Beyond Unidimensionality: Development and Validation of the Multidimensional State Disgust Questionnaire (MSDQ)

Abstract

Although well-established questionnaires for various forms of trait disgust exist, state disgust measures, such as the State Disgust Scale by Ihme and Mitte (2009), remain unidimensional. However, previous research suggests that the reaction towards disgusting stimuli can be conceptualized across four distinct dimensions: object disgust, self disgust, moral disgust, and process disgust. As a first step, we designed a 53-item questionnaire based on the conceptual framework of these four dimensions. In the second step, we conducted a pilot study after which the questionnaire was reduced to 26 items. In a final step, we conducted four studies to develop and validate the final questionnaire. The results of the first study reduced the questionnaire to 18 items, while retaining a four-factor structure with high internal consistency and construct validity across all scales. However, items which remained within each factor made it necessary to rename the scales, such that the final questionnaire was divided into physical disgust, self disgust, moral disgust and contamination concerns. Three further studies were conducted to validate the questionnaire’s structure through confirmatory factorial analysis. This work demonstrates that state disgust can be divided into four distinct dimensions, which can be effectively measured using the Multidimensional State Disgust Questionnaire (MSDQ).

Keywords

state disgust disgust dimensions disgust induction validity reliability

1. Introduction

Disgust is a fundamental human emotion elicited by a wide range of stimuli. Originally described by Darwin (1872) as an evolutionary response to prevent contamination, the concept has since evolved. Modern definitions highlight oral defense mechanisms while also recognizing the emotion’s complexity, incorporating interpersonal dynamics and violations of moral norms as key components (Rozin et al., 2009; Tybur et al., 2009). While physiological, behavioral, and neural levels of disgust responses have garnered increasing attention (Fink-Lamotte et al., 2022; Phillips et al., 1998), the subjective experience of disgust has received comparatively little investigation. Furthermore, previous research and measurement tools have primarily focused on identifying different types of stimuli that evoke disgust. To our knowledge the following represent the most important questionnaires which can be used to assess disgust:

1. The Disgust Scale (Haidt et al., 1994) includes 32 items across seven (food, animals, body products, sex, envelope violations, death, and hygiene) dimensions of disgust elicitors. The German Version of the disgust Scale (FEE - Fragebogen zur Erfassung der Ekelempfindlichkeit; Schienle et al., 2002) includes 37 items across five disgust domains: Death, body secretions, hygiene, spoilage, and oral rejection. The FEE demonstrates high overall internal consistency (α = .9), with domain-specific reliabilities ranging from α = .69 for oral rejection to α = .85 for death. It has also been shown to correlate with blood-related fears (r = .47) and compulsiveness (r = .25; Schienle et al., 2002.) A renewed version of the disgust scale, the disgust scale revised (DS-R, Olatunji et al., 2007) differentiates disgust across three domains, namely core, animal-reminder and contamination disgust after renewed psychometric assessment of the original disgust scale. Seven of the original items were removed from this renewed scale, mainly items representing moral disgust (i.e. ”You hear about an adult woman who has sex with her father”). The three domains of the DS-R show higher internal consistencies than the seven scales of the original version (Olatunji et al., 2007).

2. The Three Domain Disgust Scale (TDDS) includes three domains, pathogen, sexual, and moral disgust (Tybur et al., 2009). The three factors of the questionnaire have been confirmed through confirmatory factorial analysis (Olatunji et al., 2012). While sexual and pathogen disgust were shown to correlate with the scales of the Disgust Scale Revised, this was not true for the moral disgust scale. It has been argued that moral disgust of the TDDS is more related to anger than disgust (Olatunji et al., 2012).

3. The Disgust Propensity and Sensitivity Scale – Revised (DPSS-R; Van Overveld et al., 2006) was designed to differentiate between disgust propensity (i.e. how easily people are disgusted) and disgust sensitivity (i.e. how aversive the feeling of disgust is experienced). CFA showed that the two factors disgust propensity and sensitivity could be differentiated with this questionnaire.

4. The Disgust State Questionnaire (German original: Ekel-State Fragebogen, ESF-K; Ihme and Mitte, 2009) is the first German-language instrument to assess the subjective experience of disgust, measuring situational disgust through 15 items. The questionnaire follows a one-factor structure, conceptualizing disgust as a uniform construct regardless of the eliciting stimulus. A validated English version of the questionnaire has also been published (Bates & Chadwick, 2015).

Of these questionnaires, the only one specifically designed to measure the subjective experience of disgust within a given situation is the ESF-K, by Ihme and Mitte (2009). However, the ESF-K measures disgust as a uniform construct, while the subjective experience of disgust, as of all emotions, can be seen as a multifaceted phenomenon (Davey, 2021). A questionnaire capable of distinguishing between distinct facets of the disgust reaction could enhance the precision in identifying the specific disgust dimension at play in a given situation, potentially linking it to a corresponding psychopathology. Therefore, we developed and validated the Multidimensional State Disgust Questionnaire (MSDQ) to assess the differential aspects of state disgust, enabling a more nuanced evaluation of the subjective situational experience of disgust. Building on Davey’s (2021) idea of four different mechanisms of disgust in psychopathology, we originally proposed that the situational perception of disgust could be conceptualized along four distinct dimensions: Object disgust, self disgust, moral disgust, and process disgust.

Object-based experiences of disgust involve immediate reactions to the triggering stimulus, such as changes in sensory perceptions (Darwin, 1872; Susskind et al., 2008) or oral defenses (Olatunji & Sawchuk, 2005; Rozin et al., 1999b).

The self-based experience of disgust involves perceptions directed towards oneself. These perceptions can focus on one’s appearance, behavior, thoughts, or feelings, and may be accompanied by a desire for social withdrawal (Powell et al., 2015).

The violation of moral and social norms forms the basis of moral disgust experiences. Similar to Rozin et al.'s (1999a) view that the original function of disgust was to protect not only the body but also the mind from potential contamination, the link between disgust and morality is increasingly recognized (Horberg et al., 2009; Wheatley & Haidt, 2005). Situational disgust in response to the violation of specific norms can manifest as a desire to distance oneself from the situation or the person responsible, in order to preserve one’s own integrity (Plakias, 2018).

