Arch Sex Behav https://doi.org/10.1007/s10508-018-1165-z

ORIGINAL PAPER

Responsibility/Threat Overestimation Moderates the Relationship Between Contamination‑Based Disgust and Obsessive–Compulsive Concerns About Sexual Orientation Terence H. W. Ching1 · Monnica T. Williams1 · Jedidiah Siev2 · Bunmi O. Olatunji3 

Received: 30 December 2016 / Revised: 3 June 2017 / Accepted: 29 January 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018

Abstract  Disgust has been shown to perform a “diseaseavoidance” function in contamination fears. However, no studies have examined the relevance of disgust to obsessive– compulsive (OC) concerns about sexual orientation (e.g., fear of one’s sexual orientation transforming against one’s will, and compulsive avoidance of same-sex and/or gay or lesbian individuals to prevent that from happening). Therefore, we investigated whether the specific domain of contamination-based disgust (i.e., evoked by the perceived threat of transmission of essences between individuals) predicted OC concerns about sexual orientation, and whether this effect was moderated/amplified by obsessive beliefs, in evaluation of a “sexual orientation transformation-avoidance” function. We recruited 283 self-identified heterosexual college students (152 females, 131 males; mean age = 20.88 years, SD = 3.19) who completed three measures assessing disgust, obsessive beliefs, and OC concerns about sexual orientation. Results showed that contamination-based disgust (β = .17), responsibility/threat overestimation beliefs (β = .15), and their interaction (β = .17) each uniquely predicted OC concerns about sexual orientation, ts = 2.22, 2.50, and 2.90, ps < .05. Post hoc probing indicated that high contaminationbased disgust accompanied by strong responsibility/threat overestimation beliefs predicted more severe OC concerns about sexual orientation, β = .48, t = 3.24, p < .001. The

* Terence H. W. Ching [email protected] 1



Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA

2



Department of Psychology, Swarthmore College, Swarthmore, PA, USA

3



Department of Psychological Sciences, Vanderbilt University, Nashville, TN, USA

present study, therefore, provided preliminary evidence for a “sexual orientation transformation-avoidance” process underlying OC concerns about sexual orientation in heterosexual college students, which is facilitated by contamination-based disgust, and exacerbated by responsibility/threat overestimation beliefs. Treatment for OC concerns about sexual orientation should target such beliefs. Keywords  Contamination-based disgust · Sexual orientation · Obsessive–compulsive disorder

Introduction The emotion of disgust comprises mainly the domains of core disgust (i.e., evoked by ingesting spoiled foods, encountering animals conventionally associated with garbage, and bodily waste products), animal-reminder disgust (i.e., evoked by reminders of one’s mortality and/or inherent animalistic nature), and contamination-based disgust (i.e., evoked by the perceived threat of transmission of essences between individuals) (Olatunji, Haidt, McKay, & David, 2008; Olatunji et al., 2007b). Disgust is implicated in many psychological disorders (for reviews, see Cisler, Olatunji, & Lohr, 2009; Mason & Richardson, 2012), but has mostly been studied in relation to symptoms of contamination-based obsessive– compulsive disorder (OCD; for reviews, see Berle & Phillips, 2006; Calkins, Berman, & Wilhelm, 2013) in support of a “disease-avoidance” function, where disgust motivates avoidance of potential contaminants in contamination-based OCD in order to prevent disease transmission (Matchett & Davey, 1991; Oaten, Stevenson, & Case, 2009). For example, several studies with clinical, analogue, or non-clinical samples have found greater self-reported disgust in high versus low contamination-based OCD groups (e.g.,

