Q & A: A Patient Disgusted by the Sight of Food

Reprinted from Eating Disorders Review
November/December 2011 Volume 22, Number 6
©2011 Gürze Books

Q. One of my patients with anorexia nervosa describes to me not only that she doesn’t want to eat because she’s fearful of gaining weight, but that the sight of food positively disgusts her. Is this a characteristic feature of anorexia nervosa? Does this have any clinical implications? (P.R. Des Moines, IA)

A. Although not ubiquitous among patients with anorexia nervosa (AN), the feeling of disgust toward food is certainly a common-enough finding (Eur Eat Disord Rev; 2011 Jul 25. doi: 10.1002/erv.1124). Studies of disgust sensitivity in patients generally, but not always, find that patients with AN show greater disgust sensitivity than do controls, especially in the domain of food (Int J Eat Disord 2000; 27: 446). Of note, disgust sensitivity has been associated with obsessive-compulsive disorder, particularly among patients whose major symptoms concern contamination fears.

Neuroimaging correlations involving the insula, an area of the brain implicated in processing the emotions of disgust, have been associated with these findings, suggesting a specific neurophysiological basis for this phenomenon (Metab Brain Dis 2006; 21:267). Conceivably, AN patients with comorbid obsessive-compulsive disorder (a sizable minority of patients) are more prone to feelings of disgust than are others. Patients with such aversions may also develop conditioned disgust, for example when specific foods have been associated with serious illness and vomiting. One of us (W.V.) has seen such a case, when specific foods were associated with forced oral sex. You might want to assess your patient for the presence of co-morbid obsessive-compulsive disorder and for a history of events that might possibly relate to disgust-associated conditioned responses.

— JY, WV

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