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People who are certain they stink, and the psychiatrists who sense this may be a disorder [Updated]

May 25, 2010 | 12:20 pm

Psychiatrists meeting this week in New Orleans at their annual confab got a first look at a largely unresearched patient population beset with a deeply distressing delusion: that they smell bad -- really bad.

Patients with the proposed diagnosis of "olfactory reference disorder" (sometimes referred to as a "syndrome") are certain beyond doubt that they stink, when in fact they smell no worse than is average for a 21st century American. According to Dr. Katharine Phillips, director of Rhode Island Hospital's Body Image Program, four in 10 people who likely have the disorder have sought out medical treatments for what they believe to be bad breath, foul body odor, stinky feet or residual fecal or urine smell. Their worry preoccupies them for between three and eight hours a day, on average, and impels patients to shower for hours, consume bars of soap or gallons of mouthwash in a single day -- even to drink perfume in an effort to eradicate the imagined smell.

A slight majority -- 60% -- of sufferers appear to be women, Phillips told her colleagues, and most began to suspect that they emitted foul odors at around 15 to 16 years of age. 

For people afflicted with this delusion, social situations can be a gantlet of shame and self-consciousness, said Phillips: When people with whom they come into contact innocently scratch their noses or a stray allergen causes someone to sniff, people with this unique bodily delusion report they feel certain it is in response to their own foul body odor. Another person's move to open a window or door in a stuffy room will fill such a patient with fear that he or she has stunk up the place. When they confide their fears to others and are assured they smell perfectly fine, these patients do not believe it: They suspect a friend is just being nice or has a poor sense of smell, Phillips said.

Not surprisingly, 40% report they have remained housebound for at least a week out of fear of offending others. Two-thirds have contemplated suicide, and a third have attempted it, Phillips reported. The vast majority suffer from depression or some other mental disorder, and substance abuse -- possibly an effort to "self-medicate," according to Phillips -- is common.

"I'm just so struck by the incredible distress they're feeling, the incredible sense of social ostracism," Phillips said. 

Is it real -- not the body odor, but the psychiatric disorder? That is something psychiatrists will likely begin to explore over the next decade: The American Psychiatric Assn. has proposed adding "olfactory reference disorder" to the appendix of the Diagnostic and Statistic Manual (DSM) V as an entity worthy of further research and consideration. Among the many questions that must be explored before the nation's psychiatrists would consider conferring on "olfactory reference disorder" the full status of a diagnosable disease: How widespread are these symptoms in the general population? How impairing is it? How does it start and manifest itself over a patient's life? Are these symptoms more closely related to compulsive behavior, depression, body dysmorphia? And what therapies does it respond to?

On this last point, Phillips said there is early evidence that cognitive behavioral therapy -- a form of "talk therapy" that is narrowly focused on problematic behavior and the thought processes that contribute to it -- can be helpful to some sufferers. She said antidepressants that are in wide use -- known as SSRIs -- may help some as well.

An article in the Journal of Family Pracitice is a good overview of the condition. If you think you may suffer from this, you could take this test. For a Los Angeles-based treatment program, see here.

-- Melissa Healy

[Updated at 12:15 p.m.: An earlier version of this post incorrectly stated the number of people who have sought out medical treatments for "olfactory reference disorder."]

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Comments (12)

yea thats great, so now not only do you stink, but the doctors want to turn you into drug addicts to boot.

Yet, another self centered condition that gets a bunch of attention. Who would of thought.

Get over yourselves.

Oh yeah- I have had a couple clients who have this delusion. Clients without personality disorders do well on medication===as do all ill people without a personality disorder, but the ones who have cluster A do not seem to budge.
Everything about patients getting better has to do with how severe their personality disorder is. The ones who do not have personality disorder can function well to vertually not really having symptoms-that's why PD's are on AXIS II, it is who they are.

In Chinese Medicine, the sense of an abnormal smell, either from one's self or the environment, often suggests what we call a Phlegm disorder. At one extreme a phlegm disorder causes mania or mental instability. Many people have phlegm but no mental problems but abnormal smell is a minor component of this problem.
Douglas Eisenstark L.Ac.

In general, healthy people pay little attention to their own smells. I see plenty of patients with foul breath. They never warn me about it. I've seen a dozen or two that complain of bad breath. When I smell, they never have it. Now and then I see patients with smelly feet or body odor. They're not demented but they don't seem to notice.

Steve Dingtank-- it is actually a DELUSION- like psychosis.
I totally get what you are saying and you are speaking about personality disorders who get attention in passive aggressive ways- that is why I mentioned them. BUT, some of these people are really sweet and have this delusion. One guy I had got into a car accident and then was psychotic. Psychosis is very commen with head injuries.
That is why it is so smart to knock yourself around, drive while texting, drunk, etc, and to do drugs-brilliant!!
All we can do is give meds for delusions- no evidence shows scientology works :)

This disorder is more common in Japan where hygiene and social courtesy are held to a higher standard (eg: taijin kyofusho) and is considered a culture-bound syndrome in the DSM-TR. Thank you mass media advertising for bringing it to the USA. 8-/

-Godot

Actually, scent chemist Lucas Turin successfully advised ("cured") a woman like this, some years ago, in Britain. You can find it in Chandler Burr's biography on Turin, called "The Emperor of Scent."

You know who has a disorder? The leeches that pass for psychiatric and medical "professionals" who turn anything that doesn't fit into their world view into a "disorder". People who are consciously part of an industry that legally turns people into drug addicts, while MASKING illnesses rather than healing them, are as guilty as common drug pushers off the street. Those who supposedly practice the HEALING arts--I'm talking to you.

I was one of those persons for years, and still have the problem, though not as much.

Hi my name is Dr Alex Parson I'm a bacterial researcher. In response to the volume of emails I receive from people desperate to get rid of their Halitosis I've directed them to Articlesbase I've created this series of articles to help people understand and control their bad breath. I also recommend all chronic bad breath sufferers visit the site http://www.oraltech.com.au as they advise how you can cure halitosis at home and reports to me show the best health outcomes from Oraltech Labs.

The question is: have psychiatrists correctly come up with a disorder, or do the people genuinely smell ? At the moment people think of body odor as a skin surface problem, but it's more likely that the majority of those who are 'concerned' about a body odor problem have a SYSTEMIC body odor. The main cause will likely be a deficiency in one of our many enzymes. The only current accepted form is trimethylaminuria. Most are 'mild' cases, which means they are transient. Also they usually cannot smell themselves, and neither can relatives. If you think about anyone with body odor or halitosis that you know, does it seem they can smell themselves ? Other enzyme body odors have been reported, such as dimethylglycinuria. I'm gussing mild isovaleric acidemia will be another. Psychiatrists could help society by making it mandatory to test anyone who comes to them about apparent ORS, but I'm guessing they have other priorities. Someday systemic body odors will be recognised and treated by the medical system. An international body odor research center would be the most cheapest and effective way. You can read more about systemic body odors at http://www.meboresearch.com

Here is a lady that would likely easily fit the ORS diagnosis, if it were not that she had tested for TMAU
http://abcnews.go.com/Primetime/story?id=2287206&page=1



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