Process-based disgust involves various cognitive biases that can affect attention, interpretation, and memory of a given situation. This dimension is linked to two fundamental principles of sympathetic magic: the law of contagion, which holds that once two things come into contact, they remain permanently connected through a magical link and transfer some of their properties (Fink-Lamotte et al., 2024; Rozin et al., 1986), and the law of similarity, which suggests that stimuli that appear similar also share similar properties or are even identical (Haidt et al., 1997).

Given these differential aspects of disgust, it is not surprising that disgust is linked to the development and maintenance of various clinical disorders (Clarke et al., 2019).

High object-based disgust can lead to avoidance or withdrawal due to the aversive nature of the reaction (Mason & Richardson, 2010). As a result, psychopathologies such as contamination-based OCD may be linked to this disgust response (Davey, 2021).

High self-based disgust has been shown to be linked to psychopathologies such as depression (Clarke et al., 2019; Simpson et al., 2010). As a result, more pronounced negative self-schemas and self-critical tendencies can contribute to social withdrawal, isolation, and negative thought patterns (Powell et al., 2014). These findings are supported by the strong association between self-disgust and emotions like guilt and shame, which are particularly prevalent in individuals with depressive disorders (Schienle et al., 2014).

High moral disgust has been suggested to be associated with obsessive hygiene behaviors and other forms of OCD, such as scrupulosity (Davey, 2021; Inozu et al., 2017).

High process-based disgust can contribute to any psychopathology that is “acquired and maintained through threat-related attentional and interpretation biases” (Davey, 2021). As a result, this aspect of disgust should also be associated with OCD and depression.

The present questionnaire is the first to attempt a multidimensional assessment of the four assumed facets of situational disgust within a single instrument, aiming to provide a more differentiated evaluation of state disgust than previous measures. By capturing distinct facets of disgust, it may also help clarify their potential relevance for the etiology and maintenance of clinical conditions. If specific facets of situational disgust are associated with different psychopathologies, this approach could inform the development of more targeted interventions. The final questionnaire was validated across four studies. Following a pilot study used to reduce items, an exploratory factor analysis (EFA) in Study 1 was conducted to select items. This selection prompted reconsideration of two of the original scale labels, although a four-factor structure was retained. The questionnaire’s structure was then confirmed via confirmatory factor analyses (CFA) using data from Studies 2, 3, and 4. All studies reported here were conducted with German-speaking participants. Accordingly, all validation questionnaires were administered in German—either original German instruments, direct translations, or adaptations of English scales. German abbreviations are used throughout the manuscript, with the original versions specified in the study descriptions.

2. Development of the Questionnaire

Our aim was to assess the subjective situational experience of disgust rather than primarily the eliciting domains typically emphasized by existing measures. Prior instruments either organize items by stimulus categories (e.g., Disgust Scale, FEE, DS-R) or conceptualize state disgust as unitary (ESF-K), leaving the multidimensional structure of state experience under-specified. Guided by Davey’s (2021) proposal of four mechanisms, we therefore operationalized object-, self-, moral-, and process-based components. This structure is theoretically linked to differential clinical profiles (e.g., object disgust for contamination-related OCD or self-disgust in depression), motivating a component-level assessment. Item generation followed a multi-source approach. First, qualitative interviews were utilized in previous bachelor theses to identify new items of the subjective situational perception of disgust that went beyond thus far mentioned aspects. 21 of these items were taken and used for the questionnaire. The first examined version of the questionnaire largely consisted of items that were compiled through an extensive literature search related to the suggested four dimensions. All but one item (“I feel pressure in my ears and jaw”), which were taken from the qualitative interviews, could be backed up by scientific papers or book chapters. In addition, some items were directly adopted or paraphrased from other published scales. Two items were directly adopted from the ESF-K (Ihme & Mitte, 2009) and two further ones were only slightly changed from the original version. Additionally, three items of the “Fragebogen zur Erfassung des Selbstekels” (Overton et al., 2008; Schienle et al., 2014) were adopted. The initial pool comprised 53 items rated on a 5-point Likert scale (0 = “Doesn’t apply at all” to 4 = “Applies strongly”), with 13–15 items per component. In a pilot survey (N = 151), participants imagined a disgust-eliciting situation; instructions were varied to emphasize self-, moral-, or object-focused disgust in order to sample component-specific variance during responding. After this pilot study, items that could not be reliably assigned to a factor or were considered to measure a different construct (e.g. guilt or shame) were excluded, resulting in a 26-item version of the questionnaire used in the subsequent study. Table 2 in the supplementary materials provides details of all 53 original items, their source, if it was a direct or slight adaptation from previous instruments and the reason why an item was not used in the final questionnaire. Together, the development process links contemporary theory on disgust mechanisms to a pragmatic measurement strategy that differentiates how disgust is experienced in a specific situation (object, self, moral, process), laying the groundwork for the factorial testing reported below.

3. Study 1

3.1. Introduction

The first study was designed to examine how well the questionnaire’s scales align with different types of disgust inductions. To identify suitable inductions, we referred to the Disgust Scale–Revised (Olatunji et al., 2007). Based on this framework, we developed three disgust inductions corresponding to the dimensions of animal-reminder, core, and contamination disgust. In addition, we created two further inductions aimed at eliciting self-disgust and moral disgust (moral violation induction), as these dimensions are not included in the Disgust Scale–Revised. The full induction texts (in English) are provided in the supplementary materials, while the German versions, along with both German and English audio files, are available in the OSF repository. A flowchart outlining the procedures of all studies can also be found in the Supplemental materials (Figure 1).

3.2. Materials

Dimensional state disgust was measured using the 26 remaining items of the MSDQ following the pilot study. To validate our questionnaire, several additional measures were administered. Trait disgust was assessed using the validated German version of the Disgust Scale (FEE: Fragebogen zur Erfassung der Ekelempfindlichkeit; Haidt et al., 1994; Olatunji et al., 2007; Schienle et al., 2002; see Section 1 for further details). Depressive symptoms were measured with the German version of the Beck Depression Inventory II, which demonstrates high internal consistency (α ≥ .84) and effectively differentiates between varying levels of depressive symptomatology (Kühner et al., 2007). Obsessive-compulsive symptoms were assessed using the OCI-R (Foa et al., 2002), a scale with strong internal consistency, test–retest reliability, and robust discriminant validity among individuals with OCD, other psychopathologies and non-anxious controls.

