Major Finding: Most patients with olfactory reference syndrome (85%) have concurrent major depressive disorder, and 44% have sought nonpsychiatric medical treatment for their perceived odor.
Data Source: A study of 20 patients with olfactory reference syndrome.
Disclosures: Dr. Phillips disclosed that she has received grant and research support from the American Foundation for Suicide Prevention and the National Institute of Mental Health.
Patients with olfactory reference syndrome have high rates of clinical depression and other comorbid psychiatric disorders, and nearly half of them do not seek psychiatric treatment for their perceived order.
Those are key findings from a small, novel study discussed during a press briefing sponsored by the American Psychiatric Association.
Olfactory reference syndrome (ORS) is a preoccupation with the belief that one emits a foul or offensive body odor that is not perceived by other people, said lead study investigator Dr. Katharine A. Phillips, of the department of psychiatry at Rhode Island Hospital/Brown University, Providence.
The few reports about ORS that have been published in the last century “suggest that it is clinically important,” she said. “Patients suffer tremendously as a result of this false belief, and they appear to be very impaired in terms of their functioning and to have high rates of suicidality.”
In an effort to better understand the clinical features of ORS, the researchers used semistructured measurement tools to assess 20 patients with the syndrome, including the Structured Clinical Interview for DSM-IV (SCID) to assess comorbidity, the Brown Assessment of Beliefs Scale to assess insight/delusionality and referential thinking, and a slightly modified version of the Yale-Brown Obsessive Compulsive Scale to assess ORS severity. The mean age of patients was 33 years, 60% were female, and the mean age of onset was 16 years.
Patients reported being preoccupied with their perceived body odor for 3-8 hours per day, mostly the mouth (75%), armpits (60%), and genitals (35%). Bad breath was the most common odor description reported (75%), followed by sweat (65%).
Most patients (85%) reported being completely convinced that their belief about the odor was accurate, and 77% reported thinking “that other people take special notice of them in a negative way because they smell so bad,” Dr. Phillips said. In addition, 85% of patients reported that they actually smelled the odor (an olfactory hallucination).
All of the patients reported practicing repetitive behaviors in an effort to camouflage the perceived odor, mostly with perfume or scented powder (90%), chewing gum (60%), deodorant (55%), and mints (55%).
“Some patients actually drank perfume,” she said. “Some of them constantly chewed gum, ate mints, or reapplied deodorant over and over throughout the day [and] used prescription strength mouthwashes frequently. Some patients showered for hours a day, using an entire bar of soap, trying to remove the odor they perceived.”
In addition, 74% reported that ORS symptoms led to avoidance of social interactions “because they felt so ashamed,” she said. “They worried that other people thought badly of them because they felt they stank.”
More than a third of the patients (40%) said that symptoms were so bad that they were housebound for at least 1 week. “They didn't leave the house at all because they felt too embarrassed [or] ashamed,” she said.
More than two-thirds of the patients (68%) had a history of suicidal ideation, 32% had attempted suicide, and 53% had been hospitalized in a psychiatric unit. The most common lifetime comorbid disorder was major depressive disorder (85%), followed by social phobia (65%), and substance use disorders (50%).
Dr. Phillips also reported that 44% of patients had sought nonpsychiatric medical treatment for the perceived odor. “They went to dentists if they thought they had bad breath, [to] dermatologists if they thought they had smelly sweat,” she said. “One participant in our study had their tonsils removed because they thought their tonsils were causing their breath to be bad.”
About one-third of patients received nonpsychiatric treatment for the perceived odor “but in no case did this treatment diminish the worry about the perceived body odor.”
Dr. Phillips concluded her remarks by noting that ORS “appears to be very under-recognized, and we certainly need more research on this area of study.”
The study also was presented during a poster session at the APA's annual meeting in New Orleans.
Patients 'appear to be very impaired in terms of their functioning and to have high rates of suicidality.'
Source DR. PHILLIPS