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Broderick, Grisham, & Weidemann, 2013; Inchausti, Delgado, & Prieto, 2015; Woody & Tolin, 2002) and/or observed specific associations between self-reported disgust and contamination-based OCD symptom severity (e.g., David et al., 2009; Olatunji et al., 2010; Olatunji, Sawchuk, Lohr, & de Jong, 2004). These findings are also supported by studies employing a variety of behavioral avoidance tasks, in which individuals with greater contamination-based OCD symptoms exhibited greater avoidance of disgust-related stimuli (e.g., Deacon & Olatunji, 2007; Olatunji, Ebesutani, Haidt, & Sawchuk, 2014; Olatunji, Lohr, Sawchuk, & Tolin, 2007a). Other studies have found information processing biases for disgust-related stimuli with greater contamination-based OCD symptoms (e.g., Adams & Lohr, 2012; Armstrong, Olatunji, Sarawgi, & Simmons, 2010; Jhung et al., 2010). Additionally, prospective studies have observed decreases in disgust and contamination-based OCD symptoms in tandem as a function of treatment (e.g., Athey et al., 2015; Olatunji, Tart, Ciesielski, McGrath, & Smits, 2011; van den Hout, Engelhard, Toffolo, & van Uijen, 2011). In contrast, there has been no research on the relevance of disgust domains to OC concerns about sexual orientation, which revolve around the theme of fear of sexual orientation transformation. This is a relatively common fear among those with an OCD diagnosis (sometimes referred to as sexual orientation–OCD [SO-OCD] in the literature; Hershfield, & Corboy, 2013; Melli, Moulding, Gelli, Chiorri, & Pinto, 2016; Williams, 2008), and it includes unwanted obsessions about sexual relationships contrary to one’s sexual orientation and/or compulsive actions performed to prevent that from happening (Gordon, 2002; Williams, Crozier, & Powers, 2011; Williams, Slimowicz, Tellawi, & Wetterneck, 2014). The absence of research in this aspect is surprising, especially since there are strong, abstract similarities between the role of disgust in the “disease-avoidance” model for contamination fears, and OC concerns about sexual orientation. To elaborate, the theme of aversion to/avoidance of potential contaminants due to perceived threat of contagion and interpersonal transmission of essences is central to the specific domain of contamination-based disgust (Olatunji et al., 2007b). In an abstract sense, this is also highly descriptive of core OC concerns about sexual orientation. For example, it is not uncommon to observe, in a heterosexual male with severe OC concerns about sexual orientation, an aversion to and compulsive avoidance of interactions with same-sex or gay or lesbian individuals. This can be due to the perceived threat of transformation of his sexual orientation (“If I interact with other men, I will turn gay”) and/or interpersonal transmission of an unwanted sexual orientation (e.g., “If I interact with gay men, my sexual orientation will change”) (Williams, 2008; Williams, Tellawi, Davis, & Slimowicz, 2015a). It is important to note that such avoidance in heterosexual individuals with OC concerns about sexual

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orientation is rarely motivated by homophobia. In a recent psychometric validation of a measure of OC concerns about sexual orientation with a large sample of 1399 heterosexual college students, scores on this measure were not significantly correlated with scores on another measure of negative and prejudiced attitudes toward gay and lesbian individuals (Williams et al., 2017). Rather, heterosexual individuals with OC concerns about sexual orientation are mainly concerned about no longer being able to enjoy romantic, intimate heterosexual relationships, should their sexual orientation transform against their will (Williams, 2008; Williams, Wetterneck, Tellawi, & Duque, 2015b). As such, there may also be avoidance of situations in which interactions with same-sex or gay or lesbian individuals may occur, as well as avoidance of objects and other reminders of such interactions, for the same aforementioned reasons (e.g., Williams et al., 2015a). In other words, contamination-based disgust might facilitate a “sexual orientation transformation-avoidance” function in OC concerns about sexual orientation, analogous to a “disease-avoidance” function in contamination-based OCD symptoms. Examining the link between contamination-based disgust and OC concerns about sexual orientation will thus address the need to better understand these symptoms, given the substantial prevalence of such concerns in individuals seeking treatment for OCD (10%; Williams & Farris, 2011) and the extreme associated distress (Williams et al., 2015b). Because obsessive beliefs (e.g., the three domains of importance/control of thoughts, responsibility/threat overestimation, and perfectionism/intolerance of uncertainty) are also implicated in OCD (Obsessive Compulsive Cognitions Working Group [OCCWG], 2005), we thought it would be useful to incorporate them into this study, for a more comprehensive examination of possible mechanisms underlying OC concerns about sexual orientation. Indeed, Teachman (2006) provided a theoretical integration of obsessive beliefs into the disgust–OCD picture by postulating how obsessive beliefs about the experience of disgust (i.e., interactions between obsessive belief domains and disgust) can exacerbate, particularly, contamination-based OCD symptoms. In empirical support of this theory, Cisler, Brady, Olatunji, and Lohr (2010) found that obsessive beliefs potentiated the impact of disgust on contamination fears in two large non-clinical samples, suggesting that contaminations fears are exacerbated by obsessive beliefs about the significance of evoked disgust responses to the threat of contamination. Therefore, we were also interested in testing different obsessive belief domains as moderators of the possible relationship between contamination-based disgust and OC concerns about sexual orientation. Specifically, we hypothesized that contamination-based disgust, rather than core or animal-reminder disgust, would be uniquely predictive of such concerns. We also explored which of the three obsessive belief domains would independently predict OC concerns about sexual orientation. In line

