Journal of Anxiety Disorders 22 (2008) 56–66

Recognition of facial expressions in

obsessive–compulsive disorder
Kathleen M. Corcoran a, Sheila R. Woody a,*, David F. Tolin b
a
University of British Columbia, Vancouver, British Columbia, Canada
b
The Institute of Living, Hartford, CT, United States
Received 8 September 2006; received in revised form 22 December 2006; accepted 26 January 2007

Abstract
Sprengelmeyer et al. [Sprengelmeyer, R., Young, A. W., Pundt, I., Sprengelmeyer, A., Calder, A. J., Berrios, G., et al. (1997).
Disgust implicated in obsessive–compulsive disorder. Proceedings of the Royal Society of London, 264, 1767–1773] found that
patients with OCD showed severely impaired recognition of facial expressions of disgust. This result has potential to provide a
unique window into the psychopathology of OCD, but several published attempts to replicate this finding have failed. The current
study compared OCD patients to normal controls and panic disorder patients on ability to recognize facial expressions of negative
emotions. Overall, the OCD patients were impaired in their ability to recognize disgust expressions, but only 33% of patients
showed this deficit. These deficits were related to OCD symptom severity and general functioning, factors that may account for the
inconsistent findings observed in different laboratories.
# 2007 Elsevier Ltd. All rights reserved.

Keywords: Disgust perception; Obsessive–compulsive disorder; Facial expression recognition

1. Introduction sadness, and surprise (Ekman, Levenson, & Friesen,

Accurate recognition of facial expressions is a
critical element of humans’ social structure (Ekman,
1992), serving as a guide for social behaviour. Even
toddlers gain important information from the facial
expressions of others (La Barbera, Izard, Vietze, &
Parisi, 1976; Sorce, Emde, Campos, & Klinnert, 1985;
Young-Browne, Rosenfeld, & Horowitz, 1977). Adults
across various cultures recognize six basic facial
expressions of emotion: anger, disgust, fear, happiness,
* Corresponding author at: Department of Psychology, University of
British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4 Canada.
Tel.: +1 604 822 2719; fax: +1 604 822 6923.
E-mail address: swoody@psych.ubc.ca (S.R. Woody).
1983; Ekman, Sorenson, & Friesen, 1969; Izard, 1971),
a finding that is reliable across numerous procedural
variations (Boucher & Carlson, 1980; Izard, 1971).
Despite this apparent universal ability, individuals
with some forms of psychopathology are impaired in
their recognition of facial expressions, although the
specific quality and meaning of these deficits is still
poorly understood. Researchers have documented
abnormalities in facial expression recognition in
alcoholism (Kornreich et al., 2001a, 2001b), Alzhei-
mer’s disease (Hargrave, Maddock, & Stone, 2002),
anorexia nervosa (Zonnevijlle-Bendek, van Goozen,
Cohen-Kettenis, van Elburg, & van Engeland, 2002),
bipolar disorder (Ketter & Lembke, 2002), criminal
psychopathy (Kosson, Suchy, Mayer, & Libby, 2002),
social phobia (Simonian, Beidel, Turner, Berkes, &

0887-6185/$ – see front matter # 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.janxdis.2007.01.003
 K.M. Corcoran et al. / Journal of Anxiety Disorders 22 (2008) 56–66
Long, 2001), major depression (Rubinow & Post,
1992), schizophrenia (Addington & Addington, 1998;
Archer, Hay, & Young, 1992; Heimberg, Gur, Erwin,
Shtasel, & Gur, 1992), and obsessive–compulsive
disorder (Sprengelmeyer et al., 1997), the subject of
this investigation.
Even in the case of depression and schizophrenia,
which have been more extensively studied, the precise
nature of the deficits is unclear. Some studies report
generally impaired recognition of facial expressions
among those with major depression (Persad & Polivy,
1993) or schizophrenia (Lewis & Garver, 1995), which
would suggest that the impairments reflect a general
deficit in face processing or overall neurocognitive
functioning, rather than expression recognition per se
(Addington & Addington, 1998; Bryson, Bell, &
Lysaker, 1997; Kerr & Neale, 1993). More typically,
however, results point to problematic recognition of
specific facial expressions in depression (Mikhailova,
Vladimirova, Iznak, Tsusulkovskaya, & Sushko, 1996;
Rubinow & Post, 1992) and schizophrenia (Davis &
Gibson, 2000; Dougherty, Bartlett, & Izard, 1974;
Kucharska-Pietura & Klimkowski, 2002; Muzekari &
Bates, 1977; Walker, Marwit, & Emory, 1980). Notably,
in a study with normal undergraduates, Rozin, Taylor,
Ross, Bennette, and Hejmadi (2005) observed wide
variability across participants in general ability to
classify emotions depicted in facial expression but no
evidence of individual differences in specific recogni-
tion deficits.
Although affect recognition deficits have been
observed in both schizophrenia and depression, the
findings show important differences with potential
clinical implications. The impairments in the recogni-
tion of facial expressions are more severe in schizo-
phrenia than in depression (Feinberg, Rifkin, Schaffer,
& Walker, 1986; Heimberg et al., 1992). Impairment in
affect recognition appears to improve upon symptom
remission in depression (Mikhailova et al., 1996) but
not in schizophrenia (Addington & Addington, 1998;
Gaebel & Woelwer, 1992), although the deficits predict
poor treatment outcome in depression (Geerts &
Bouhuys, 1998).
In the case of obsessive–compulsive disorder (OCD),
researchers have speculated that disgust may play a role
in some forms of the disorder, particularly contamina-
tion-based types (Phillips, Senior, Fahy, & David,
1998a; Power & Dalgleish, 1997; Woody & Teachman,
2000). In 1997, Sprengelmeyer et al. tested 12
participants with OCD (primarily checking symptoms),
12 with Tourette’s Syndrome (five of whom also
showed prominent obsessive–compulsive behaviours),
57
8 anxiety disorder controls, and 40 normal controls on
two tasks of facial expression recognition. OCD patients
showed a marked deficit in recognition of disgust
expressions and normal performance on expressions of
anger, fear, happiness, sadness, and surprise. Intrigu-
ingly, Tourette’s patients with prominent obsessive–
compulsive behaviours demonstrated the disgust
recognition impairment, while those without obses-
sive–compulsive behaviours did not. Sprengelmeyer
et al. included a control task to rule out reluctance to
choose the label ‘‘disgust’’ on the part of individuals
with OCD.
