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Many Delusional About Smelling Bad

Researchers Say Olfactory Reference Syndrome Is Vastly Under-Recognized
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WebMD Health News
Reviewed by Laura J. Martin, MD

May 25, 2010 (New Orleans) -- Researchers say a psychiatric condition characterized by a person's mistaken belief that he or she smells bad is vastly under-recognized.

Called olfactory reference syndrome, the condition is "probably very common," says Katharine Phillips, MD, of Rhode Island Hospital in Providence.

"These patients suffer tremendously,” she tells WebMD. "They are preoccupied with the belief that they are emitting a foul or offensive body odor, which is not perceived by others."

"They’re impaired in terms of functioning and they have high rates of suicidality," Phillips says.

At a news briefing at the American Psychiatric Association meeting, Phillips said the condition has been described around the world for more than a century but has only been minimally studied.

So she and colleagues examined the features of olfactory reference syndrome in 20 patients seen at a Providence, R.I. hospital.

Their average age was 33, and 60% were female. Their symptoms started between ages 15 and 16, on average.

Many Hours Spent Preoccupied With Smelling Bad

Overall, patients spent three to eight hours a day preoccupied with their concerns that they smelled bad.

"They had thoughts such as "I smell horrid' or "People are moving because I stink,'" Phillips says.

A total of 85% were completely convinced that that they emitted a foul odor, even though they didn't.

About three-fourths thought others took special notice of them, misinterpreting benign acts like scratching their nose or wanting to open a window because a room is stuffy, she says.

Also, 44% sought non-psychiatric treatment for their perceived body odor, including visits to gastroenterologists, dentists, and dermatologists.

"Usually, those treatments didn’t diminish their worry about body odor," Phillips says.

Bad Breath No. 1 Complaint

The majority (75%) thought they had bad breath, and 65% believed their sweat smelled bad. About 30% blamed flatulence or feces for their foul smell, and 20% blamed their urine.

"Most were preoccupied with three different smells on average," Phillips says.

To mask their perceived odors, 90% turned to perfume or powders. "One person even swallowed perfume to improve her breath," Phillips says.

About 70% resorted to frequent showers, 60% constantly chewed gum, and 50% sucked on mints.  About a quarter changed their clothes several times a day to get rid of the imaginary stench.

"Some of these patients would use an entire bar of soap in one shower," she says.

Two-Thirds Think About Suicide

The condition affected their entire life, she says. A total of 74% said they avoided social situations, and 40% stayed in for at least a week because they were so embarrassed by their problem.

More problematic, Phillips says, is that 68% had suicidal thoughts and 32% actually attempted killing themselves. About half had been hospitalized for a psychiatric problem.

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