Arch Sex Behav

with Teachman’s (2006) theory, and similar to Cisler et al.’s (2010) findings, we further hypothesized that the predictive effects of contamination-based disgust and any significant obsessive belief domain(s) would be qualified by an interaction effect (i.e., moderation), in that increased endorsement of the latter would amplify the relationship between contamination-based disgust and OC concerns about sexual orientation.

structure across non-clinical samples globally (Olatunji et al., 2009a). Items were rated on a 5-point scale, from 0 (strongly disagree or not disgusting at all) to 4 (strongly agree or ex‑ tremely disgusting). Higher total or subscale scores indicate greater disgust. In the present sample, Cronbach’s alphas for the three subscales, as well as the full scale, were .81, .80, .57, and .89, respectively. These estimates are similar to those obtained in a recent psychometric validation of the DS-R by van Overveld, de Jong, Peters, and Schouten (2011).

Method Participants and Procedure

Obsessive Beliefs Questionnaire‑44 (OBQ‑44; OCCWG, 2005)

A convenience sample of 283 self-identified heterosexual college students (152 females, 131 males) enrolled in an Introductory Psychology course in a large Midwestern university participated for course credit. The study was advertised online in a secure portal to which only students enrolled in that course had access. The mean age of the sample was 20.88 years (SD = 3.19). The total sample comprised 221 non-Hispanic Whites, 28 Blacks/African-Americans, 19 Asians/Asian-Americans, 5 Hispanic/Latino Americans, 1 Native American, and 9 individuals of other ethnoracial identities. After obtaining informed consent, participants were e-mailed a link directing them to another secure Webbased portal, on which they completed measures assessing constructs of interest (i.e., disgust, obsessive beliefs, and OC concerns about sexual orientation). All items had to be responded to before participants could be fully credited. This online study was approved by the university’s institutional review board.

The OBQ-44 is a reliable, valid, and factorially stable selfreport measure of three domains of obsessive beliefs: 12 items for importance/control of thoughts (i.e., beliefs about the significance of one’s thoughts and the need to control them; e.g., “Having nasty thoughts means I am a terrible person”), 16 items for responsibility/threat overestimation (i.e., beliefs about the exaggerated likelihood of untoward events occurring to oneself or others; e.g., “Avoiding serious problems [for example, illness or accidents] requires constant effort on my part”), and 16 items for perfectionism/intolerance of uncertainty (i.e., beliefs about the need to be perfect and perfectly certain about most things; e.g., “Things should be perfect according to my own standards”). The items were rated on a 7-point scale, from 1 (disagree very much) to 7 (agree very much). Higher total or subscale scores indicate greater obsessive beliefs. In the present sample, Cronbach’s alphas for the three subscales, as well as the full scale, were .88, .89, .86, and .94, respectively.

