The olfactory reference syndrome ( ORS ) is a psychiatric condition in which there is a persistent false belief and preoccupation with the idea of ​​emitting an abnormal body odor that the patient perceives as rotten and attacking others.
People with this condition often misinterpret the behavior of others, such as sniffing, touching the nose or opening a window, as a reference to unpleasant body odors that in reality do not exist and can not be detected by others.
This disorder is often accompanied by shame, embarrassment, significant distress, avoidance behavior, social phobia and social isolation.
The term olfactory reference syndrome is derived from:
- Smell, related to the sense of smell.
- References, due to the belief that other people's behavior refers to the smell they ought to be.
- Syndrome, as this is a collection of recognizable features that happen together.
Video Olfactory reference syndrome
Classification
Although the presence of ORS is generally accepted, there is some controversy whether it is a different or partial condition or a manifestation of other psychiatric conditions, mainly due to overlapping similarity. Similarly, there is controversy with regard to how disruptions should be classified. Because ORS has obsessive and compulsive features, some regard it as a type of obsessive compulsive spectrum disorder, while others consider it an anxiety disorder due to a strong anxiety component. It is also suggested to be a type of body dysmorphic disorder or, because it involves a single delusional belief, some suggest that ORS is a monosymptomatic hypochondriacal hyposis (a type of hypochondriacal delusion disorder, see monothematic delusion).
10 revisions of the World Health Organization of the International Statistical Classification of Diseases and Health Related Issues (ICD-10) have no special entry for ORS, or use the term, but in the "persistent delusional disorder" section, expressing delusions can "express the belief that... people others think he smells. "
ORS also never allocated any special entry in any issue of the Diagnostic and Statistical Mental Disorders of the American Psychiatric Association. In the third edition (DSM-III), ORS is mentioned under "atypical somatoform disorder". The third edition of the revision (DSM-III-R) mentions the ORS in the text, stating: "the belief that the person emits a bad smell... is one of the most common types of delusions, somatic type." The fourth edition (DSM-IV), does not use the term ORS but again mentions such a condition under "delusional, somatic-type disorder", states "somatic delusions can occur in some form.the most common is the belief of the person that he or odor rotten from the skin, mouth, rectum or vagina. "In the fifth edition (DSM-5), another ORS does not appear as a different diagnosis, but is mentioned in relation to taijin ky? Fush? (?????, "interruption of fear of personal interaction"). Taijin ky variant? Fush? (shubo-kyofu "phobia of the disabled body" and jikoshu-kyofu "fear of foul odor") listed under 300.3 (F42) "obsessive compulsive and other related disorders", and about a person's fear that his or her body, offending others. There are 4 subtypes of taijin ky? Fush? 17% of these people suffer from "phobias having a bad body odor", a subtype called jikoshu-kyofu. Even though taijin ky? Fush? has been described as a limited cultural bound syndrome in East Asia (eg Japan and Korea), it has been suggested that the jikoshu-kyofu variant of taijin ky? fush? closely related or identical to the ORS, and that such conditions occur in other cultures. However, some sources (West) state that jikoshu-kyofu and ORS can be distinguished due to cultural differences, namely Western culture that mainly deals with individual needs, and Japanese culture especially with the needs of many people. Therefore, he claims that ORS primarily focuses on the embarrassment of affected individuals, and jinkoshu-kyofu is focused on fear to create shame in others. In this article, jinkoshu-kyofu and ORS are considered as a condition.
Synonym for ORS, much history, including bromidrosiphobia, olfactory phobia syndrome, chronic olfactory paranoid syndrome, autodysomophobia, bromosis delusions, hallucinatory odor and delusional olfactory syndrome. By definition, many of the terms that have been suggested in dental literature to refer to subjective halitosis complaints (ie where a person complains of halitosis but no clinically detectable odor) may also be considered under the umbrella of ORS. Examples include halitophobia, non-native halitosis, delusional halitosis, pseudo-halitosis, imaginary halitosis, psychosomatic halitosis, and self halitosis.
