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Rare Disorder Has People Convinced They Smell Bad

Sufferers often isolate themselves, consider suicide, study finds

TUESDAY, May 25 (HealthDay News) -- New research sheds light on a rare but disabling psychiatric disorder known as olfactory reference syndrome (ORS), where sufferers are convinced that they emit horrible smells and, as a result, often isolate themselves or even attempt suicide.

"Patients suffer tremendously as a result of this false belief, and they appear to be very impaired in terms of functioning and appear to have high rates of suicidality," said Dr. Katharine A. Phillips, a professor of psychiatry and human behavior at Rhode Island Hospital/Brown University in Providence. "But ORS is surprisingly minimally studied. It's not a well-known disorder."

Phillips, who is to present her research on the syndrome Tuesday at the American Psychiatric Association (APA) annual meeting in New Orleans, spoke at a Tuesday teleconference. The APA is considering whether the syndrome deserves to be defined as its own official disorder in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

"ORS has been described around the world for more than a century," Phillips explained. "It consists of a preoccupation with the belief that one emits a foul or offensive body odor which is not perceivable by other people."

Likely cultural standards, especially in earlier times when hygiene was less of a priority, probably also play a role, added Dr. Bryan Page, chairman of anthropology and a professor of psychiatry at the University of Miami Miller School of Medicine.

In the United States, where people are very concerned with cleanliness, for instance, the phobia may be more prevalent, he noted.

The study authors analyzed 20 patients with ORS to determine the general characteristics of the disorder.

Patients in the sample were an average of 33.4 years old and, on average, had been suffering from ORS since they were 15 or 16. Sixty percent were female.

On average, volunteers spent a good three to eight hours a day preoccupied with negative thoughts about their perceived odor. Many also engaged in repetitive activities (perhaps using an entire bar of soap in a day) for hours each day. Eighty-five percent were convinced that their beliefs were completely accurate, even though no one else agreed, Phillips said, and three-quarters felt that others were noticing them because of their "smell."

"If someone rubs their nose because of an allergy or opens a door, they misinterpret that to think they stink," Phillips explained.

Three-quarters of the participants were certain they had bad breath. Other sources of perceived odor included sweat (65 percent), armpits (60 percent) and genitals (35 percent).

Ninety-five percent practiced at least one compulsive behavior on a daily basis because of this conviction. Eighty percent smelled themselves continually, 68 percent showered obsessively and 50 percent changed clothing repeatedly. Many used powder or perfume (sometimes even drinking the perfume), deodorant, gum and other products to rid themselves of the scent. One individual actually had their tonsils removed, thinking this would take care of the perceived bad breath.

The syndrome also left many people isolated, with three-quarters saying they avoided social interactions because of the "smell" and 40 percent reporting having been housebound for at least a week. More than two-thirds had contemplated suicide, one-third had attempted suicide and more than half had been hospitalized for psychiatric reasons.

Many also had major depressive disorder and social phobia.

Despite the psychological ramifications of the disorder, 44 percent sought non-psychiatric treatment, such as dentists or dermatologists.

The majority (85 percent) said they could actually smell themselves -- an "olfactory hallucination."

"I would encourage patients to seek psychiatric treatment. As far as we know, non-psychiatric dental and medical treatment doesn't help," Phillips said. "Cognitive behavioral therapy has been shown in a small case series to be helpful, and certain medications."

More information

Visit the American Psychiatric Association for more on how ORS might be included in the next Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

SOURCES: May 25, 2010, teleconference with: Katharine A. Phillips, M.D., professor, psychiatry and human behavior, Rhode Island Hospital/Brown University, Providence; Bryan Page, Ph.D., professor and chairman, anthropology, professor, psychiatry, University of Miami Miller School of Medicine; May 25, 2010, presentation, American Psychiatric Association annual meeting, New Orleans

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