The mediating role of anxiety sensitivity and distress tolerance in the relationship between disgust and severity of washing/contamination obsessivecompulsive symptoms among adolescents with obsessive-compulsive disorder

Abstract

Background: Disgust is among the most prevalent emotions experienced in obsessive-compulsive disorder (OCD). Individual differences in emotional processing and response patterns significantly influence coping strategies employed when confronting aversive emotional experiences. Objectives: Obsessive-compulsive disorder represents a chronic psychiatric condition, with adolescent symptom onset potentially indicating more adverse long-term prognosis. This study examined how two modifiable psychological constructs—anxiety sensitivity and distress tolerance—mediate the relationship between disgust propensity and sensitivity and washing/contamination OCD symptom severity. Methods: This cross-sectional investigation employed structural equation modeling to examine data from 189 adolescents (ages 11-18 years) diagnosed with OCD, recruited through convenience sampling from Kargarnejad Hospital and affiliated psychotherapy centers in 2024. Assessment instruments included the Disgust Propensity and Sensitivity Scale-Revised (DPSS-R), Padua Inventory-Washington State University Revision (PI-WSUR), Anxiety Sensitivity Index (ASI), and Distress Tolerance Scale (DTS). Statistical analyses were conducted using SPSS version 26 and SmartPLS version 3. Results: Correlation analyses revealed significant associations between disgust propensity and washing/contamination OCD symptoms (r = 0.79, p < 0.01), anxiety sensitivity (r = 0.67, p < 0.01), and distress tolerance (r = 0.39, p < 0.01). Structural equation modeling demonstrated significant partial mediation effects for both distress tolerance (indirect path coefficient = -0.123, VAF = 0.194) and anxiety sensitivity (indirect path coefficient = 0.228, VAF = 0.241) in the disgust-OCD symptom relationship (p < 0.001). Model fit indices indicated adequate model fit (NFI = 0.915, SRMR = 0.09, χ² = 48.296). Conclusions: Elevated anxiety sensitivity and diminished distress tolerance were associated with greater severity of disgust-related OCD symptoms in adolescents. These findings suggest that therapeutic interventions specifically targeting anxiety sensitivity reduction and distress tolerance enhancement may optimize treatment outcomes for washing/contamination OCD presentations, particularly when integrated with exposure-based therapeutic approaches addressing disgust-related triggers.