So way back in the mists of time I was a medical student on my psychiatry rotation. I am starting by saying that I loved everything about it. I remember a 25 years old lady admitted to our psychiatry outpatient clinic with a complaint of foul body odor. She had an idea that she emitted a sweaty body odor that disgusted people around her. She had applied to other clinics several times and asked for help to get rid of this smell, which however could not be detected by others. She regularly checked her odor, showered every time she left home, used excessive amounts of perfume, and habitually tried to sit at a distance from other people. Due to her stress, her social life was impaired. Her physical, neurologic, and laboratory evaluation showed no abnormalities. She had been suffering from olfactory reference syndrome (ORS) for 5 years. Her complaints had started while attending an art workshop. A guy sitting next to her asked her a question and had an unpleasant expression on her face. She had a belief that it might be her body odor that caused this response, and this belief grew stronger. The presented case suggests a relationship between a triggering stressful life event and the onset of ORS. Olfactory reference syndrome is an under recognized condition. Patients think they smell bad, but they don't. There is a mismatch between their own perception and the perception of others. It seems ORS is more common than generally believed. But it goes unrecognized and undiagnosed. Patients may have obsessive compulsive disorder (OCD), also body dysmorphic disorder (BDD).
Common Olfactory Reference Syndrome obsessions include:
Exaggerated fear of having extremely bad breath (halitophobia),
Fear of having a foul overall body/anal/vaginal or mouth odor or chemical odor.
Believing others’ behavior is related to their smell.
ORS can be impairing, to the point where some people consider suicide. If one thinks he/she smells bad but it is a false believe, better to find out if he/she has ORS. It is wise to be sure that one doesn't have a seizure disorder or another medical condition that might explain the symptoms. The differential diagnose for ORS may be complicated as the disorder shares features with other conditions. ORS may be misdiagnosed as another psychiatric or medical condition and vice versa.
What should we make of the study of patients' stories…
The past couple of weeks were primarily devoted to family and loved ones - what a year! It was necessary to spend some time just reminding each other of good things that happened, good things which are here and good things to look forward to.
My attention has been devoted to mastering the sewing machine… “mastering” is a strong term but with the help of a good friend, lots of soda, an inscrutable manual and at least a few YouTube videos I was able to sew a couple of lines - forward and backward. Below is the actual eureka moment captured in video!
This is an entirely new medium for me who up until now had mostly only sewn buttons! I’ve always had such respect for clothes makers, I have now added more for the extraordinary patience that is required.
Evidence! Hopefully it will get better...
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Pooneh Heshmati is an award-winning cognitive neuroscientist, physician, and post doctoral researcher at Northwell Health in New York.
Joana Ricou is an award-winning NYC-based artist, and creative director of Regenerative Medicine Partnership for Life.