3.2.1. Participants

A total of 133 participants were recruited via the university’s survey platform (UmfragenUP) and received course credit for their participation. Of the 133 participants who began the questionnaire, 30 did not complete it and were excluded from further analysis. Additionally, four participants reported being ’distracted while answering two or more times’ and were also excluded. Additionally, five participants were excluded due to outlying answering times (Q1 − 3 ∗ IQR < Time < Q3 + 3 ∗ IQR, where Q is the quartile and IQR is the interquartile range). Additionally, 19 questionnaire completions were removed if the longstring index was two standard deviations above the mean. The final sample consisted of 94 participants answering the questionnaire a total of 263 times with a mean age of 27.8 (SD = 12.69) ranging from 18 to 78. 64 participants (68.0%) were female, 1 (1.1%) identified as diverse, and 1 (1.1%) did not provide a response.

3.2.2. Procedure

As noted in the introduction, we included inductions for core, animal-reminder, and contamination disgust, along with the self-related and moral violation inductions. Participants were randomly assigned three different inductions to balance data richness and participant burden. They were guided through each scenario and completed the questionnaire after each, resulting in three completions per participant. Prior to induction, participants completed the FEE to assess disgust sensitivity without situational bias. After the third induction and answering of the MSDQ, they filled out the OCI-R and BDI-II. This study was preregistered, the preregistration protocol can be found in the OSF repository.

3.3. Exploratory Factorial Analysis

An EFA was conducted separately for each administration (deployed on the OSF data repository) of the questionnaire to assess the stability of the factor structure over time. Additionally, a pooled EFA was performed across all administrations to identify a robust factor solution with maximal sample size.

The Kaiser–Meyer–Olkin (KMO) and Cronbach’s alpha criteria indicated that the pooled data was suitable for analysis (KMO = 0.88; std.alpha = 0.91). Appropriate values were displayed as well by first, (0.78; 0.89), second (0.84; 0.93) and third (0.83; 0.91) MSDQ assessment. The scree plots for all four EFAs suggested a four-factor structure. Therefore, given the factor-to-item ratio and the item-to-sample size ratio for all four conducted EFAs, the sample size for the EFAs conducted for each questionnaire administration is deemed between acceptable for each single assessment and very good for the pooled EFA (Goretzko et al., 2021; Mundfrom et al., 2005).

A four factor EFA was undertaken through the utilisation of an oblimin rotation, thereby facilitating the correlation between factors. A cut-off criterion was implemented for the retention of items, with those loading below .50 being excluded for the purpose of interpretation, which led to the exclusion of five items. To increase efficiency of the questionnaire and reduce the total number of items one additional item was excluded from the final pooled analysis due to poor conceptual fit as well as a low communaltiy and two items were excluded from further analysis due to conceptual redundancy. The factor loadings, as well as communality and complexity values for the EFA with the pooled data can be found in Table 3 of the supplementary materials. The complete output of all separate EFAs can be found within the OSF repository.

The final four-factor structure of the questionnaire remained stable across administrations. However, some original scale labels—derived from the theoretical framework proposed by Davey (2021)—no longer adequately reflected the content of the scales in their final form. Following factor analysis, only a subset of highly specific items from the original pools of 13–15 items per scale was retained. Specifically, items retained from the original object disgust scale exclusively referred to bodily or physiological reactions to disgust-eliciting stimuli. Items retained from the original process disgust scale captured concerns related solely to contamination. Within the moral disgust scale, only items explicitly directed toward others remained; nevertheless, these items continue to reflect a disgust response grounded in the moral evaluation of a situation. Support for this interpretation is provided by the results of the disgust induction procedures reported below. The Self-Disgust scale, in contrast, retained its original conceptual focus. Accordingly, while preserving the item composition and factor assignments of the MSDQ as determined by the factor analysis, we renamed two scales to more accurately reflect their empirical content. This renaming process and its conceptual implications are addressed in detail in the Discussion. The final version of the MSDQ comprised 18 items loading onto four factors:

• Physical Disgust Reaction (PhD -5 items)

• Contamination Concerns (CC - 4 items)

• Self-directed Disgust (SD - 5 items)

• Moral Disgust (MD - 4 items)

Although the renaming of the scales partially alters their conceptual interpretation, the questionnaire itself remained unchanged (i.e.,all items were retained in their original form). Importantly, the scale renaming was conducted after all studies had been completed and the data analyzed, in response to a reviewer’s suggestion. We address this issue at this point in the manuscript to facilitate interpretation of the results reported in the subsequent studies.

4. Study 2

Study 2 was designed to confirm the four-factor structure identified in Study 1. It constituted an almost-exact replication, with the addition of two disgust-specific questionnaires (ESF-K and FESE) to assess construct validity; the BDI-II was not administered again.

4.1. Participants

A total of 126 new participants were initially assessed. Of these, 19 either did not complete the questionnaire or reported being distracted during the study. Two additional participants were excluded due to extreme answering times, and 16 completions were removed based on longstring indexing. This resulted in a final sample of N = 103 participants, completing the MSDQ a total of 293 times. The mean age was 27.0 years (SD = 9.95, range = [18;60]). Seventy-nine participants (77%) identified as female, and 2 (2%) as diverse/other.

4.2. Materials and Procedure

Dimensional state disgust was measured using the 18-item MSDQ from Study 1. Based on participant feedback from Study 1, a response option “this question does not fit the situation” was added to the 5-point Likert scale; responses marked with this option were treated as missing. In addition to the OCI-R and FEE, state disgust was assessed using the ESF-K (Ihme & Mitte, 2009), and self-disgust was assessed using the German Self-Disgust Scale (Fragebogen zur Erfassung des Selbstekels; FESE; Overton et al., 2008; Schienle et al., 2014). The procedure largely mirrored that of Study 1. Each participant listened to three of the five disgust inductions and completed the MSDQ after each induction. All disgust-related questionnaires were administered prior to the inductions to avoid bias in responses, while the OCI-R was administered afterwards.

