Rare but Serious Mental Illness Linked to High Risk for Suicidality

Caroline Cassels

June 02, 2010

June 2, 2010 (New Orleans, Louisiana) — A rare but serious mental illness causing individuals to falsely believe that they omit an offensive or foul body odor is associated with significant increased risk for attempted suicide and psychosocial impairment, new research suggests.

Presented here at the American Psychiatric Association (APA) 2010 Annual Meeting, investigators from Brown University in Providence, Rhode Island, found that 32% of patients with olfactory reference syndrome (ORS) attempt suicide and 68% have suicidal thoughts.

In addition, these patients have significant rates of psychiatric hospitalization, they avoid social situations, and many become completely housebound for significant periods.

"These patients suffer tremendously as a result of this false belief and appear to be very impaired in terms of their function and at high risk of suicidality," principal investigator Katharine Phillips, MD, told reporters attending a press briefing here.

Dr. Katharine Phillips

Despite its significant morbidity and mortality risk, ORS is a "seriously underrecognized and understudied syndrome," she added.

Described for a Century

According to Dr. Phillips, ORS has been described for more than a century but has received little attention from a research perspective.

To gain better insight into the clinical features of the condition, the investigators examined 20 individuals with ORS using several standardized methods that have not been used in prior studies.

These methods included the Structured Clinical Interview for DSM Disorders 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.

Subjects had a mean age of 33.4 years, and 60% were female. Typically, the disorder began in adolescence with a mean age of onset of 15.6 years.

The study revealed that patients spent between 3 and 8 hours per day thinking about their perceived body odor. Furthermore, 85% were convinced the belief about the odor was true, and 77% believed others noticed they smelled.

Almost half (44%) of subjects sought nonpsychiatric treatment for their disorder, and of these one-third received it.

Nonpsychiatric Treatment Sought

According to Dr. Phillips, study participants sought the help of gastroenterologists, dentists, and dermatologists in an attempt to reduce their body odor. One subject, she said, went so far as to have a tonsillectomy because he believed his tonsils were causing him to have bad breath. However, in all cases, such treatment proved ineffective.

The most common source of perceived body odor was the mouth, followed by armpits, genitalia, anus, feet, skin, groin, hands, head, and scalp. On average, said Dr. Phillips, individual patients reported 3 different body odors.

Nearly all subjects (95%) performed at least 1 ORS-related compulsive behavior. These included camouflaging (100%), which included spraying perfume, constant gum chewing, and/or consuming mints. One patient actually drank perfume in an attempt to cover up the perceived body odor, reported Dr. Phillips.

Other repetitive ORS behaviors included smelling themselves (80%), excessive showering (68%), and excessive changing of clothes (50%).

"We also found that most of these patients at some point had avoided social situations entirely because they felt so ashamed and they didn't want anyone else to detect this. Forty percent had been completely housebound for at least a week, where they didn't leave the house at all because they felt embarrassed and ashamed and didn't want anyone to detect this [smell]," said Dr. Phillips.

In addition, the study showed that 68% had a history of suicidal ideation, 32% had attempted suicide, and 53% had been hospitalized for psychiatric reasons.

The most common lifetime comorbid disorders were major depressive disorder (85%), social phobia (65%), and substance use disorders (50%).

"This disorder is associated with high rates of functional impairment and high rates of suicidality. It appears to be very underrecognized, and we certainly need more research on this very understudied syndrome," said Dr. Phillips.

Asked to comment on the study, Jeffery Borenstein, MD, Council on Communications chair for the APA, said this is the first time he has heard of the condition.

"I have never seen a patient concerned about body odors, but it sounds as if the condition is very debilitating and people would benefit from treatment. I think we definitely need more research to look at the relationship with co-occurring disorders and to determine potential treatment implications," he said.

Dr. Phillips and Dr. Borenstein have disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2010 Annual Meeting: Abstract NR4-87. Presented May 25, 2010.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.