The central role of disgust in disorders of food avoidance

Abstract

Background Individuals with extreme food avoidance such as Avoidant Restrictive Food Intake Disorder (ARFID) experience impairing physical and mental health consequences from nutrition of insufficient variety or/and quantity. Identifying mechanisms contributing to food avoidance is essential to develop effective interventions. Anxiety figures prominently in theoretical models of food avoidance; however, there is limited evidence that repeated exposures to foods increases approach behavior in ARFID. Studying disgust, and relationships between disgust and anxiety, may offer novel insights, as disgust is functionally associated with avoidance of contamination from pathogens (as may occur via ingestion) and is largely resistant to extinction. Method This exploratory, cross‐sectional study included data from 1,644 adults who completed an online questionnaire. Participant responses were used to measure ARFID classification, picky eating, sensory sensitivity, disgust, and anxiety. Structural equation modeling tested a measurement model of latent disgust and anxiety factors as measured by self‐reported frequency of disgust and anxiety reactions. Mediational models were used to explore causal ordering. Results A latent disgust factor was more strongly related to severity of picky eating (B ≈ 0.4) and ARFID classification (B ≈ 0.6) than the latent anxiety factor (B ≈ 0.1). Disgust partially mediated the association between anxiety and picky eating and fully mediated the association between anxiety and ARFID. Models testing the reverse causal ordering demonstrated poorer fit. Findings suggest anxiety may be associated with food avoidance in part due to increased disgust. Conclusions Disgust may play a prominent role in food avoidance. Findings may inform novel approaches to treatment.

Characteristics of avoidant/restrictive food intake disorder in a general paediatric inpatient sample

“…In contrast to AN, patients with ARFID lack shape concerns, body image preoccupation, and drive for thinness (Norris, Spettigue, & Katzman, 2016; Schmidt, Vogel, Hiemisch, Kiess, & Hilbert, 2018). Instead, they often have a narrow range of accepted foods based on taste, texture, colour, appearance, or odour, a fear of swallowing, choking or vomiting, and/or a lack of interest in food or disgust (Harris et al, 2019; Mammel & Ornstein, 2017; Norris et al, 2018; Reilly, Brown, Gray, Kaye, & Menzel, 2019; Zickgraf, Lane‐Loney, Essayli, & Ornstein, 2019). Generally, ARFID has a higher prevalence in younger children and boys than other eating disorders and is frequently associated with concurrent physical and psychological symptoms and lower quality of life (Fisher et al, 2014; Krom et al, 2019; Nicely, Lane‐Loney, Masciulli, Hollenbeak, & Ornstein, 2014).…”

Disgust Theory Through the Lens of Psychiatric Medicine

“…Future work would be expected to provide more clarity to this debate. Notwithstanding, if future research further supports this conceptualization, it would have important clinical implications in that disorders for which disgust is a core component had been missed because of low scores on measures developed in accordance with the cultural evolution or adaptationist models (e.g., food disgust in avoidant restrictive food intake disorder; Harris et al, 2019).…”

Editorial to the virtual issue highlighting neuroscience based research in eating disorders to mark the 49th Society for Neuroscience Annual Meeting

“…Recently there has been renewed focus on taste perception, specifically disgust in the context of food avoidance. Harris et al () found in a survey across a large cohort of adult individuals that measures for disgust were closely related to anxiety in avoidant restrictive food intake disorder. This led to the hypothesis that sensory sensitivity could be a risk factor for food avoidance behaviors and if we can identify the underlying mechanism or neurobiology we could develop a novel target for treatment (Menzel, Reilly, Luo, & Kaye, ).…”