The findings presented by Sprengelmeyer et al.
(1997) have attracted attention not only for their pattern
of results but also for their magnitude. Every individual
with OCD was impaired in the recognition of disgust,
whereas no participant without clinically significant
obsessive–compulsive behaviours showed this impair-
ment. Moreover, OCD patients showed specific
impairment in the recognition of disgust, rather than
a general pattern of poor performance on the task. Some
observers have suggested that the effect may occur only
among a subset of individuals with OCD—perhaps
those with contamination concerns (Power & Dalgleish,
1997; Woody & Tolin, 2002). Other researchers have
pointed to brain functioning in OCD, with imaging
results thus far pointing toward the basal ganglia and
anterior insula (Phillips, Young et al., 1998; Phillips
et al., 1997; Sprengelmeyer, Rausch, Eysel, & Przuntek,
1998).
Despite the unusually strong effect observed by
Sprengelmeyer and his colleagues, no other research
team has replicated the result. Parker, McNally,
Nakayama, and Wilhelm (2004) used procedures that
were very close to those used by Sprengelmeyer, with
the addition of new models for the facial expressions.
They found no overall differences in performance
between the OCD and normal control groups. Buhl-
mann, McNally, Etcoff, Tuschen-Caffier, and Wilhelm
(2004) reported similar performance for individuals
with OCD and normal controls on a recognition task of
prototypical emotional expressions. Although Rozin
et al. (2005) used a normal sample, they conducted an
analysis examining 26 individuals who scored in the
clinical range on the Obsessive Compulsive Inventory
(Foa, Kozak, Salkovskis, Coles, & Amir, 1998). These
individuals actually recognized disgust expressions
better than did participants with lower scores.
The Sprengelmeyer et al. (1997) study was intriguing,
but without replication it simply remains mysterious.
Several of the replication attempts described above were
underpowered by ordinary standards, although the initial
58 K.M. Corcoran et al. / Journal of Anxiety Disorders 22 (2008) 56–66
Sprengelmeyer results yielded such large effects that
even very small samples would be expected to replicate
them. Parker et al. (2004) raised one interesting clue.
Although they failed to replicate the overall results,
Parker et al. described one individual, the most severe
OCD patient in the sample, who showed marked
impairment in recognition of disgust, suggesting that
severity of OCD may be an important element of the
effect.
Unfortunately, severity of symptoms was not
detailed in the Sprengelmeyer et al. (1997) study.
The study also provided little information on other
diagnostic issues such as how diagnosis was deter-
mined, which comorbid conditions were present, or
types of OCD symptoms beyond checking. The present
study aimed to replicate the Sprengelmeyer et al.
finding, using a sample of individuals with OCD who
were seeking treatment in anxiety specialty clinics as
well as adding methodological controls such as
structured clinical interviews for diagnosis and symp-
tom severity assessment. Because individuals with
depression show deficits in the recognition of facial
expressions of emotion, we also examined the role of
comorbid depression.
Although we adhered closely to the method
presented by Sprengelmeyer et al. in many ways, we
changed the stimuli to test the robustness of the finding.
This study used two models (one male and one female)
from the Ekman and Friesen (1976) set, neither of
which was the one used by Sprengelmeyer et al. The
most common error for Sprengelmeyer’s OCD parti-
cipants was to select anger in place of disgust when
naming facial expressions, an error also observed in
normal samples (Ekman & Friesen, 1976; Rozin et al.,
2005). The Sprengelmeyer et al. stimuli were prepared
by morphing each facial expression with two others to
increase the difficulty of the task. In the case of disgust
stimuli, the expression was morphed with anger or
sadness, but not fear. Stimuli in the current study
included all possible morphed combinations of disgust,
anger, fear and sadness although only the prototypical
facial expressions were analyzed.
2. Method
2.1. Participants
Three different samples were tested. Individuals with
primary OCD (n = 40) and those with primary panic
disorder (n = 36) were recruited from anxiety disorder
specialty clinics in Vancouver, Canada and Hartford,
Connecticut. On the basis of an initial evaluation with a
structured clinical interview, clinical participants with a
primary diagnosis of OCD or panic disorder (without
history of OCD) were invited to participate in the study.
Many OCD patients also met criteria for major
depression (32.5%), and some (13.9%) met criteria for
an additional anxiety disorder diagnosis. Some in the
panic disorder group also met criteria for major
depression (5%) or another anxiety disorder (27.7%).
The OCD and panic disorder groups did not differ with
regard to their DSM-IV Axis V level of functioning
(GAF scale means were 56.29  8.04 and 57.93  7.79
for the OCD and panic disorder groups, respectively),
t(60) = 0.81, p > 0.40. As is typically the case, the main
symptom varied across participants with OCD: check-
ing/ordering (33.3%), contamination (22.2%), primary
obsessions (i.e., sexual, blasphemous, or aggressive
obsessions in the absence of rituals; 22.2%), super-
stitious rituals (8.3%), and hoarding (5.6%). Some
participants (8.3%) presented with symptoms that did
not fit these categories. The mean age of onset of OCD
was 18.1 years (8.0).
Participants in the normal comparison group (n = 36)
were recruited through advertisements located through-
out the University of British Columbia campus. They
were selected to balance the OCD sample for age and
gender, and they were excluded from participation if
they endorsed a history of anxiety disorder or psychosis
or symptoms consistent with a current mood disorder.
Most of the participants were women (63.9%), with a
similar proportion across groups, x2(2, N = 112) = 2.89,
p > 0.20. Participants’ mean age was 34.0 years
(S.D. = 11.1), with no group differences, F(2,
108) = 2.47, p = 0.09. Of participants who reported
their ethnic or racial group, 75.9% identified themselves
as Caucasian, 10.7% identified as Asian, and 10.7%
identified other racial or ethnic backgrounds. There was
a significant difference in distribution of ethnicity
across groups, x2(2, N = 109) = 7.32, p < 0.05, due to
the normal comparison group having a higher propor-
tion of non-Caucasian individuals. The two clinical
groups did not differ on ethnic composition, x2(2,
N = 74) = 1.86, p > 0.15.
