• Somatoform Disorders

Olfactory reference syndrome (ORS) is a disabling psychiatric disorder that is characterized by the excessive, irrational fear that one is emitting a foul or unpleasant odor. The obsession may be an exaggerated, disproportionate concern with a natural body smell or may involve an entirely imagined odor.

Patients with ORS “suffer tremendously,” said Katharine Phillips, MD, Rhode Island Hospital, Providence, RI. “They are impaired in terms of functioning and have high rates of suicidality.”

Dr. Phillips and colleagues assessed 20 patients and found that the average patient was female, in her early 30s, and had first started experiencing these concerns around the age of 16 years. These subjects were convinced their belief about the odor was real, even though no one else could detect it.

Nearly all subjects (95%) performed at least one ORS-related compulsive behavior, most commonly smelling themselves (80%), showering excessively (68%), and changing clothes excessively (50%).

“These individuals spend 3 to 8 hours a day preoccupied with concerns about body odors,” said Dr. Phillips. “Some used an entire bar of soap in one shower.”

The most common areas patients felt the odor originated from was the mouth, followed by the armpits, genitalia, anus, feet, and skin. Bad breath was the concern of most (75%), followed by foul sweat (65%), flatulence or feces (30%), and urine (20%). Most were concerned about multiple odor sources, and 85% reported actually smelling the odor—ie, they had what was described by Dr. Phillips as an olfactory hallucination.

Three quarters had avoided social situations, and 40% reported staying at home at least one week at a time because of perceived odors. Suicidal thoughts were reported by 68%, and 32% had actually attempted suicide. About half (53%) had had psychiatric hospitalizations.

The most common lifetime comorbid disorders that were associated with ORS were major depressive disorder (85%), social phobia (65%), and substance use disorders (50%). Nearly half (44%) had sought nonpsychiatric treatment for their perceived body odor, such as from a dermatologist.

• © 2010 MD Conference Express