Measures

Sexual Orientation Obsessions and Reactions Test (SORT; Williams et al., 2017)

Disgust Scale—Revised (DS‑R; Olatunji et al., 2007b) The DS-R is a 25-item self-report measure of three domains of disgust: 12 items for core disgust (i.e., disgust in response to food, animals, and bodily products; e.g., “If I see someone vomit, it makes me sick to my stomach”), 8 items for animalreminder disgust (i.e., disgust in response to bodily violations, mutilation, or death; e.g., “It would bother me to be in a science class, and to see a human hand preserved in a jar”), and 5 items for contamination-based disgust (i.e., disgust in response to perceived threat of transmission of essences between individuals; e.g., “I probably would not go to my favorite restaurant if I found out that the cook had a cold”). The DS-R had high internal consistency and good convergent and discriminant validity in large non-clinical and OCD patient samples (Olatunji et al., 2007b), and a stable three-factor

The SORT is a self-report measure of OC concerns about sexual orientation (Williams et al., 2017). The SORT contains 12 items (e.g., “I worry that my sexual orientation may change”). In its most recent psychometric evaluation, the SORT demonstrated good to excellent reliability and validity in non-clinical and OCD samples (e.g., significant correlations of .88 and .79 with the Yale–Brown Obsessive–Compulsive Scale—Second Edition—Severity Scale [Y-BOCSII-SS; Storch et al., 2010] and the Obsessive Compulsive Inventory—Revised [OCI-R; Foa et al., 2002], respectively, in OCD patients with primary symptoms pertaining to sexual orientation concerns). Each item was rated on a 5-point scale from 0 (never) to 4 (always). Higher total scores indicate more severe OC concerns about sexual orientation. In the present sample, Cronbach’s alpha for the full scale was .83.

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Statistical Analysis Descriptive statistics and Pearson’s bivariate correlations of constructs of interest were first obtained. Thereafter, three hierarchical regression analyses (i.e., a different obsessive belief domain in each, with the respective contaminationbased disgust × obsessive belief domain interaction term entered last) were conducted, to determine the unique contributions of contamination-based disgust, obsessive belief domains, and their interactions to severity of OC concerns about sexual orientation. Covariates were core and animalreminder disgust, to further ascertain the specificity of contamination-based disgust to OC concerns about sexual orientation. Scores on all predictors were centered prior to computation of interaction terms and analysis. Post hoc probing of any significant interaction (i.e., determining the exact nature of the moderation of the link between contaminationbased disgust and OC concerns about sexual orientation by the relevant obsessive belief domain) was then conducted, according to the procedure stipulated by Holmbeck (2002).

Results Table 1 shows the descriptive statistics and Pearson’s bivariate correlations of subscale scores on the DS-R and OBQ-44, as well as summed scores for the SORT. There were significant interrelationships among contamination-based disgust (rather than core and animal-reminder disgust), importance/ control of thoughts, responsibility/threat overestimation, and OC concerns about sexual orientation, rs = .12 to .20, all ps < .04. This suggested that beliefs about importance/ control of thoughts and responsibility/threat overestimation could be potential moderators of the relationship between contamination-based disgust and OC concerns about sexual orientation. Table 2 summarizes the results of the three hierarchical regression analyses. In the first hierarchical regression analysis, the three disgust domains and importance/control