Maps Olfactory reference syndrome
Signs and symptoms
The onset of ORS may be sudden, which usually occurs after a peak, or gradual event.
odor complaints
The defining feature of ORS is that excessive mind has an offensive body odor (s) that can be detected by others. Individuals may report that the odor originates from: the nose and/or the mouth, ie halitosis (bad breath), anus, genitals, general skin, or especially the groin, armpits or legs. The source of the odor should also change over time. There are also some who are unsure about the true origin of the odor. The smell is usually reported to continue to be present. Character odor can be reported similar to the substance of the body, such as feces, flatus, urine, sweat, vomit, semen, vaginal fluid; or as an alternative may be an unnatural, non-human or chemical odor, eg ammonia, detergent, rotten onions, burnt cloth, wax, garbage, burnt fish, medicines, old cheeses. Again, the character of reported odor complaints may change over time. Halitosis appears to be the most common manifestation of ORS, with 75% complaining of bad breath, alone or in combination with other odors. The next most common complaint is sweat (60%).
Although all individuals with ORS believe they have an odor, in some cases individuals report that they can not feel the smell itself. In the latter cases, trust arises through misinterpretation of the behavior of others or on the grounds that olfactory disorders that prevent self-detection of odors (ie anosmia) exist. In cases where no odor can be detected, this is usually regarded as phantosmia (olfactory hallucination). The olfactory hallucinations may be regarded as a result of a belief in odor delusions, or beliefs due to olfactory hallucinations. In one review, individuals with unconditional ORS were convinced that they could detect the odor itself in 22% of cases, while in 19% there was occasional or intermittent detection and in 59% lack of self-detection was present.
Some distinguish delusional delusional and non-delusional forms of ORS. In the delusional type, there is full confidence that the smell is real. In the non-delusional type, the individual is able to understand the condition, and can recognize that the scent may not be real, and their attention level is excessive. Others argue that reported cases of ORS present a spectrum of different levels of understanding. Because sometimes the core beliefs of the ORS are not of delusional intensity, it is argued that considering conditions as a form of delusional disorder, as seems to be the case with DSM, is inappropriate. In one review, in 57% of confidence cases ensured, held with full confidence, and individuals could not be assured that the smell was not there. In 43% of cases, individuals hold beliefs with incomplete beliefs, and are capable of varying degrees to consider the possibility that the odor does not exist.
Other symptoms can be reported and claimed related to the cause of the odor, such as damage to anal sphincter, skin diseases, "sore uterus", stomach problems or other unknown organic diseases. Excessive leaching of ORS has been reported to lead to the development of eczema.
Referential ideas
People with ORS misinterpret the behavior of others associated with the smell imaginable (reference mind). In one review, the idea of ​​reference was present in 74% of cases. Typically, this involves misinterpretation of comments, gestures and actions of others so it is believed that the offensive odor of the individual is being referred. This reference thinking is more evident in social situations where individuals with ORS may find stress, such as public transport, crowded lift, workplaces, classrooms, etc. Examples of misinterpreted behaviors include coughing, sneezing, turning heads, opening windows, facial expressions, sniffing, touching noses, scratching heads, moving, moving away, avoiding people, whistling. Generally, when being around other people talking among themselves, people with ORS will be confident that the conversation is about its smell. Even animal actions (eg dog barks) can be interpreted as references to smells. People with ORS may have difficulty concentrating on a given task or in certain situations because of obsessive thoughts about body odor.
Repeat behavior
95% of people with ORS are involved in at least one excessive hygiene, care or other related repetitive practice in an attempt to reduce, cover and monitor perceived odor. It has been described as a regretful reaction, and repetitive, counterphobic, "safety", ritual or compulsive behavior. Despite this action, odor symptoms are reported to still offend other people. Examples of ORS behaviors include: repetitive bathing and other treatment behaviors, excessive brushing, or scratching the tongue (treatment for halitosis), repeating the odor of self to check for smells, frequent use of bathrooms, trying to mask odors, use of deodorant, perfume, mouthwash, mint, chewing gum, scented candles, and soap; changing clothes (eg underwear), several times a day, frequently washing clothes, wearing several layers of clothing, wrapping the feet in plastic, wearing clothes marketed as odor reducers, eating special foods, dietary supplements (eg intended to reduce stomach bloating) repeatedly seeking assurance from others that there is no odor, although negative responses are usually interpreted not as courtesy rather than truth, and avoidance behavior as it usually sits at a distance from others, minimizes movement in "not spreading" efforts, keeping the mouth closed and avoiding talking or talking with your hands in front of the mouth.