4.3. Confirmatory Factorial Analysis

To confirm the four-factor structure from study 1, a CFA using the lavaan package (Rosseel, 2012) was performed in R. Since the additional option “this question does not fit the situation” produced non-numeric values, these were treated as missings in the CFA with full information maximum likelihood method (‘fiml’) for missing values. The model specified for each CFA was the factor assignment from Study 1, assuming that the corresponding items would load on their assigned factor only (i.e.,five items on physical disgust and self disgust, and four items on moral disgust and contamination concerns). Participant id was treated as a cluster to account for repeated responses, with cluster-robust standard errors (CRSE) used for parameter estimation. Model fit was acceptable without any modification (χ²(129) = 327.26, p < .001; CFI.scaled = .905; TLI = .888; RMSEA = .078, 95% CI [0.069, 0.088]; SRMR= .079). All items loaded significantly (p < .001) onto their respective factors, with standardized estimates ranging from .640 to .914 (for all factor loadings see Table 1).

Table 1.

Standardized Factor Loadings and Inter Factor Correlations of Confirmatory Factorial Analysis for Studies 2, 3, and 4 Respectively

		Study 2	Study 3	Study 4
N (Completed Questionnaires)		293	454	276
N (Participants)		103	164	276
Factor	Item	Std. loading (δ)
F1 (Physical disgust)	PhD_stomach	.705	.660	.827
	PhD_nauseous	.846	.839	.811
	PhD_gag	.873	.748	.607
	PhD_vomit	.695	.703	.595
	PhD_taste	.679	.718	.586
F2 (Self disgust)	SD_disgusting	.889	.915	.768
	SD_unclean	.884	.886	.788
	SD_standmyself	.640	.761	.471
	SD_others	.749	.830	.425
	SD_wash	.684	.787	.649
F3 (Moral disgust)	MD_avoid	.786	.803	.820
	MD_repulsive	.914	.836	.906
	MD_seen	.860	.792	.778
	MD_wrong	.808	.682	.641
F4 (Contamination concerns)	CC_area	.870	.754	.636
	CC_objects	.798	.860	.714
	CC_infected	.712	.683	.767
	CC_contagious	.691	.817	.752
Covariances between factors
F1
	_∼∼F2	.28	.44	.48
	_∼∼F3	.21	.62	.33
	_∼∼F4	.33	.62	.38
F2
	_∼∼F3	.43	.43	.36
	_∼∼F4	.47	.39	.71
F3
	_∼∼F4	.26	.45	.45

5. Study 3

Study 3 was conducted with a different primary aim than the development of the MSDQ — namely, the creation of a questionnaire to assess disgust in sexual contexts. However, as participants in this study were also exposed to various disgust-eliciting situations, we included the MSDQ to further examine and confirm its factor structure under different conditions.

5.1. Participants

Overall, 488 new participants started assessment in Study 3. Of these, 316 did not complete the questionnaire or said they were distracted during the study. Further 7 participants were excluded due to extreme answering times and 41 completions were excluded due to longstring indexing. This led to a final sample of N = 164 participants completing the MSDQ a total of 454 times with a mean age of 31.4 (SD = 8.63, range = [18;58]). Of the participants, 86 (52%) identified as female, and 6 (3.5%) as non-binary or other.

5.2. Materials and Procedure

Firstly, participants indicated their levels of sexual function before completing a newly developed questionnaire of disgust in sexual situations. Participants then read each of three disgust inductions and afterwards filled out the MSDQ (similar to the procedure in Studies 1 and 2 with different induction scenarios). The complete study description, the questionnaire for disgust in sexual situations as well as the disgust inductions can be found in the OSF repository.

5.3. Confirmatory Factorial Analysis

CFA was conducted analogously to the CFA for study 2. Model fit again was acceptable without any modification (χ²(129) = 397.22, p < .001; CFI.scaled = .914; TLI = .894; RMSEA = .078, 95% CI [0.070, 0.085]; SRMR = .080). All items loaded significantly (p < .001) onto their respective factors, with standardized estimates ranging from .660 to .915 (for all factor loadings see Table 1).

6. Study 4

Study 4 was originally designed to measure the degree of disgust and beliefs about contagion (Rozin et al., 1986) between students of psychology and medicine as well as professional health care workers. Within this study besides measuring trait disgust with the FEE, state disgust was measured with the MSDQ. Again, although validating the MSDQ was not the primary goal of this study, we will use the data within this manuscript to further increase support for the fit of the questionnaire.

6.1. Participants

Overall, 557 new participants started assessment in study 4. Of these, 271 did not complete the questionnaire or said they were distracted during the study. Further 10 participants were excluded due to longstring indexing. This led to a final sample of N = 276 participants completing the MSDQ each once with a mean age of 34.29 (SD = 14.14, range = [18;71]). Of the participants, 219 (79%) identified as female and 2 (0.7%) as diverse.

6.2. Materials and Procedure

Participants first had to indicate if they were psychology or medicine students or health care workers with or without medical education. They afterwards filled out a battery of questions regarding their occupation before conducting the chain of contagion task (Fink-Lamotte et al., 2024; Tolin et al., 2004) assessing their contagious beliefs and filling out the FEE. They were then instructed to imagine a disgusting situation within a hospital which they had experienced themselves or, if they did not remember a disgusting situation within a hospital, any other disgusting situation of their past, such that disgust induction was idiosyncratic. They afterwards only filled out the MSDQ once.

6.3. Confirmatory Factorial Analysis

CFA was conducted analogously to the CFA for study 2 except that no clustering of participants was done, because each participant only filled out the questionnaire once. Model fit was very good without any modification (χ²(129) = 206.60, p < .001; CFI.scaled = .961; TLI = .948; RMSEA = .047, 95% CI [0.035, 0.059]; SRMR = .053). All items loaded significantly (p < .001) onto their respective factors, with standardized estimates ranging from .425 to .906 (for all factor loadings see Table 1).

7. General Results

7.1. Demographic Influences

Demographic influences were assessed for the pooled data set over all four studies with N = 637 participants. For Studies 1, 2 and 3, mean values over all three successive responses were calculated for each participant beforehand.

