recommended by experts when addressing disgust in OCD. OCD treatment involves tolerating the feeling of disgust and disconfirming expectations of what would happen if disgust is triggered; you allow yourself to feel disgusted.
Since there is much less focus on habituation and more on tolerance, elements of acceptance and commitment therapy (ACT) can be included in treatment. The use of mindfulness can guide folks on how to tolerate disgust. During treatment at Leap Counseling, I find that it is also beneficial to focus more on values than on the level of disgust. ACT involves identifying values and committing to a meaningful life. Meaningful, valued choices can carry uncomfortable feelings with them, and we accept those feelings as part of life.
As an online OCD Therapist, I tend to think of acceptance as thus: Disgust is a feeling that is uncomfortable and unwanted. It is like a briefcase that is permanently chained to your wrist. You can spend all your time and energy trying to find weaknesses in the chain, trying to find some way to get rid of this briefcase. OR you can pick up the briefcase and carry it with you while you do the things you want to do. Things that provide meaning and hope in your life.
Disgust Doesn't Have to Drive Your Decisions Anymore. Online OCD Treatment in Wauwatosa, WI, Can Help
When disgust is running the show, it can feel like your own body is working against you — but that overwhelming sense of revulsion is something OCD therapy can directly address. With the right treatment, you can learn to tolerate disgust without letting it dictate what you touch, where you go, or how you live.
Leap Counseling and Consultation is a Wisconsin-based solo therapy practice led by Dr. Johanna Wood, who specializes in OCD and anxiety disorders, including disgust-driven contamination OCD. Dr. Wood offers personalized, evidence-based treatment designed to help clients sit with discomfort and disgust rather than escape it through compulsions. Getting started is easier than it might feel right now:
Voice your concerns and explore treatment outcomes during a free 15-minute consultation
Work one-on-one with an experienced OCD therapist in Wauwatosa who understands the role disgust plays in OCD
Learn how to tolerate discomfort and loosen disgust's grip on your daily life with support every step of the way
Other Services With Leap Counseling in Wisconsin & All PSYPACT States
When disgust is at the core of your OCD, therapy goes beyond managing anxiety. It requires learning how to tolerate an emotion that feels completely unbearable without running from it. Many people who work through disgust in OCD treatment find that they're not only less controlled by their triggers but more confident in their ability to handle discomfort in all areas of life.
Disgust-based contamination OCD is one of many conditions I treat at my Wisconsin-based online therapy practice, and it rarely exists in a vacuum. If you're carrying other concerns alongside your OCD, those are worth exploring too. I offer therapy for a broad range of anxiety disorders, including Panic Disorder, Agoraphobia, Generalized Anxiety Disorder, Social Anxiety Disorder, and Phobias. As a licensed psychologist in Wisconsin and all PSYPACT states, I work with clients online across a wide range of locations.
Wherever disgust and anxiety have taken hold in your life, they don't have to stay in charge. Browse my mental health blog for more on contamination OCD and anxiety treatment, and reach out when you're ready to take that first step.
About the Author
Dr. Johanna Wood is a Wisconsin-based clinical psychologist specializing in evidence-based OCD treatment, including Exposure and Response Prevention (ERP). She earned her PhD in Clinical Psychology from Northern Illinois University, completed her doctoral internship at Rogers Behavioral Health in the OCD and Anxiety Adult Residential Program, and has supervised clinical staff in residential OCD treatment settings. She is licensed in Wisconsin, holds PSYPACT authorization, and is an active member of the International OCD Foundation, contributing to national education efforts on scrupulosity OCD.
What makes Dr. Wood's approach to disgust-driven OCD especially meaningful is that she's no stranger to the emotional intensity OCD can generate. Having navigated intrusive thoughts and the anxiety spiral of relationship OCD personally, she understands what it's like when an emotion feels too big, too threatening, and too persistent to sit with. Her own ERP treatment is an experience she draws on directly when helping clients work through the overwhelming nature of disgust and the compulsions it fuels. That combination of firsthand experience and deep clinical expertise is at the heart of the compassionate, no-nonsense OCD therapy she provides at her Wisconsin-based practice.