Functional disorder
People with ORS tend to develop behavioral patterns of avoidance of social activities and progressive social withdrawal. They often avoid travel, dating, relationships, breaking off engagements and avoiding family activities. Embarrassed and ashamed, they may avoid school or work, or repeatedly change jobs and move to another city. Significant developments can occur such as job loss, divorce, becoming a hospital, a mental hospital, and a suicide attempt. According to some reports, 74% of people with ORS avoid social situations, 47% avoid work, academics or other important activities, 40% have stayed home for at least 1 week because of ORS, and 31.6% have had psychiatric hospitalization. In connection with suicide, reports range from 43-68% with suicidal ideation, and 32% with a history of at least one suicide attempt. 5.6% managed to commit suicide.
Psychiatric mentality
Psychiatric morbidity in ORS is reported. Depression, which is often severe, may be caused by ORS, or may have existed before. Personality disorders, especially cluster C, and especially avoid type, may exist with ORAL. bipolar disorder, schizophrenia, hypochondriasis, alcohol, substance abuse and obsessive compulsive disorder.
Cause
The cause of ORAL is unknown. It is estimated that significant negative experiences can lead to the development of ORS. It has been considered as two types: a key traumatic experience related to olfactory, and a live stressor is present when the condition develops but is not related to olfactory. In one review, 85% of reported cases had a traumatic, odor-related experience, and 17% of cases had stress factors that were not related to olfactory. The reported odor-related experience usually revolves around family members, friends, co-workers, peers or others who comment on the smell of the person, causing shame and embarrassment. Examples include accusations of abdominal bloating during religious ceremonies, or bully for abdominal bloating like at school, urinating in class, announcements about passengers who need to use deodorant over speakers by a driver on public transport, sinusitis that causes discomfort in the mouth , ridicule about the smell of fish from a finger that has been inserted into one's vagina in the context of a sexual assault, and disgust about your menarche and sexual intimacy. It has been argued that some of the reported experiences may not be real, but the initial symptoms of ORS (ie, referential minds). Examples of periods unrelated to unpleasant odors include guilt for romantic relationships, abandonment by spouses, school violence, family illnesses when growing up (eg cancer), and bullying.
The importance of family history of mental illness or other conditions in the ORS is unclear, as most reported cases do not have this information. In some cases, psychiatric and medical conditions have been reported in first-level families such as schizophrenia, psychosis, alcoholism, suicide, affective disorders, obsessive compulsive disorder, anxiety, paranoia, neurosis, sociopathy, and epilepsy. Sometimes more than one family member has conditions worth noting.
Neuroimaging has been used to investigate ORS. Hexamethylpropyleneamine oxime single-photon emission computed tomography (HMPAO SPECT) shows frontotemporal lobe hypoperfusion in one case. That is, the part of the brain receives insufficient blood flow. In other, functional magnetic resonance imaging is done when people with ORS listen to neutral words and emotive words. Compared to the age and sex of healthy control subjects who fit under the same conditions, individuals with ORS exhibit more activation areas in the brain when listening to emotional words being loaded. This distinction is described as abnormal, but less obvious as it would be observed in a person's brain with psychotic disorders.
Diagnosis
Diagnostic criteria
Diagnostic criteria have been proposed for ORS:
- Hanging (& gt; six months), the false belief that someone emits an offensive odor, which no one else feels. There may be a degree of insight (ie beliefs may or may not be of delusional intensity).