2.2. Measures
2.2.1. Diagnostic interviews
Diagnostic technicians on staff at two research-based
specialty anxiety clinics conducted the diagnostic
interviews for the clinical groups. Interviewers were
well-trained master’s level technicians with several
years’ experience conducting diagnostic evaluations for
research trials. Because patients were being assessed in
 K.M. Corcoran et al. / Journal of Anxiety Disorders 22 (2008) 56–66
preparation for participation in various treatment
research projects, two different structured interviews
were used: the Anxiety Disorders Interview Schedule
for DSM-IV (ADIS-IV; Brown, DiNardo, & Barlow,
1994) or the Structured Clinical Interview for DSM-IV
Axis I Disorders (SCID-I; First, Spitzer, Gibbon, &
Williams, 1997). The ADIS-IV is a semi-structured
interview for diagnosis of anxiety, mood, somatoform,
and substance abuse disorders with good interrater
reliability for panic disorder and OCD (Brown, Di
Nardo, Lehman, & Campbell, 2001). The SCID-I is the
most widely used diagnostic interview in North
American psychiatric research (Antony & Barlow,
2002). Earlier versions of the measure showed adequate
interrater reliability for diagnosis of OCD (Williams
et al., 1992). Screening questions from the SCID-I were
used as a diagnostic tool for the normal comparison
group.
2.2.2. Obsessive–compulsive symptoms
The Yale-Brown Obsessive–Compulsive Scale, a
widely used measure with good reliability and validity
(Goodman et al., 1989; Woody, Steketee, & Chambless,
1995), was used to assess the severity of OCD
symptoms. The diagnostic technician administered
the YBOCS following the structured diagnostic inter-
view for those who met criteria for OCD. The mean
YBOCS Total score for OCD participants in this study
was 22.97 (S.D. = 4.58). Subscale scores were 11.76
(S.D. = 2.26) for Obsessions and 11.47 (S.D. = 3.10) for
Compulsions.
2.2.3. Depressive symptoms
The Beck Depression Inventory (BDI) is a com-
monly used measure to evaluate severity of depressive
symptoms in clinical and non-clinical samples. It has
excellent psychometric properties (Beck, Steer, &
Garbin, 1988). The mean BDI score for the OCD
group was 16.59 (S.D. = 10.57) and 11.58 (S.D. = 8.41)
for the panic disorder group, t(53) = 1.93, p < 0.06.
2.2.4. Disgust sensitivity
The Disgust Scale (Haidt, McCauley, & Rozin,
1994) is a widely used broad index of sensitivity to
disgust-eliciting stimuli across eight domains of disgust
elicitors, such as food, body products, or mutilation.
This measure elicits ratings of how disgusting particular
experiences would be, such as, ‘‘You see maggots on a
piece of meat in an outdoor garbage pail.’’ The scale
developers report good internal consistency and
evidence of discriminant validity (Haidt et al., 1994),
and the measure relates moderately well (r = 0.51) to
59
disgust-related behaviour (Rozin, Haidt, McCauley,
Dunlop, & Ashmore, 1999).
2.3. Stimuli
From a set of black and white photographs shown by
Ekman and Friesen (1976) to elicit reliable responses in
normal individuals, photographs of anger, disgust, fear,
and sadness expressions were selected for two models,
one male and one female. The model used in the
Sprengelmeyer et al. (1997) study was intentionally not
selected for this study. The expressions happiness and
surprise, which are easily recognized and rarely
confused with disgust, were not used.
Following the Sprengelmeyer procedure, stimuli for
this study were prepared using a computer interpolation
program. Each facial expression was morphed with
every other expression in a procedure that yielded
expressions that blended features of two emotions, thus
increasing the difficulty level of the task. These
photographs, as well as the prototypical facial expres-
sions, were presented to participants using a customized
software program.
2.4. Procedure
Prospective clinical participants were screened by
telephone and subsequently completed their diagnostic
interview and questionnaires at the clinic. Participants
completed the facial recognition task at their first or
second visit to the clinic. Participants in the normal
comparison group completed the SCID-I screening
interview in a quiet non-clinic experimental room
before beginning the computer task.
The facial expression task involved four trials; in
each trial participants classified the same 60 individual
facial expressions presented in random order. Partici-
pants indicated whether each expression most
resembled anger, disgust, fear or sadness by using
the mouse to select one of these four answer choices
located below the photographs. The order of the answer
choices was counterbalanced across blocks of trials.
Each photograph remained on the computer screen until
a response was made and the participant clicked on a
button labelled ‘‘Next,’’ which appeared below the
response options. The entire task took approximately
20 min.
3. Results
The primary question of interest in this study was
whether OCD patients differ from those with panic and
60 K.M. Corcoran et al. / Journal of Anxiety Disorders 22 (2008) 56–66

from normal controls in their ability to recognize facial Table 1

expressions of disgust. Frequency of correct facial
expression identifications was tabulated for each
participant, across trials for each of the four pure facial
expressions. Hit rate was the dependent variable in
3  4 repeated measures ANOVA, with one within-
subjects factor (stimulus expression: anger, disgust,
fear, and sadness) and one between-groups factor
(diagnostic group: OCD, panic, and normal control).1
This analysis was accompanied by planned nonortho-
gonal contrasts, described below. If OCD patients are
specifically impaired in their recognition of the
expression of disgust, the analysis should show an
interaction of facial expression with diagnostic group.
The Greenhouse-Geisser adjustment corrected for a
violation of the assumption of sphericity. In addition,
due to the violation of sphericity, four participants from
the OCD group were randomly dropped from the
analyses of variance to form equal size groups
(Tabachnick & Fidell, 2001).2
3.1. Analysis of variance
Table 1 presents the frequency of correct identifica-
tion of the prototypical facial expressions for each
diagnostic group; the maximum number of correct
responses was 24. Results of the ANOVA revealed a
significant main effect of stimulus expression, F(2,
226) = 19.16, p < 0.0001, h2p ¼ 0:15, which was qua-
lified by a significant interaction, F(2, 226) = 2.70,
p < 0.05, h2p ¼ 0:05. Simple main effects analyses
revealed a significant effect of stimulus expression for the
OCD group, F(3, 226) = 11.32, p < 0.0001, h2p ¼ 0:13,
and for the panic group, F(3, 226) = 3.70, p < 0.05,
h2p ¼ 0:05. Tukey’s method of post hoc comparisons
revealed that the OCD group was significantly less
accurate at the recognition of disgust relative to all other
expressions (fear: q = 8.10, p < 0.001; anger: q = 5.33,
p < 0.01; sadness: q = 4.69, p < 0.01). In addition,
Tukey’s method revealed that panic patients recognized
fear significantly more accurately than they recognized
disgust (q = 4.16, p < 0.05). Their accuracy at recogniz-
1
Analyses were also conducted using Wagner’s unbiased hit rate,
HU. As the results were essentially unchanged, and hit rate is con-
ceptually easier to understand, only the analyses of hit rate are
described.