of thoughts were entered in the first step. These variables accounted for 3.8% of the variance in OC concerns about sexual orientation, F(4, 278) = 2.73, MSe = 28.52, p = .030. Only contamination-based disgust emerged as a unique predictor of OC concerns about sexual orientation in this step, β = .17, SE = .11, t(278) = 2.20, p = .029, 95% CIs for b = [.03, .46]. The contamination-based disgust × importance/control of thoughts interaction term was entered in the last step. However, it neither accounted for incremental variance, Fchange < 1, nor uniquely predicted OC concerns about sexual orientation, β = .04, SE = .01, t < 1, 95% CI for b = [− .01, .02]. In the second hierarchical regression analysis, the three disgust domains and responsibility/threat overestimation were entered in the first step. They accounted for 4.7% of the variance in OC concerns about sexual orientation, F(4, 278) = 3.41, MSe = 28.25, p = .010. Only contaminationbased disgust and responsibility/threat overestimation emerged as unique predictors of OC concerns about sexual orientation in this step, βs = .17 and .15, SEs = .11 and .02, ts(278) = 2.22 and 2.50, ps = .027 and .013, 95% CIs for bs = [.03, .46] and [.01, .10], respectively. The contamination-based disgust × responsibility/threat overestimation interaction term was entered in the last step, and accounted for an incremental 2.8% variance, Fchange(1, 277) = 8.43, p = .004, and, as hypothesized, was also a unique predictor of OC concerns about sexual orientation, β = .17, SE = .01, t(277) = 2.90, p = .004, 95% CI for b = [.01, .03]. Post hoc probing of the interaction was conducted to determine the exact nature of the moderation effect (see Holmbeck, 2002). Specifically, high contamination-based disgust accompanied by strong responsibility/threat overestimation beliefs predicted more severe OC concerns about sexual orientation (β = .48, t = 3.24, p < .001), while high contamination-based disgust accompanied by low endorsement of beliefs about importance/control of thoughts did not (β = − .04, t < 1). This amplification (i.e., moderation) of the association between contamination-based disgust and OC concerns about sexual orientation by responsibility/threat overestimation is displayed in Fig. 1.

Table 1  Descriptive statistics and correlations for all measures Measure

M (SD)

2.

3.

4.

5.

6.

7.

1. DS-R Contamination-based disgust 2. DS-R Core disgust 3. DS-R Animal-reminder disgust 4. OBQ-44 Importance/control of thoughts 5. OBQ-44 Responsibility/threat overestimation 6. OBQ-44 Perfectionism/intolerance of uncertainty

6.63 (3.69) 27.59 (8.66) 15.48 (6.98) 29.88 (11.07) 54.39 (14.95) 57.59 (14.00)

.60***

.48*** .66***

.20*** .06 .08

.13* .01 .01 .59***

.10 .01 .04 .57*** .66***

.12* -.01 .02 .14* .17** .12*

7. SORT M mean, SD standard deviation *p < .05; ** p < .01; *** p < .001 (two-tailed)

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5.82 (5.41)

Arch Sex Behav Table 2  Summary of hierarchical regression analyses for variables predicting OC concerns about sexual orientation (N = 283)

Model 1

Model 2

Analysis

Variable

b

SE for b

β

b

SE for b

β

1

1 2 3 4 1 × 4

.24 − .08 .01 .06

.11 .05 .06 .03

.17* − .12 .01 .11

.11 .05 .06 .03 .01

.16* − .12 .01 .12 .04

R2 F for ∆R2 1 2 3 5 1 × 5

.038

.23 − .07 .01 .06 .01 .040

.11 .05 .06 .02

.17* − .12 .02 .15*

.22 − .06 .01 .06 .02 .075

.11 .05 .06 .02 .01

.15* − .10 .02 .18** .17**

.11 .05 .06 .02

.18* − .12 .01 .11

.11 .05 .06 .02 .01

.18* − .12 .01 .11 .01

2

3

R2 F for ∆R2 1 2 3 6 1 × 6

2.73* .24 − .08 .02 .05

0.52

.047 3.41** .26 − .08 .01 .04

8.43**

R2

.036

.26 − .08 .01 .04 .002 .036

F for ∆R2

2.61*

0.05

Variable: 1 = DS-R contamination-based disgust; 2 = DS-R core disgust; 3 = DS-R animal-reminder disgust; 4 = OBQ-44 importance/control of thoughts; 5 = OBQ-44 responsibility/threat overestimation; 6 = OBQ-44 perfectionism/intolerance of uncertainty. All variables were centered at their means prior to computation of interaction terms and analysis *p < .05; ** p < .01 (two-tailed)

SORT Total Score

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278) = 2.61, MSe = 28.56, p = .036. Only contaminationbased disgust emerged as a unique predictor of OC concerns about sexual orientation in this step, β = .18, SE = .11, t(278) = 2.42, p = .016, 95% CI for b = [.05, .48]. The contamination-based disgust × responsibility/threat overestimation interaction term entered in the last step neither accounted for incremental variance, Fchange < 1, nor uniquely predicted OC concerns about sexual orientation, β = .01, SE = .01, t < 1, 95% CI for b = [-.01, .02].