- This pre-occupation causes clinically significant stress (depression, anxiety, embarrassment), social and occupational disabilities, or may take some time (ie occupying an individual at least an hour per day).
- Trust is not a symptom of schizophrenia or other psychotic disorders, and not because of drug effects or drug abuse, or other general medical conditions.
Differential diagnosis
The differential diagnosis for ORS may be tricky because of the sharing of features with other conditions. As a result, ORS may be misdiagnosed as a medical or other psychiatric condition and otherwise .
A typical ORS history involves long delays while the person continues to believe there is a genuine odor. On average, patients with ORS were undiagnosed for about 8 years. Recurrent consultation with several different non-psychiatric medical specialists ("physician shopping") in an attempt to eliminate untreated body odor is often reported. Individuals with ORS may be present for dermatologists, gastroentrologists, otolaryngologists, dentists, proctologists, and gynecologists. Although there is no clinically detectable odor, doctors and surgeons may initiate unnecessary investigations (eg gastroscopy), and treatments, including surgery such as thoracic sympathectomy, tonsillectomy, etc. Such treatments generally do not have long-term effects on individual beliefs in odor symptoms. If a non-psychiatric doctor refuses to take care on the basis that there is no real odor and offers to refer them to a psychologist or psychiatrist, people with ORS usually refuse and instead seek "better" doctors/dentists.
Conversely, some argue that the medical conditions that cause the original odor can sometimes be misdiagnosed as ORS. There are many different medical conditions that are reported to be potentially causing a genuine odor, and this is usually thought to correspond to the origin of the odor, eg halitosis (bad breath), bromhidrosis (body odor), etc. This condition is excluded before the ORS diagnosis is made. While there are many different publications on topics such as halitosis, these symptoms are still poorly understood and managed in practice. It is known that symptoms such as halitosis may occur intermittently, and therefore may not be present at the time of consultation, leading to misdiagnosis. Individuals with original odor symptoms can present with the same mindset and behavior for people with ORS. For example, an autolaryngologist researcher noted "behavioral problems such as continuous work with oral hygiene issues, obsessive use of cosmetic breathing products such as mouthwash, candy, gum, and sprays, avoiding close contact with others, and turning heads. during conversation "as part of the so-called" skunk syndrome " in patients with native halitosis due to chronic tonsillitis. Another author, writing about halitosis, notes that there are generally 3 types of people who complain of halitosis: those with above average odor, those with average or almost average sensitivity smells, and those who are below average or no odor that believes they have an offensive breath. Therefore, in people with genuine odor complaints, distress and anxiety usually do not match the reality of the problem. Genuine halitosis has been described as a social barrier between individuals and friends, relatives, partners and colleagues, and can negatively change self-esteem and quality of life. Similar psychosocial problems are reported in other conditions that cause pure odor symptoms. In the literature on halitosis, emphasis is often placed on various consultations to reduce the risk of misdiagnosis, and also asks individuals to have reliable trustees accompany them to consultations that can confirm the reality of reported symptoms. Patients ORS can not provide such trust because they do not have an objective odor.
Various organic diseases can cause parosmias (distortion of the sense of smell). Also, since odors and flavors are closely related senses, a spirit disorder (eg dysgeusia-flavor dysfunction) may be present as an odor-related complaint, and otherwise . This condition, collectively called chemosensory dysfunction, is numerous and varied, and they can induce a person to complain of odor rather than absent, but the diagnostic criteria for ORS require an exclusion from the cause. They include the pathology of the right hemisphere of the brain, substance abuse, arterial malformations in the brain, and temporal lobe epilepsy.
Social anxiety disorder (SAD) and ORS have some demographic and clinical similarities. Where social anxiety and avoidance behaviors primarily focus on worries about body odor, ORS is a more precise diagnosis than avoidant personality disorder or SAD. Dysmorphic disorder of the body (BDD) has been described as the nearest diagnosis in DSM-IV to ORS as both focus on body symptoms. The defining difference between the two is that in BDD the preoccupation is with physical appearance instead of body odor. Similarly, where obsessive behavior is directly and consistently associated with body odor than anything else, ORS is a more precise diagnosis than a compulsive obsessive disorder, in which obsessions are different and multiply over time.
