The Mediating Role of Anxiety Sensitivity and Distress Tolerance in the Relationship Between Disgust and Severity of Washing/Contamination Obsessive-Compulsive 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: The OCD represents a chronic psychiatric condition, with adolescent symptom onset potentially indicating a more adverse long-term prognosis. The present study examined how two modifiable psychological constructs — anxiety sensitivity (AS) and distress tolerance (DT) — 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), AS (r = 0.67, P < 0.01), and DT (r = 0.39, P < 0.01). Structural equation modeling demonstrated significant partial mediation effects for both DT (indirect path coefficient = -0.123, VAF = 0.194) and AS (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 AS and diminished DT were associated with greater severity of disgust-related OCD symptoms in adolescents. These findings suggest that therapeutic interventions specifically targeting AS reduction and DT enhancement may optimize treatment outcomes for washing/contamination OCD presentations, particularly when integrated with exposure-based therapeutic approaches addressing disgust-related triggers.