2
The analysis was additionally performed with the intact sample
(i.e., without random removal of participants). Identical results were
found for the main effects and interactions, but some post hoc tests
could not be calculated accurately with unequal cell sizes, so the equal
cell size results are presented.
Mean (and standard deviation) frequency of correct identification of
facial expressions of emotions by diagnostic group
Expression Participant group
OCD Panic Normal
Anger 22.14 (2.67) 21.69 (2.36) 21.61 (2.97)
Disgust 19.36 (4.89) 21.39 (4.03) 21.86 (3.21)
Fear 23.58 (1.00) 23.56 (1.13) 23.50 (1.16)
Sadness 21.81 (3.40) 22.81 (1.77) 22.36 (2.64)
Note: These stimuli were taken directly from the Ekman and Friesen
set of emotional expressions; participants rated 24 of these photo-
graphs.
ing disgust was not different from their recognition
of sadness (q = 2.72, p > 0.10) or anger (q = 0.59,
p > 0.10). There was no main effect for diagnostic group,
F(2, 105) = 1.65, p > 0.10, h2p ¼ 0:03.
3.2. Planned comparisons
Planned nonorthogonal contrasts were conducted in
order to test specific hypotheses not tested directly by
the omnibus ANOVAs. Whereas the overall F-test
yields information about whether there are any
differences among the groups, planned contrasts permit
specific predictions to be tested with relatively strong
statistical power. The number of contrasts was limited to
two in order to maintain control over Type I error
(Rosenthal & Rosnow, 1985). The first contrast
compared the three groups specifically on disgust
recognition. The OCD group performed this task
significantly less accurately than the other two groups,
F(1, 105) = 10.78, p < 0.01, r = 0.31. The second
contrast compared recognition of disgust facial expres-
sions in the OCD group against all other emotional
expressions and other groups. The OCD group
recognized disgust expressions less accurately than
all other groups and all other emotional expressions,
F(1, 331) = 29.45, p < 0.00001, r = 0.28.
3.3. Predictors of poor performance
Fig. 1 shows the distribution of hit rates for
recognition of pure disgust expressions across the three
groups. Most individuals in the panic and normal
control groups showed excellent ability to recognize
disgust, with the mean coming close to 100% accuracy
despite the presence of several individuals who
performed quite poorly. The distribution for the OCD
group, however, was much more variable. In an effort to
examine potential predictors of poor performance, OCD
participants were divided into two groups: those who
 K.M. Corcoran et al. / Journal of Anxiety Disorders 22 (2008) 56–66 61

p < 0.01. Similar numbers of participants (<5) in each

Fig. 1. Hit rate for recognition of disgust facial expressions across
diagnostic groups.
recognized pure (prototypical) facial expressions of
disgust within normal limits and those who were clearly
impaired at recognizing disgust. Performing within
normal limits was arbitrarily defined as demonstrating a
hit rate within 1.5 standard deviations of the mean of the
normal comparison group. Twenty seven individuals
fell into this group, with a mean hit rate of 22.56
(S.D. = 1.69). 13 individuals were clearly impaired,
falling more than 1.5 standard deviations below the
mean of the normal comparison group in the recognition
of prototypical facial expressions of disgust (hit rate
M = 12.92, S.D. = 3.43).
Using this definition for impaired recognition
performance described above, in addition to the 13
participants with impaired performance in the OCD
group, three participants in the normal comparison
group and four participants in the panic group
demonstrated impaired functioning on this task. Their
observations can be seen as within-group outliers in
Fig. 1. This difference in distribution of impaired
performance was significant, x2(2, N = 112) = 9.19,
group showed impaired recognition of facial expres-
sions other than disgust, but the distribution of these
deficits was equivalent across groups.
Using a series of t-tests, OCD patients who
performed normally on the pure expression task were
compared to those who showed a deficit in an effort to
discover descriptive or illness-related factors that
correlate with impaired recognition of disgust expres-
sions. Sample sizes differ for each t-test due to missing
data. Severity of symptoms was of particular interest,
given the results reported by Parker et al. (2004).
Symptom severity indicators used in these analyses
were: (a) Global Assessment of Functioning (GAF; the
Axis V indicator of general functioning and illness
severity gleaned from the diagnostic interview and rated
by the interviewer), (b) YBOCS Total Score, (c)
YBOCS Compulsions subscale score, (d) YBOCS
Obsessions subscale score, (e) BDI score, and (f)
duration of OCD in years. Participants’ current age was
also explored as a possible predictor, as age has been
found to be related to performance on facial expression
judgment tasks (McDowell, Harrison, & Demaree,
1994). One-tailed tests were used for t-tests due to the a
priori hypotheses that performance would be negatively
affected by greater severity of symptoms and higher
age.
Table 2 shows the results of this analysis. OCD
patients with normal disgust recognition were sig-
nificantly more functional and less symptomatic than
those who were impaired in their recognition of disgust
facial expressions. OCD patients who were impaired on
the disgust recognition task had significantly higher
scores on the YBOCS (both subscales as well as the
total score) and significantly lower GAF ratings. Results
of the t-tests on age of onset, duration of OCD, current
age, and disgust sensitivity did not reveal significant
differences.

Table 2
Comparison of individuals with OCD who showed normal versus impaired recognition of disgust facial expressions
Variable Normal mean (S.D.) Impaired mean (S.D.) t d.f. r
y
GAF 57.08 (7.66) 53.00 (8.54) 1.47 36 0.21
YBOCS total 21.96 (4.44) 25.08 (4.29) 2.02* 35 0.30
YBOCS obsessions 11.30 (2.27) 12.73 (2.00) 1.78* 32 0.25
YBOCS compulsions 10.74 (3.11) 13.00 (2.57) 2.09* 32 0.34
BDI 15.6 (8.97) 18.78 (13.87) 0.74 27 0.19
Duration of OCD 15.3 (11.33) 17.36 (12.56) 0.48 32 0.00
Age 34.12 (11.71) 36.62 (13.82) 0.59 37 0.02
Disgust sensitivity 16.51 (6.47) 15.79 (5.96) 0.27 24 0.12
Note: yp < 0.10, *p < 0.05 (one-tailed); GAF: Global Assessment of Functioning (SCID-I); YBOCS: Yale-Brown Obsessive Compulsive Scale;
BDI: Beck Depression Inventory. Correlations refer to hit rates; all are in the expected direction.