OBQ-44-RT (+1SD) OBQ-44-RT (Mean) OBQ-44-RT (-1SD)

6 4 2 0

DS-R-Cont (-1SD)

DS-R-Cont (Mean)

DS-R-Cont (+1SD)

Fig. 1  Severity of OC concerns about sexual orientation (SORT total score) as a function of contamination-based disgust (DS-R-Cont) and responsibility/threat overestimation (OBQ-RT). − 1SD = one standard deviation below mean; + 1SD = one standard deviation above mean

In the third hierarchical regression analysis, the three disgust domains and perfectionism/intolerance of uncertainty were entered in the first step. These accounted for 3.6% of the variance in OC concerns about sexual orientation, F(4,

Discussion In the present study, we found that contamination-based disgust, rather than core or animal-reminder disgust, uniquely and consistently predicted OC concerns about sexual orientation. This novel finding of a specific link between contamination-based disgust and OC concerns about sexual orientation provides preliminary support for the hypothesized “sexual orientation transformation-avoidance” function of contamination-based disgust in such symptoms. Analogous to how disgust motivates avoidance of potential contaminants to

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prevent disease in the “disease-avoidance” model for someone with contamination fears (Matchett & Davey, 1991; Oaten et al., 2009), concerns about interpersonal transmission of essences might also motivate compulsive avoidance of samesex and/or gay or lesbian individuals (or situations where such contact might occur, and objects and other reminders of such individuals) in a heterosexual individual with OC concerns about sexual orientation, to prevent the perceived possibility of sexual orientation transformation. This also coheres with the domain of concerns about “interpersonal contamination” due to contact with out-group members (in this case, for example, individuals with a sexual orientation different from one’s own) in Rozin, Haidt, and McCauley’s (2000) typology of disgust. Responsibility/threat overestimation beliefs (i.e., beliefs about the exaggerated likelihood of untoward events occurring to oneself or others) also uniquely predicted OC concerns about sexual orientation. More importantly, responsibility/threat overestimation beliefs further interacted with contamination-based disgust in uniquely predicting OC concerns about sexual orientation. Post hoc probing indicated that high contamination-based disgust accompanied by strong, rather than low, endorsement of responsibility/threat overestimation beliefs predicted more severe OC concerns about sexual orientation, similar to Cisler et al.’s (2010) finding of obsessive beliefs potentiating the impact of disgust on contamination fears. These findings therefore provide insights into OC concerns about sexual orientation by highlighting two possible interactive mechanisms that may exacerbate such symptoms (see Teachman, 2006). For example, a heterosexual individual with severe OC concerns about sexual orientation may: (1) experience strong disgust about being “contaminated” with an unwanted sexual orientation when in the physical presence of same-sex or gay or lesbian individuals; (2) strongly believe that elicited disgust about perceived “interpersonal contamination” and triggered intrusive doubt about one’s sexual orientation both signal the increased likelihood or threat that one’s sexual orientation will change; and therefore (3) engage in compulsive avoidance of same-sex or gay or lesbian individuals for fear of being further “contaminated” with an unwanted sexual orientation, resulting in functional impairment. Although fears of sexual orientation transformation are temporarily allayed, such avoidance ultimately maintains OC concerns about sexual orientation (Starcevic et al., 2011), and presumably contamination-based disgust reactions and beliefs about such reactions and responsibility/ threat overestimation, to the detriment of fulfilling sexual activities and romantic relationships (Williams et al., 2015b). It is important to reiterate that such avoidance in heterosexual individuals with OC concerns about sexual orientation is rarely motivated by homophobia (Williams et al., 2017). The main concern, instead, is the loss of access to heterosexual