Pearson correlations showed significant negative correlations between all MSDQ scales and age. The correlation was strongest for self disgust (r = −0.28, p < 0.001) followed by contamination concerns (r = −0.19, p < 0.001), physical disgust (r = −0.14, p < 0.001) and moral disgust (r = −0.10, p= 0.02).

Gender had a highly significant effect on all four disgust dimensions with women scoring higher than men on all dimensions. This influence was highest for physical disgust (F = 23.27, p < 0.001) followed by moral disgust, (F = 11.83, p < 0.001), contamination concerns (F = 7.16, p < 0.01) and self disgust (F = 5.93, p = 0.02).

7.2. Validity and Reliability

Internal Consistency: The complete questionnaire, using data from Studies 2, 3, and 4 (data from Study 1 were excluded from the reliability analyses because a) it contained additional items that were later removed, and b) it did not include the response option “this question does not fit the situation”), demonstrated excellent internal consistency (α = 0.89; ω = 0.90). All subscales showed good to excellent internal consistencies: Physical disgust (α= 0.87, ω= 0.87), self disgust (α= 0.88, ω = 0.88), contamination concerns (α = 0.84, ω = 0.84), and moral disgust (α = 0.89, ω = 0.89).

Influence of Induction: To assess the construct validity of the final questionnaire, we analyzed data from Studies 1 and 2 using linear mixed-effects models, with subject included as a random factor and scale type as a fixed effect. This approach was chosen because each participant completed the questionnaire three times, corresponding to three experimental conditions. Analyses were restricted to Studies 1 and 2, as the relevant disgust inductions were not administered in Studies 3 and 4. Mean scale scores served as the dependent variable to test for differences between scales within each induction condition. The resulting mean scale values are illustrated in Figure 1. Across all inductions, one scale was consistently elevated relative to the remaining scales. Specifically, physical disgust showed the highest values following the core disgust and animal reminder inductions, moral disgust was highest following the moral violation induction, self-disgust was highest following the self induction, and contamination concerns were highest following the contamination induction. These patterns were fully consistent with our preregistered hypotheses, noting that the preregistration refers to the original scale labels. In all conditions, the highest scale score was significantly greater than the remaining scales at a threshold of p < .0001. To avoid reporting an excessive number of pairwise comparisons (15 per induction), we report detailed statistics comparing the highest scale with the second-highest scale for each induction. In the animal reminder induction, physical disgust was significantly higher than self disgust (t = 8.8, p < .0001, d = 0.96, 95% CI [0.66,1.25]). In the contamination induction, contamination concerns were significantly higher than moral disgust (t = 8.7, p < .0001, d = 0.74, 95% CI [0.48,1.00]). In the core disgust induction, physical disgust exceeded self disgust (t = 11.3, p < .0001, d = 1.01, 95% CI [0.73,1.29]). In the moral violation induction, moral disgust was significantly higher than physical disgust (t = 17.1, p < .0001, d = 2.33, 95% CI [1.98,2.67]). Finally, in the self disgust induction, self disgust was significantly higher than moral disgust (t = 12.5, p < .0001, d = 1.56, 95% CI [1.27,1.85]). All remaining pairwise comparisons involving the highest scale yielded equal or larger effect sizes.

Figure 1.

Mean values for the four scales of the MSDQ for the five inductions, studies 1 and 2 combined. Significance bars only represent pairwise comparisons for each scale to the next lower scale for clarity. **** p< 0.0001, ** p< 0.01, ‘ p< 0.1

Correlation with existing measures: As a second measure of validity, correlations between the four scales (calculated as the mean of all consecutive answers of each participant in studies where the questionnaire was assessed more than once) and previous instruments are presented in Table 2. For the MSDQ scales, only the final 18 items and the final factor assignment were used throughout all studies. Scores for the four MSDQ scales were calculated as the mean over all answered items within this scale (meaning 4-5 items per scale). It is important to note that existing measures were not assessed in study 3, FEE was assessed in studies 1, 2 and 4, OCI-R in studies 1 and 2, BDI-II only in study 1 and ESF-K as well as FESE only in study 2.

Table 2.

Correlations Between the Different MSDQ Scales and Previous Instruments (Studies 1, 2 and 4)

MSDQ Scale	FEE (N=473)	ESF-K (N=103)	FESE (N=103)	OCI-R (N=197)	BDI-II (N=94)
Physical Disgust (PhD)	.33 ***	.45 ***	.08	.33 ***	.22 *
Moral Disgust (MD)	.29 ***	.30 **	.21 *	.23 **	.05
Self Disgust (SD)	.35 ***	.36 ***	.24 *	.37 ***	.28 **
Contamination Concerns (CC)	.31 ***	.14	-.05	.37 ***	.33 **

Note. That BDI-II was only assessed in study 1 and ESF and FESE only in study 2 and OCI-R only in studies 1 and 2.

FEE = Fragebogen für Ekelempfindlichkeit (German Version of the Disgust Scale); ESF = Ekel State Fragebogen (German original of a state disgust questionnaire); FESE = Fragebogen zur Erfassung des Selbstekels (German version of the self disgust scale), OCI-R = Obsessive Compulsive Inventory - revised; BDI = Beck Depression Inventory.

*p< .05, **p< .01, ***p< .001.

All MSDQ scales showed significant, rather similar correlations with the FEE with self disgust showing the highest correlation (r = 0.35, p < 0.001) and moral disgust the lowest (r = 0.29, p < 0.001). State disgust, measured with the ESF was significantly correlated to all but the contamination concerns scale, with physical disgust (as predicted) showing the highest correlation (r = 0.45, p < 0.001). Self disgust showed the highest correlation of all MSDQ scales to the previous self disgust measure FESE (r = 0.24, p = 0.01). Also, moral disgust was significantly correlated with the FESE (r = 0.21, p = 0.03). All scales correlated significantly with OCD-symptomatology measured with the OCI-R, with the lowest correlation for moral disgust (r = 0.23, p < 0.01). The highest correlation to OCI-R was found for the self disgust scale and the contamination concerns scale (r = 0.37, p < 0.001). BDI-II was significantly correlated with all but the moral disgust scale. Contamination concerns showed the highest correlation with BDI (r = 0.37, p < 0.001) followed by self disgust (r = 0.28, p < 0.01). Means of all previous scales as well as the four MSDQ scales for the overall sample and split by gender can be found in Table 3.