62 K.M. Corcoran et al. / Journal of Anxiety Disorders 22 (2008) 56–66
3.4. Role of depression
Examining the hit rates for pure disgust expressions,
which showed a larger effect size than the morphed
expressions, comorbid depression does not account
for the poor recognition rates exhibited by the OCD
group. The correlation between recognition rate of pure
disgust expressions and the BDI was r = 0.19.
Individuals who were impaired in their recognition
of disgust were not more likely to be diagnosed
with current or partially remitted depression, x2(1,
N = 40) = 1.05, p > 0.30.
3.5. Role of symptom profile
Individuals with OCD were classified according to
their primary symptom in an effort to discover whether
contamination concerns (which some researchers
hypothesize would be more related to disgust percep-
tion) or checking rituals (which was the primary
symptom experienced by individuals in the Sprengel-
meyer et al. study) would be related to impaired
recognition of disgust expressions. Among participants
with primary contamination concerns, 22% showed
impaired performance on the task. In comparison, 18%
of participants with primary checking rituals showed
impaired performance. A larger percentage of indivi-
duals with primary obsessions (45%) showed impaired
performance, but with such a small sample, this
difference was not statistically significant, x2(2,
N = 31) = 2.27, p > 0.30. Other types of OCD symp-
toms were not analyzed because of low frequency.
Participants in the three primary symptom groups did
not differ with regard to severity of OCD symptoms,
F(2, 29) = 1.38, or global functioning, F(2, 30) = 1.77.
4. Discussion
OCD patients were significantly less accurate at
recognizing facial expressions of disgust as compared to
the normal and panic disorder comparison groups. OCD
patients were also significantly less accurate in
recognizing disgust in comparison to their recognition
of three other negative emotions. These results
supported the initial hypotheses but are contrary to
two published failures to replicate these deficits among
patients with OCD (Buhlmann et al., 2004; Parker et al.,
2004). Given the difficulty of publishing negative
results, the actual number of failed attempts to replicate
this result is probably higher.
Although the present study did find statistically
significant differences between groups, the results
did not show the stark demarcation reported by
Sprengelmeyer et al. (1997). Recall that all of the
Sprengelmeyer et al. OCD patients showed a marked
deficit in recognizing disgust, and no participant
without obsessive–compulsive symptoms showed the
deficit. In our sample, about a third of the participants
with OCD were impaired in their recognition of disgust
expressions.
What distinguishes OCD patients with impaired
recognition of disgust from those who perform the task
normally? Depression, frequently comorbid with OCD,
is associated with facial expression recognition deficits,
but recognition of disgust in this study was not
associated with depression symptoms or diagnosis.
Some researchers have proposed that individuals who
are highly sensitive to contamination would be either
hypersensitive or impervious to others’ expressions of
disgust, but these ideas were not supported. Patients
with primary contamination symptoms were no more
likely than other patients to show the effect, and
sensitivity to experiencing disgust was unrelated to task
performance. Nor was age of onset a factor in the effect,
which would argue against this kind of learning
explanation.
Participants with OCD who showed poor recognition
of disgust were more functionally impaired and
reported more severe OCD symptoms than did those
who performed normally on the task. Severity of OCD
may be a critical factor behind previous failures to
replicate the finding. Parker et al. (2004) reported one
patient who showed the disgust recognition deficit; this
patient had the most severe symptoms in their sample.
The mean YBOCS score for our sample was a half
standard deviation higher than for the Parker et al.
sample. Power may also be a factor; our sample was
substantially larger than either the Parker et al. or
Buhlmann et al. (2004) samples.
An explanation is not immediately apparent for why
severity of OCD would be associated with a deficit in
recognition of the specific facial expression of disgust.
Severity of symptoms has been associated with deficits
in facial information processing in schizophrenia
(Kohler, Bilker, Hagendoorn, Gur, & Gur, 2000;
Martin, Baudouin, Tiberghien, & Franck, 2005). The
results are less consistent for depression, as facial
expression recognition deficits have been correlated
with symptom severity in some studies (Mikhailova
et al., 1996) but not others (Leppänen, Milders, Bell,
Terriere, & Hietanen, 2004). Within OCD, severity is an
unreliable predictor of performance on other neuro-
cognitive tasks. In a recent review, about half of 22
studies examining the issue found performance on
 K.M. Corcoran et al. / Journal of Anxiety Disorders 22 (2008) 56–66
neuropsychological tests to be related to severity
(Kuelz, Hohagen, & Voderholzer, 2004).
Imaging studies have highlighted specific neural
substrates for perception of others’ disgust (Phillips
et al., 1997; Phillips, Young et al., 1998b; Sprengel-
meyer et al., 1998). Perception of facial expressions of
disgust involve activation of the orbitofrontal cortex
(Sprengelmeyer et al., 1998) and the anterior insula
(Phillips et al., 1997). These regions also appear to be
involved in the response to disgusting visual stimuli
(Schienle, Stark, & Walter, 2002). The putamen, which
is part of the basal ganglia, also seems to be involved in
perception of disgust expressions (Phillips et al., 1997;
Sprengelmeyer et al., 1998). Researchers investigating
the biological aspects of OCD have identified some of
these same regions as of interest. Imaging studies have
shown reliable differences between normal controls and
OCD patients in activity in the orbitofrontal cortex,
especially the orbital gyrus, and in the basal ganglia,
especially the head of the caudate nucleus (Whiteside,
Port, & Abramowitz, 2004).
Nevertheless, many mysteries remain. The brain
regions identified as being involved in perception of
emotion do not appear to be specific to disgust. The
orbitofrontal cortex is also activated during perception
of facial expressions of fear and anger (Sprengelmeyer
et al., 1998). The anterior insula, a part of the limbic
system that is believed to be involved emotional aspects
of sensory experience, is activated during response to
pain and fear-inducing stimuli as well as revulsion
(Schienle et al., 2002). Furthermore, there is no obvious
explanation for the role of disorder severity. Neuroima-
ging studies differ with regard to whether OCD
symptom severity correlates with brain activity. For
example, Lacerda et al. (2003) reported correlations
between symptom severity and regional cerebral blood
flow in bilateral inferior frontal lobes and the right basal
ganglia. On the other hand, in a similarly powered study,
van den Heuvel et al. (2005) reported that observed
frontal–striatal dysfunction was independent of OCD
symptom severity.
