Background and Objective: Contamination-based Obsessive-Compulsive Disorder (OCD) is a severe and disabling subtype, primarily driven by the emotion of disgust rather than anxiety. It manifests through compulsive washing, avoidance, and excessive concerns about cleanliness. This study aimed to explore the cognitive, emotional, and sociocultural mechanisms of disgust in individuals with this OCD subtype to inform more effective treatment strategies.
Materials and Methods: This mixed-methods study was conducted on 30 adult participants (aged 22–42) formally diagnosed with contamination-based OCD according to DSM-5 or ICD-10 criteria by a clinical psychiatrist. Data were collected through semi-structured interviews, standardized questionnaires, behavioral observations, and clinical assessments. Grounded Theory, Structural Equation Modeling, network analysis, and fuzzy-set Qualitative Comparative Analysis were used for data analysis and model construction.
Results: Disgust emerged as the core affective mechanism reinforcing compulsive washing (73.3%) and contamination avoidance (36.7%). The Structural Equation Modeling and network analysis confirmed significant links between disgust sensitivity and compulsive behaviors, while fuzzy-set Qualitative Comparative Analysis identified demographic and sociocultural configurations—such as being female gender, unmarried status, and religious upbringing—that amplify these behaviors. Disgust showed notable resistance to traditional Exposure and Response Prevention treatments, suggesting the need for disgust-specific interventions. This study emphasizes that disgust, shaped by biological, cognitive, and environmental factors, operates as a self-reinforcing emotional driver of obsessive-compulsive patterns.
Conclusion: This study proposes a multidimensional model positioning disgust at the center of contamination-based OCD. Addressing this emotion directly through innovative therapeutic strategies is essential for improving outcomes in this resistant OCD subtype.