Table 3.

Values for the 4 Scales of the MSDQ and Previous Instruments According to Gender

	PhD	MD	SD	CC	FEE	ESF	OCI-R	FESE	BDI-II
All	1.46	1.53	1.54	1.50	2.02	2.42	19.6	2.04	9.34
Male	1.17	1.29	1.40	1.32	1.77	2.35	17.9	2.16	8.18
Female	1.57	1.63	1.59	1.57	2.10	2.44	20.1	1.98	10.13

Note. That BDI-II was only assessed in study 1 and ESF and FESE only in study 2 and OCI-R only in studies 1 and 2 and FEE in studies 1, 2 and 4. The means of the MSDQ scales overall and split by gender are the result from N= 637 subjects from studies 1 through 4.

PhD = Physical Disgust; MD = Moral Disgust; SD = Self Disgust; CC = Contamination Concerns; ESF = Ekel State Fragebogen; OCI-R = Obsessive Compulsive Inventory - revised; FESE = Fragebogen zur Erfassung des Selbstekels; FEE = Fragebogen zur Erfassung der Ekelempfindlichkeit.

8. General Discussion

We designed and tested the Mechanistic State Disgust Questionnaire (MSDQ) across one pilot study and four online studies. The MSDQ assesses state disgust across physical, self, and moral disgust, as well as contamination concerns. Both the English and German versions of the questionnaire are available in the supplementary materials and on OSF. Although the German version was translated into English and reviewed by native speakers, the English version has not yet been formally validated.

8.1. New Scale Names and Their Implications

The renaming of two of the four original scales, the resulting shift in the conceptualization of the questionnaire’s dimensions, and the strong focus of the moral disgust Scale on interpersonal aspects constitute the primary points of discussion and are therefore addressed in a separate section. As outlined in the introduction, disgust experiences involving immediate reactions to a triggering stimulus were originally conceptualized as object-based disgust. However, following factor analysis, only items explicitly describing bodily reactions were retained. Items capturing expressive components (e.g., “I raise my upper lip”) or behavioral tendencies (e.g., “I freeze for a moment”) did not load reliably on this factor and were therefore excluded. This pattern suggests that only specific physiological responses to disgust form a coherent and stable factor among the proposed items. Since the conceptual scope of this scale has shifted, further studies are necessary to link these scales to the previously assumed mechanism of disgust termed object disgust. The retained items uniformly describe highly aversive bodily reactions known to promote avoidance behaviour which on a theoretical level links them to the original idea of object disgust (Davey, 2021). However, future research, measuring behavioural avoidance with regard to disgust eliciting objects and correlating them with the physical disgust scale of the MSDQ could strengthen this link. The items of the original process disgust scale were intended to assess specific cognitive biases associated with disgust reactions. However, neither the pilot study nor Study 1 supported a distinct factor with the items chosen. Instead, only items reflecting contamination-related concerns formed a statistically coherent factor, which matches with the idea of the factor structures of the disgust scale revised, that contaminating stimuli are different from core disgust stimuli, not only on the basis of the eliciting stimulus, but also on the basis of the disgust reaction (Haidt et al., 1994; Olatunji et al., 2007). Our results may reflect limitations in the number or formulation of the original items, such that other parts of the process variable were formulated too weakly. Alternatively, contamination concerns may represent the primary—or even sole—cognitive component relevant to state disgust. Future research, linking this scale to cognitive biases associated with disgust and C-OCD, such as attentional or interpretation biases could strengthen the link of this scale to its previously assumed mechanism. With respect to psychopathological relevance, the resulting contamination concerns scale is still expected to play a central role in contamination-focused obsessive–compulsive disorder (C-OCD), consistent with previous findings highlighting the importance of this cognitive dimension (Mathes et al., 2019; Tolin et al., 2004 Fink-Lamotte et al., 2024).

In the original questionnaire, items intended to capture moral violations were assigned to the moral disgust scale. Although most of these items already focused on the behavior of others, factor analysis revealed that only items explicitly describing disgust elicited by other individuals were retained. Items that did not clearly refer to others (e.g., “I feel unclean,” “I imagine creating a similarly disgusting situation myself,” or “I remove myself from the disgusting situation to avoid being seen by others”) did not load reliably on this factor and were therefore excluded. As a consequence, moral transgressions committed by the self are not specifically represented within this scale. This prompted consideration of renaming the scale to interpersonal disgust. However, inspection of the results presented in Figure 1 indicates that the retained items do not capture interpersonal disgust independently of moral transgressions. For instance, scenarios involving a sick person drinking from one’s glass or another person breaking their arm with exposed bone did not elicit significant increases on this scale. If the scale were to reflect interpersonal disgust more broadly, these scenarios would be expected to elevate scores. In contrast, a scenario involving sexual harassment did produce a marked increase on this scale, and a smaller increase was also observed when the participant themselves were the source of the disgust stimulus. In summary, although the original conceptualization of the specific dimensions of the disgust response could not be fully retained during questionnaire development, distinct and theoretically meaningful aspects of these original constructs are nevertheless captured by the MSDQ. At the same time, the present findings suggest that additional dimensions of state disgust may exist that are not represented in the current scale. Future research is therefore needed to further identify such dimensions and to clarify their relationships with psychopathology.

8.2. Previous Disgust Factors and the MSDQ

As outlined in the introduction, existing disgust measures predominantly focus on the stimuli that elicit a disgust response. In contrast, the present work aimed to develop a questionnaire that differentiates components of the disgust reaction itself rather than the eliciting stimulus. These two aspects, however, cannot be fully disentangled, as certain stimuli logically and reliably amplify specific components of the disgust response. This pattern was demonstrated in Studies 1 and 2, in which we constructed scenarios based on disgust-eliciting stimuli and formulated a priori predictions regarding which components of the disgust response would be most strongly activated. At an aggregate level, these predictions were largely supported, as specific inductions tended to selectively elevate the expected MSDQ scales. Nevertheless, substantial interindividual variability was observed, such that the same situation often produced markedly different response profiles across participants. An illustrative example of this variability is provided in the Supplemental Materials in Figure 2.