Although the results of this study do replicate the
intriguing finding from the Sprengelmeyer et al. (1997),
it is clear that the effect is not as robust as it originally
appeared. The facial expression stimuli may play an
important role in the elusiveness of the effect. We
specifically selected different models than the one
Sprengelmeyer’s group used. At the time we designed
and collected data for the present study, we were
unaware of the parallel work being conducted by the
two groups at Harvard (Buhlmann et al., 2004; Parker
et al., 2004). By chance, our two models were among
63
the four used in the Parker et al. study (H. Parker,
personal communication, November 1, 2005). Although
variations in disgust expressions are reliably identifiable
(Rozin, Lowery, & Ebert, 1994), different facial muscle
patterns appear to characterize different levels of
intensity of disgust affect (Wolf et al., 2005). Among
individuals with major depression, testing with varying
intensities of emotional expression shows subtle
impairments in discrimination accuracy (Surguladze
et al., 2004), something that has not been specifically
tested within OCD. Quite possibly, the impairment in
OCD is only observable when the facial stimulus has
certain features that have yet to be defined. One recent
innovation that may be worth exploring is the use of
moving images of facial expressions (Kan, Mimura,
Kamijima, & Kawamura, 2004).
A fruitful direction for research may be to explore
similarities between Huntington’s disease and OCD.
Huntington’s disease is characterized by a specific
deficit for recognition of facial expressions of disgust
(Gray, Young, Barker, Curtis, & Gibson, 1997;
Sprengelmeyer et al., 1996). Huntington’s patients also
show deficits in perception of disgust in other
modalities, such as vocal intonation or gustatory and
olfactory perception (Mitchell, Heims, Neville, &
Rickards, 2005; Sprengelmeyer et al., 1996), but no
extant studies have examined these areas of impair-
ments in OCD. Furthermore, obsessions or compulsions
often occur as a part of Huntington’s disease (Anderson,
Louis, Stern, & Marder, 2001; Naarding & Janzing,
2003), as they do with Tourette’s syndrome.
Disgust has only recently appeared as a topic of
interest to anxiety disorders researchers, and research-
ers have begun to examine various ways that disgust
may be involved in OCD, including emotional
experience in the disorder, motivators of avoidance
and compulsions, and distinctions between OCD
subtypes. To use the phenomenon as an opportunity
to understand neuroscience or perceptual aspects of
psychopathology of OCD requires being able to
replicate the effect as well as understanding the
conditions under which it occurs. Although several
recent efforts to replicate the phenomenon have failed,
the present study documents a partial replication and
some ideas for understanding the inconsistencies across
studies.
Acknowledgements
This research was supported in part by a grant to the
second author from the Social Sciences and Humanities
Research Council of Canada. We would like to thank
64 K.M. Corcoran et al. / Journal of Anxiety Disorders 22 (2008) 56–66
Wolfgang Linden and Mark Schaller for their helpful
comments on an earlier version of this manuscript,
which served as the first author’s master’s thesis.
Finally, we gratefully acknowledge the assistance of the
late James Grossman, who prepared the stimuli.
References
Addington, J., & Addington, D. (1998). Facial affect recognition and
information processing in schizophrenia and bipolar disorder.
Schizophrenia Research, 32, 171–181.
Anderson, K. E., Louis, E. D., Stern, Y., & Marder, K. S. (2001).
Cognitive correlates of obsessive and compulsive symptoms in
Huntington’s disease. American Journal of Psychiatry, 158, 799–
801.
Antony, M. M., & Barlow, D. H. (Eds.). (2002). Handbook of
assessment and treatment planning for psychological disorders.
New York: Guilford Press.
Archer, J., Hay, D. C., & Young, A. W. (1992). Face processing in
psychiatric conditions. British Journal of Clinical Psychology, 31,
45–61.
Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric
properties of the Beck depression inventory: twenty-five years of
evaluation. Clinical Psychology Review, 8, 77–100.
Boucher, J. D., & Carlson, G. E. (1980). Recognition of facial
expression in three cultures. Journal of Cross Cultural Psychology,
11, 263–280.
Brown, T. A., DiNardo, P., & Barlow, D. (1994). Anxiety disorders
interview schedule-IV (ADIS-IV). San Antonio, TX: The Psycho-
logical Corporation.
Brown, T. A., Di Nardo, P. A., Lehman, C. L., & Campbell, L. A.
(2001). Reliability of DSM-IV anxiety and mood disorders:
implications for the classification of emotional disorders. Journal
of Abnormal Psychology, 110, 49–58.
Bryson, G., Bell, M., & Lysaker, P. (1997). Affect recognition in
schizophrenia: a function of global impairment or a specific
cognitive deficit. Psychiatry Research, 71, 105–113.
Buhlmann, U., McNally, R. J., Etcoff, N. L., Tuschen-Caffier, B., &
Wilhelm, S. (2004). Emotion recognition deficits in body
dysmorphic disorder. Journal of Psychiatric Research, 38,
201–206.
Davis, P. J., & Gibson, M. G. (2000). Recognition of posed and
genuine facial expressions of emotion in paranoid and nonpar-
anoid schizophrenia. Journal of Abnormal Psychology, 109, 445–
450.
Dougherty, F. E., Bartlett, E. S., & Izard, C. E. (1974). Responses of
schizophrenics to expressions of the fundamental emotions. Jour-
nal of Clinical Psychology, 30, 243–246.
Ekman, P. (1992). An argument for basic emotions. Cognition and
Emotion, 6, 169–200.
Ekman, P., & Friesen, W. V. (1976). Pictures of facial affect. Palo Alto,
CA: Consulting Psychologists Press.
Ekman, P., Levenson, R. W., & Friesen, W. V. (1983). Autonomic
nervous system activity distinguishes among emotions. Science,
221, 1208–1210.
Ekman, P., Sorenson, E. R., & Friesen, W. V. (1969). Pan-cultural
elements in facial displays of emotion. Science, 164, 86–88.
Feinberg, T. E., Rifkin, A., Schaffer, C., & Walker, E. (1986). Facial
discrimination and emotional recognition in schizophrenia and
affective disorders. Archives of General Psychiatry, 43, 276–279.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997).
Structured clinical interview for DSM-IV Axis I disorders.
Washington, DC: American Psychiatric Association.
Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E., & Amir, N.
(1998). The validation of a new obsessive–compulsive disorder
scale: the Obsessive Compulsive Inventory. Psychological Assess-
ment, 10, 206–214.
Gaebel, W., & Woelwer, W. (1992). Facial expression and emotional
face recognition in schizophrenia and depression. European
Archives of Psychiatry and Clinical Neuroscience, 242, 46–52.
Geerts, E., & Bouhuys, N. (1998). Multi-level prediction of short-term
outcome of depression: non-verbal interpersonal processes, cog-
nitions and personality traits. Psychiatry Research, 79, 59–72.
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C.,
Fleischmann, R. L., Hill, C. L., et al. (1989). Yale-Brown
Obsessive Compulsive Scale: I. Development, use, and reliability.
Archives of General Psychiatry, 46, 1006–1011.
Gray, J. M., Young, A. W., Barker, W. A., Curtis, A., & Gibson, D.
(1997). Impaired recognition of disgust in Huntington’s disease
gene carriers. Brain, 120, 2029–2038.
Haidt, J., McCauley, C., & Rozin, P. (1994). Individual differences in
sensitivity to disgust: a scale sampling seven domains of disgust
elicitors. Personality and Individual Differences, 16, 701–713.
Hargrave, R., Maddock, R. J., & Stone, V. (2002). Impaired recogni-
tion of facial expressions of emotion in Alzheimer’s disease.
Journal of Neuropsychiatry and Clinical Neurosciences, 14,
64–71.
Heimberg, C., Gur, R. E., Erwin, R. J., Shtasel, D. L., & Gur, R. C.
(1992). Facial emotion discrimination: III. Behavioral findings in
schizophrenia. Psychiatry Research, 42, 253–265.
Izard, C. E. (1971). The face of emotion. New York, NY: Appleton-
Century-Crofts.
Kan, Y., Mimura, M., Kamijima, K., & Kawamura, M. (2004). Journal
of Neurology, Neurosurgery and Psychiatry. Recognition of emo-
tion from moving facial and prosodic stimuli in depressed patients,
75, 1667–1671.
Kerr, S. L., & Neale, J. M. (1993). Emotion perception in schizo-
phrenia: specific deficit or further evidence of generalized poor
performance? Journal of Abnormal Psychology, 102, 312–318.
Ketter, T. A., & Lembke, A. (2002). Impaired recognition of facial
emotion in mania. American Journal of Psychiatry, 159, 302–304.
Kohler, C. G., Bilker, W., Hagendoorn, M., Gur, R. E., & Gur, R. C.
(2000). Emotion recognition deficit in schizophrenia: association
with symptomatology and cognition. Biological Psychiatry, 48,
127–136.
Kornreich, C., Blairy, S., Philippot, P., Dan, B., Foisy, M., Hess, U.,
et al. (2001a). Impaired emotional facial expression recognition in
alcoholism compared with obsessive–compulsive disorder and
normal controls. Psychiatry Research, 102, 235–248.
Kornreich, C., Blairy, S., Philippot, P., Hess, U., Noel, X., Streel, E.,
et al. (2001b). Deficits in recognition of emotional facial expres-
sion are still present in alcoholics after mid- to long-term absti-
nence. Journal on Studies of Alcohol, 62, 533–542.
Kosson, D. S., Suchy, Y., Mayer, A. R., & Libby, J. (2002). Facial
affect recognition in criminal psychopaths. Emotion, 2, 398–
411.
Kucharska-Pietura, K., & Klimkowski, M. (2002). Perception of facial
affect in chronic schizophrenia and right brain damage. Acta
Neurobiologia, 62, 33–43.
Kuelz, A. K., Hohagen, F., & Voderholzer, U. (2004). Neuropsycho-
logical performance in obsessive–compulsive disorder: a critical
review. Biological Psychology, 65, 185–236.
 K.M. Corcoran et al. / Journal of Anxiety Disorders 22 (2008) 56–66
La Barbera, J. D., Izard, C. E., Vietze, P., & Parisi, S. A. (1976). Four-
and six-month-old infants’ visual responses to joy, anger, and
neutral expressions. Child Development, 47, 535–538.
Lacerda, A. L. T., Dalgalarrondo, P., Caetano, D., Camargo, E. E.,
Etchebehere, E. C. S. C. , & Soares, J. C. (2003). Elevated thalamic
and prefrontal regional cerebral blood flow in obsessive–compul-
sive disorder: a SPECT study. Psychiatry Research: Neuroima-
ging, 123, 125–134.
Leppänen, J. M., Milders, M., Bell, J. S., Terriere, E., & Hietanen, J. K.
(2004). Depression biases the recognition of emotionally neutral
faces. Psychiatry Research, 128, 123–133.
Lewis, S. F., & Garver, D. L. (1995). Treatment and diagnostic subtype
in facial affect recognition in schizophrenia. Journal of Psychia-
tric Research, 29, 5–11.
Martin, F., Baudouin, J.-Y., Tiberghien, G., & Franck, N. (2005).
Processing emotional expression and facial identity in schizo-
phrenia. Psychiatry Research, 134, 43–53.
McDowell, C. L., Harrison, D. W., & Demaree, H. A. (1994). Is right
hemisphere decline in the perception of emotion a function of
aging? International Journal of Neuroscience, 79, 1–11.
Mikhailova, E. S., Vladimirova, T. V., Iznak, A. F., Tsusulkovskaya, E.
J., & Sushko, N. V. (1996). Abnormal recognition of facial
expression of emotions in depressed patients with major depres-
sion disorder and schizotypal personality disorder. Biological
Psychiatry, 40, 697–705.
Mitchell, I. J., Heims, H., Neville, E. A., & Rickards, H. (2005).
Huntington’s disease patients show impaired perception of disgust
in the gustatory and olfactory modalities. The Journal of Neu-
ropsychiatry and Clinical Neurosciences, 17, 119–121.
Muzekari, L. H., & Bates, M. E. (1977). Judgment of emotion among
chronic schizophrenics. Journal of Clinical Psychology, 33, 662–
666.
Naarding, P., & Janzing, J. G. E. (2003). The neuropsychiatric
manifestations of Huntington’s disease. Current Opinion in Psy-
chiatry, 16, 337–340.
Parker, H. A., McNally, R. J., Nakayama, K., & Wilhelm, S. (2004).
No disgust recognition deficit in obsessive–compulsive disorder.