ORS can be misdiagnosed as schizophrenia. Approximately 13% of schizophrenics have olfactory hallucinations. In general, hallucinations of schizophrenia are considered as having origin, subject to external, whereas in the ORS they are admittedly derived from the individual. The suggested diagnostic criteria mean that the possibility of ORS is negated by the diagnosis of schizophrenia where persistent delusions of offensive body odor and olfactory occa- tions are a feature that contributes to criterion A. However, some cases of ORS are reported to be presented as co-morbid. Indeed, some have suggested that ORS may in time turn into schizophrenia, but others suggest there is little evidence for this. People with ORS have no other criteria to qualify for the diagnosis of schizophrenia.
It has been suggested that special investigations may be indicated to help override some of the above conditions. Depending on the case, this may include hormone neuroimaging, thyroid and adrenal tests, and analysis of body fluids (eg blood) with gas chromatography.
Treatment
There is no agreed treatment protocol. In most of the reported cases of ORS, the treatments performed were antidepressants, followed by antipsychotics and various psychotherapy. Little data is available on the efficacy of these treatments in ORS, but some show that psychotherapy produces the highest response rates for treatment, and that antidepressants are more efficacious than antipsychotics (response rates are 78%, 55% and 33% respectively). According to one review, 43% of cases showing overall improvement required more than one treatment approach, and only 31% providing the first treatment led to some improvement.
Pharmacotherapy used for ORS includes antidepressants, (eg selective serotonin reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors), antipsychotics, (eg blonanserin, lithium, chlorpromazine), and benzodiazepines. The most common treatment used for ORS is the SSRI. Specific antidepressants that have been used include clomipramine.
Psychotherapy that has been used for ORS includes cognitive behavioral therapy, eye movement desensitization and reprocessing.
Prognosis
When not treated, the prognosis for ORAL is generally poor. It is chronic, lasting for years or even decades with worsening of symptoms rather than spontaneous remission. Transformation to other psychiatric conditions is not possible, although very rarely what appears to be an ORS can then manifest into schizophrenia, psychosis, mania, or major depressive disorder. The most significant risk is suicide.
When treated, the prognosis is better. In one review, the proportion of hospitalized ORS cases reporting results was assessed. On average, patients are followed for 21 months (range: 2 weeks to 10 years). With treatment, 30% cured (ie no longer having ORS odor beliefs and mind referrals), 37% improved and in 33% there was a decrease in conditions (including suicide) or no change from pre-treatment status.
Epidemiology
Cases have been reported from various countries around the world. It is difficult to estimate the prevalence of ORS in the general population because of limited and unreliable data, and because of the delusional nature of the conditions and characteristics of confidentiality and shame.
For unknown reasons, men seem to be affected twice as often as women. The high proportion of patients with ORS is unemployed, single, and socially inactive. The reported mean age was about 20-21 years, with nearly 60% of cases occurring in subjects under 20 in one report, although another review reported an older average age for both men (29) and women (40).
History, community and culture
The term olfactory syndrome reference was first proposed in 1971 by William Pryse-Phillips. Prior to this, the published description of what is now considered ORS emerged from the late 1800s, with the first being Potts 1891. Often the condition was misrepresented as another condition, such as schizophrenia.
In modern times, commercial advertising pressures have changed public attitudes toward issues such as halitosis, which has taken on the consequences of greater negative psychosocial symptoms as a result. For example, in the United States, a poll reported that 55-75 million people regarded bad breath as a "prime concern" during social gatherings.
References
External links
- "Insights on olfactory syndrome" by prof. K Phillips August 12, 2010 (Podcast, free membership required to access)
- olfactory reference syndrome, OCD and Clinical Related Disorders and Research Units at Massachusetts General Hospital
- olfactory reference syndrome, OCD Center of Los Angeles
Source of the article : Wikipedia
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