8.3. Interpretation of the Results

Confirmatory factor analyses of the proposed four-factor model indicated acceptable to good model fit across studies. Inter-factor correlations ranged from .21 (Study 2: Physical disgust – moral disgust) to .71 (Study 4: Self disgust – contamination concerns). Variability in inter-factor correlations across studies likely reflects differences in the contextual elicitation of state disgust. In Study 2, each scenario was specifically designed to elicit a single disgust dimension, which likely contributed to lower inter-factor correlations compared to Studies 3 and 4, where scenarios were not tailored to individual scales. In sexual contexts (Study 3), correlations between physical disgust and self disgust, as well as between physical disgust and contamination concerns, were relatively high (both approximately .62). This pattern may reflect the close association between physical disgust and contamination concerns in sexual situations, as well as the tendency for physical disgust to co-occur with heightened self-directed disgust following perceived contact with a contaminating source. In Study 4, the strong association between self disgust and contamination concerns (approximately .71) may be attributable to the hospital context, in which contamination risks are often directly linked to the self, for example through contact with bodily fluids. Overall, these findings indicate that the MSDQ is highly state-dependent and should be interpreted considering the specific situational context in which disgust is elicited.

Regarding correlations with other measures, all MSDQ scales showed high associations with trait disgust as measured by the FEE, with the strongest correlations observed for self disgust and the weakest for moral disgust. This pattern suggests that the FEE may be less sensitive to moral aspects of disgust. Although we measured state disgust, correlations with existing trait measures were based on the average of three questionnaire completions per participant. Averaging in this way may have produced more trait-like responses, which could explain the high correlations with trait disgust (Steyer et al., 2015). Indeed, when only a single response per participant was considered, correlations decreased substantially. For example, examining only scenarios that elicited peak physical disgust (e.g., animal reminders or core disgust) resulted in smaller correlations with trait disgust. This indicates that when a scenario strongly elicits a specific disgust dimension, correlations with trait measures are reduced. A similar pattern was observed for self disgust in the self-induction scenarios and for moral disgust after moral violation inductions. Consequently, the correlations reported in Table 2 should be interpreted cautiously, and separate analyses may be warranted for different situational contexts. In general, trait disgust appears more strongly represented when the eliciting situation does not specifically match a scale, reflecting more person-specific tendencies. Therefore, the MSDQ is particularly well-suited for assessing disgust in relation to specific situations or states. Correlations with psychopathology measures revealed that contamination concerns and self disgust were strongly associated with depressive and OCD symptoms, highlighting these dimensions as potentially important targets in psychotherapy. In contrast, moral disgust consistently showed the lowest correlations, suggesting it may be less relevant in the context of depression or OCD treatment.

Regarding demographic factors, gender had significant effects on all MSDQ scales, with women scoring higher than men. The largest gender difference was observed for physical disgust, supporting the idea that sensory-driven disgust responses are more gender-specific than other, potentially more cognitively driven, disgust dimensions. Moral disgust was also higher in women, though this effect was most pronounced in Study 3 and not significant in Studies 1 and 2, suggesting that gender differences in moral disgust may be particularly relevant in sexual contexts. An unexpected finding was that men scored higher than women on trait self disgust as measured by the FESE. However, a follow-up ANOVA indicated that this difference was not statistically significant (d = 0.19, F_1,99 = 0.71, p = 0.40). Our questionnaire revealed significant negative correlations between age and all disgust scales, with the strongest decreases observed for self disgust and contamination concerns. The age-related decline in physical disgust may reflect reduced olfactory sensitivity (Doty et al., 1984), but this explanation is less applicable to the other scales. Self disgust may decrease with age because related symptoms—such as those seen in borderline personality disorder—tend to diminish over time (Kot et al., 2023; Shea et al., 2009), and because self-directed disgust may become less relevant once a social network is established. Moral disgust might decline in older participants either due to a convergence of disgust perception across genders (Berthold et al., 2025) or because the induction scenarios were perceived as less morally aversive by older adults. The decrease in contamination concerns with age is less intuitive, given that infection risk generally increases due to immune senescence. One possible explanation is that older adults have more experience managing exposure to potential contaminants without becoming ill. Further research is needed to clarify the relationship between age and disgust, as well as its implications for the behavioral immune system in older populations.

8.4. Limitations

One might argue that renaming the scales during questionnaire development rendered the original rationale obsolete. However, we maintain that the final scales remain related to the initial concepts. We propose a slightly revised framework of distinct mechanisms underlying the disgust response, compared to Davey (2021), as discussed in Section 8.1.

Another important limitation in the development of this questionnaire is that a new response option was added after Study 1. This option was initially treated as a missing value, and the four-factor structure identified in Study 1 was recreated. However, comparability is not fully guaranteed due to the change in response format. To address this, we randomly split the combined sample from Studies 2, 3, and 4 and conducted an EFA followed by a CFA. All factor structures remained consistent, providing confidence that the four factors identified after Study 1 are stable.

In Studies 1, 2, and 3, participants completed the questionnaire three times, and all data were included in the analyses. For Study 1, EFAs were computed for each successive sample as well as for the full dataset, yielding no substantial differences. Although participant id was used as a cluster in the CFA, we also conducted a CFA using only one completion per participant, pooled across all three studies. This approach confirmed the four-factor structure, with a comparable CFI of 0.916. While the CFA results indicated an overall acceptable fit, Studies 2 and 3 did not meet the conventional CFI threshold of 0.95 (Hu & Bentler, 1998). Nevertheless, given that (a) the factor structure was initially established via EFA, (b) the scales demonstrated high construct validity, and (c) Study 4—where disgust inductions were idiosyncratic—showed very good model fit, we are confident that the MSDQ captures four distinct disgust dimensions.

Another limitation concerns the absence of a priori power analyses. Prior to conducting the studies, we followed a general rule of thumb, aiming to collect 300 completions (Kyriazos, 2018) with an absolute minimum of 10 completions per item (i.e.,approximately 180 completions for our studies. While the target of 180 completions was met in all studies, a) the data from Studies 1–3 were not independent, as the same participants completed the questionnaire multiple times and b) in studies 1,2 and 4 we did not fully meet the 300 completions due to longstring indexing and dropouts. Although the total number of completions over all studies substantially exceeded this benchmark, formal a priori power analyses should nonetheless have been conducted.