Journal of Behavior Therapy and Experimental Psychiatry, 35,
183–192.
Persad, S. M., & Polivy, J. (1993). Differences between depressed and
nondepressed individuals in the recognition of and response to
facial emotional cues. Journal of Abnormal Psychology, 102, 358–
368.
Phillips, M. L., Senior, C., Fahy, T., & David, A. S. (1998a). Disgust—
the forgotten emotion of psychiatry. British Journal of Psychiatry,
172, 373–375.
Phillips, M. L., Young, A. W., Scott, S. K., Calder, A. J., Andrew, C.,
Giampietro, V., et al. (1998b). Neural responses to facial and vocal
expressions of fear and disgust. Proceedings of the Royal Society
of London, Series B, 265, 1809–1817.
Phillips, M. L., Young, A. W., Senior, C., Brammer, M., Andrew, C.,
Calder, A. J., et al. (1997). A specific neural substrate for
perceiving facial expressions of disgust. Nature, 389, 495–498.
Power, M., & Dalgleish, T. (1997). Cognition and emotion: from order
to disorder. East Sussex, UK: Psychology Press.
Rosenthal, R., & Rosnow, R. L. (1985). Contrast analysis: focused
comparisons in the analysis of variance. New York, NY: Cam-
bridge University Press.
Rozin, P., Haidt, J., McCauley, C., Dunlop, L., & Ashmore, M. (1999).
Individual differences in disgust sensitivity: comparisons and
evaluations of paper-and-pencil versus behavioral measures. Jour-
nal of Research in Personality, 33, 330–351.
65
Rozin, P., Lowery, L., & Ebert, R. (1994). Varieties of disgust faces
and the structure of disgust. Journal of Personality and Social
Psychology, 66, 870–881.
Rozin, P., Taylor, C., Ross, L., Bennette, G., & Hejmadi, A. (2005).
General and specific abilities to recognise negative emotions,
especially disgust, as portrayed in the face and the body. Cognition
and Emotion, 19, 397–412.
Rubinow, D. R., & Post, R. M. (1992). Impaired recognition of affect
in facial expression in depressed patients. Biological Psychiatry,
31, 947–953.
Schienle, A., Stark, R., & Walter, B. (2002). The insula is not
specifically involved in disgust processing: an fMRI study. Neu-
roreport: For Rapid Communication of Neuroscience Research,
13, 2023–2036.
Simonian, S. J., Beidel, D. C., Turner, S. M., Berkes, J. L., & Long, J.
H. (2001). Recognition of facial affect by children and adolescents
diagnosed with social phobia. Child Psychiatry and Human
Development, 32, 137–145.
Sorce, J. F., Emde, R. N., Campos, J. J., & Klinnert, M. D. (1985).
Maternal emotional signaling: its effect on the visual cliff
behavior of 1-year-olds. Developmental Psychology, 21, 195–
200.
Sprengelmeyer, R., Rausch, M., Eysel, U. T., & Przuntek, H. (1998).
Neural structures associated with recognition of facial expressions
of basic emotions. Proceedings of the Royal Society of London,
Series B, 265, 1927–1931.
Sprengelmeyer, R., Young, A. W., Calder, A. J., Karnat, A., Lange, H.,
Homberg, V., et al. (1996). Loss of disgust—perception of faces
and emotions in Huntington’s disease. Brain, 119(Part 5), 1647–
1665.
Sprengelmeyer, R., Young, A. W., Pundt, I., Sprengelmeyer, A.,
Calder, A. J., Berrios, G., et al. (1997). Disgust implicated in
obsessive–compulsive disorder. Proceedings of the Royal Society
of London, 264, 1767–1773.
Surguladze, S. A., Young, A. W., Senior, C., Brébion, G., Travis, M. J.,
& Phillips, M. L. (2004). Recognition accuracy and response bias
to happy and sad facial expressions in patients with major depres-
sion. Neuropsychology, 18, 212–218.
Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate statistics
(4th ed.). Boston, MA: Allyn and Bacon.
van den Heuvel, O. A., Veltman, D. J., Groenewegen, H. J., Cath,
D. C., van Balkom, A. J. L. M. , van Hartskamp, J., et al.
(2005). Frontal-striatal dysfunction during planning in obses-
sive–compulsive disorder. Archives of General Psychiatry, 6,
301–310.
Walker, E., Marwit, S., & Emory, E. (1980). A cross-sectional study of
emotion recognition in schizophrenics. Journal of Abnormal
Psychology, 89, 428–436.
Whiteside, S. P., Port, J. D., & Abramowitz, J. S. (2004). A meta-
analysis of functional neuroimaging in obsessive–compulsive
disorder. Psychiatry Research: Neuroimaging, 132, 69–79.
Williams, J. B., Gibbon, M., First, M. B., Spitzer, R. L., Davies, M.,
Borus, J., et al. (1992). The Structured Clinical Interview for
DSM-III-R (SCID): II. Multisite test-retest reliability. Archives of
General Psychiatry, 49, 630–636.
Wolf, K., Mass, R., Ingenbleek, T., Kiefer, F., Naber, D., & Wiede-
mann, K. (2005). The facial pattern of disgust, appetence, excited
joy and relaxed joy: an improved facial EMG study. Scandinavian
Journal of Psychology, 46, 403–409.
Woody, S. R., Steketee, G., & Chambless, D. L. (1995). Reliability and
validity of the Yale-Brown Obsessive–Compulsive Scale. Beha-
viour Research and Therapy, 33, 597–605.
66 K.M. Corcoran et al. / Journal of Anxiety Disorders 22 (2008) 56–66

Woody, S. R., & Teachman, B. (2000). Intersection of disgust and fear:
normal and pathological views. Clinical Psychology: Science and
Practice, 7, 291–311.
Woody, S. R., & Tolin, D. F. (2002). The relationship between
disgust sensitivity and avoidant behavior: studies of clinical
and nonclinical samples. Journal of Anxiety Disorders, 16,
543–559.
Young-Browne, G., Rosenfeld, H. M., & Horowitz, F. D. (1977).
Infant discrimination of facial expressions. Child Development,
48, 555–562.
Zonnevijlle-Bendek, M. J. S., van Goozen, S. H. M., Cohen-Kettenis,
P. T., van Elburg, A., & van Engeland, H. (2002). Do adolescent
anorexia nervosa patients have deficits in emotional functioning?
European Child and Adolescent Psychiatry, 11, 38–42.