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relationships with a sexual orientation that has changed, or is changing, against their will (Williams, 2008). Research has shown that disgust responses are resistant to extinction with exposure and response prevention (Ex/RP) (McKay, 2006; Olatunji, Wolitzky-Taylor, Willems, Lohr, & Armstrong, 2009b), the most strongly recommended treatment for OCD symptoms (Ludvik, Boschen, & Neumann, 2015). On the other hand, obsessive beliefs can be modified successfully through appropriate behavioral experiments and cognitive restructuring (Jónsson, Hougaard, & Bennedsen, 2011; Ponniah, Magiati, & Hollon, 2013), and have even been found to be the main mechanisms of change in cognitive therapy for OCD (Wilhelm, Berman, Keshaviah, Schwartz, & Steketee, 2015). Our findings therefore have clear clinical implications, particularly in light of this disparity in treatment response between mechanisms theorized to contribute to OCD symptoms. Specifically, we recommend that in addition to conducting Ex/RP for OC concerns about sexual orientation (instead of contamination-based disgust), cognitive behavior therapy should also target beliefs about the exaggerated likelihood or threat of sexual orientation transformation as a function of disgust reactions and intrusive doubt about one’s sexual orientation. Reducing such beliefs, for example, via cognitive bias modification (Williams & Grisha, 2013) could perhaps dampen (or even nullify) the relationship between contamination-based disgust and OC concerns about sexual orientation (see nonsignificant regression line representing low endorsement of responsibility/threat overestimation in Fig. 1). Future research, however, should further examine the nature of and reasons for this link.

Limitations and Suggestions for Future Research There were a few limitations in the present study that should be noted. A non-clinical heterosexual college student sample was recruited, and findings might not be generalizable to individuals suffering from clinically significant levels of OC concerns about sexual orientation. Replication studies with OCD patient samples with these symptoms as their primary presentation therefore need to be carried out. Additionally, OC concerns about sexual orientation can occur in gay and lesbian individuals (e.g., an affirmed gay man with obsessional fears of “turning heterosexual”), even though these cases are less frequently observed (Goldberg, 1984; Williams, 2008). Therefore, it may be interesting to explore the roles of contamination-based disgust and obsessive beliefs in OC concerns about sexual orientation replication in gay and lesbian individuals. Our data were also collected in a crosssectional manner, which meant that we could not examine causality in our hypothesized associations. Prospective or longitudinal designs in future related research (e.g., treatment outcome studies with long-term follow-up) are thus

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necessary, also to test the validity of our clinical recommendations. Furthermore, a considerable portion of the variance in severity of OC concerns about sexual orientation was not accounted for by the variables included in this investigation. This implies that additional constructs are required for expanding our conceptualization of mechanisms underlying these symptoms. For example, previous research has demonstrated relationships between mental contamination (Cougle, Lee, Horowitz, Wolitzky-Taylor, & Telch, 2008; Lee et al., 2013; Melli, Bulli, Carraresi, & Stopani, 2014) and religiosity (Inozu, Ulukut, Ergun, & Alcolado, 2014) on the one hand, and disgust, obsessive beliefs, and/or OCD symptoms on the other. As such, future studies could investigate the additional contributions of these other constructs to the possible pathogenesis, maintenance, and exacerbation of OC concerns about sexual orientation in an integrative manner.

Conclusions In summary, we provided evidence for a “sexual orientation transformation-avoidance” process underlying OC concerns about sexual orientation in a self-identified heterosexual college sample, which is facilitated by contamination-based disgust, and exacerbated by responsibility/threat overestimation beliefs. More research is needed, however, to refine and further validate these findings. Acknowledgements  The authors would like to thank Darlene Davis for development of the data collection instruments and assistance in the collection of data during the early stages of this project. The authors also thank Ghazel Tellawi, Joseph Slimowicz, Melissa Ellsworth, and Victoria Schlaudt for help with recruitment of participants. We would also like to thank Jessica Dowell for help with data entry and assisting with recruitment of participants. Authors’ contributions  All authors conceptualized the research. The first author conducted the literature search, analyzed the data, and wrote the first draft of the manuscript. All authors contributed to the final version of the manuscript. Compliance with ethical standards  Conflict of interest  The authors declare that there are no conflicts of interest. Ethical approval  This research was compliant with the ethical standards set by the institutional review board in which it was housed.

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