While the questionnaire is designed not only to assess healthy populations but also to gather information about specific disgust reactions in clinical patients, our study did not include participants with psychiatric diagnoses such as OCD or depression. Although previous research has demonstrated that analogue studies can provide valuable insights for understanding OCD (Abramowitz et al., 2014), the absence of a clinical sample represents a limitation of our work. In future studies, we aim to administer the questionnaire to clinical populations to address this gap.

Regarding correlations with existing measures, it is important to note that some items across questionnaires overlap—particularly between physical disgust and the ESF-K (4 items), and to a lesser extent between self disgust and the FESE (1 item). This overlap means that participants responded to identical items at different time points, which naturally contributes to some degree of correlation. Nevertheless, as we only used a small subset of items from these questionnaires, the strong correlation observed between the ESF-K and physical disgust suggests that even with just five items, we are capturing a construct closely aligned with that assessed by the 15 items of the ESF-K.

8.5. Outlook

Compared to previous instruments, the MSDQ allows to measure four different dimensions of state disgust, which enables researchers to distinguish between different types of disgust. Differentiating between these different types of disgust can help to explore disgust-related processes across a range of psychiatric disorders (e.g., OCD, eating disorders, personality disorders), identifying commonalities and differences. In one lab study, we for example measured the degree of contagious beliefs in participants using the chain of contagion task (Fink-Lamotte et al., 2024; Tolin et al., 2004) which mainly raised the contamination concerns scale of our questionnaire. Thus, people suffering from C-OCD due to heightened contagious beliefs might not profit as much from exposure therapy aiming at habituation, but more from changing their cognitively represented beliefs about contagion. Based on this premise, other experimental disgust induction studies using the MSDQ allow for precise assessment of which disgust dimensions are triggered by various stimuli. For example, closer investigating our results from study 4, measuring state disgust in hospital workers with the MSDQ using a variety of hospital-specific situations, will hopefully reveal interesting results. Additionally, we believe the MSDQ can be used ideally for Ecological Momentary Assessment (EMA). Single scales (containing 4-5 items) or the whole questionnaire can be used in daily-life assessments to understand how disgust experiences fluctuate across contexts and situations. The English version of the questionnaire and the application instructions are provided in the Supplemental materials (Table 1 and page 4, respectively).

8.6. Clinical Field of Application

We believe using the MSDQ across a range of psychiatric disorders might help to identify the dominant type of disgust in individual patients, informing case formulation and could potentially be used for more tailored interventions depending on the type of disgust. Physical disgust, for example, might be more susceptible to exposure and moral disgust to cognitive restructuring. Self disgust could be better targeted using imagery rescripting, self-compassion or mindfulness techniques, and, as mentioned above, contamination concerns could benefit from cognitive interventions like cognitive bias modification training. Besides tailoring treatment using the MSDQ, it can be used to track changes in disgust responses over the course of therapy (e.g., pre/post exposure sessions). Building on this, using the MSDQ might help clarifying nonresponse to standard treatments by identifying less obvious disgust dimensions (e.g, self disgust or contamination concerns), which may explain resistance to typical treatments. As a last clinical aspect, using a differential state disgust assessment can be used to help patients understand and reflect on different types of disgust they experience, fostering emotional awareness. However, it is important to state that the questionnaire has not yet been tested within a clinical sample and the aspects addressed within this section have to be further investigated and backed up by empirical data.

9. Conclusion

Through four studies we developed an 18-item state disgust questionnaire that measures situation-specific subjective disgust experiences across four dimensions: Physical, moral, self-directed and contamination-concern related disgust. Exploratory and confirmatory factorial analysis and various disgust induction scenarios confirmed that these four dimensions are separable from each other and provide empirical data to support the theoretical framework proposed by Davey (2021), while not completely fitting within the original framework. This questionnaire can contribute to a better understanding of the relationship between different disgust dimensions and various psychiatric disorders.

Supplemental Material

Supplemental Material - Beyond Unidimensionality: Development and Validation of the Multidimensional State Disgust Questionnaire (MSDQ)

Supplemental Material for Beyond Unidimensionality: Development and Validation of the Multidimensional State Disgust Questionnaire (MSDQ) by Lars O. M. Rothkegel, Shirin Bordjian-Boroudjeni, Nicolas Reinoso Schiller, Graham C. L. Davey, Jakob Fink-Lamotte in Journal of Experimental Psychopathology

Footnotes

Acknowledgments

We wish to thank all participants for their valuable contributions to this study as well as Malin Koschany, Antonia Ikas and Sarah Grube for their help and assistance on the project. We would also like to thank Frederica Brinkmann for implementing the MSDQ in her study on disgust in sexual situations (study 3) and providing us with the data we needed to complete the CFA. Last, we want to thank Thamea Winterfeld for helping us with the final formatting of the manuscript.

ORCID iDs

Lars O. M. Rothkegel

Jakob Fink-Lamotte

Ethical Considerations

All procedures in studies involving human participants were performed in accordance with the Declaration of Helsinki. Participants were informed, that if the disgust inductions would induce strong feelings of disgust, they could contact the principal investigators of the study, who are trained Psychotherapists. All checked a box in the online experiment that they have read and understood the study information and gave consent to take part in the study. An Ethics vote was obtained in 2021 from the University of Leipzig, where the original conception of the questionnaire and studies was developed.

Consent for Publication

Informed consent was obtained from all participants included in the study.

Funding

This research was supported by the authors’ affiliated institutions as part of their employment. The open access publication costs were covered by the University Library of University of Potsdam.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Open Science Statement

Open Data: The information needed to reproduce all of the reported results (factorial analysis figures & statistics) is available at . I confirm that all the scripts, code and outputs needed to reproduce the results from the main manuscript are provided (Lars Rothkegel, February 6th, 2025). Preregistration and Analysis Plan: The second and third study within this article was preregistered. The corresponding preregistration protocol of study 2 can be found at https://osf.io/5w8x2/, study two was preregistered at as.predicted (#218118), study four was also preregistered at as.predicted. (#232767). For insctructions how to replicate the results, please refer to the provided readme.pdf file in the OSF repository.

Supplemental Material

Supplemental material for this article is available online. The online supplementary materials are available at .

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