Brain activation by disgust-inducing pictures in obsessive-compulsive disorder

Background: There is growing interest in the role of disgust in the pathogenesis of obsessive-compulsive disorder (OCD). Methods: Eight OCD subjects with contamination preoccupations and eight gender- and age-matched healthy volunteers viewed pictures from the International Affective Picture System during functional magnetic resonance imaging scans. Results: A different distribution of brain activations was found during disgust-inducing visual stimulation in several areas, most notably the insula, compared with neutral stimulation in both OCD subjects and healthy volunteers. Furthermore, whereas activation during the threat-inducing task in OCD subjects showed a pattern similar to that in healthy volunteers, the pattern of activation during the disgust- inducing task was significantly different, including greater increases in the right insula, parahippocampal region, and inferior frontal sites. Conclusions: This pilot study supports the relevance of disgust in the neurocircuitry of OCD with contamination preoccupation symptoms; future studies looking at non-OCD individuals with high disgust ratings, non-contamination-preoccupied OCD individuals, and individuals with other anxiety disorders are needed. (C) 2003 Society of Biological Psychiatry.