Self-odor delusion is a delusional content that makes patients believe in a repulsive self-odor. Higher-level disorders such as schizophrenia, obsessive-compulsive disorder, or brain organic damage play a role in the development of the delusion. Treatment involves a combination of medication administration and therapy.
What is self-odor mania?
The group of delusional disorders contains different clinical pictures of the psyche. Delusional disorders, for example, differ significantly with delusional content. In the self-odor delusion, the content of the delusion corresponds to a bad body odor. Sufferers are obsessed with the thought that their smell has a repulsive effect on others. Self-odor delusion is also known as bromidrosiphobia or bromosis and was originally described in the literature against the culturally specific background of Japan. Taijin Kyōfushō is considered the first describer. Since the 1970s, the delusional content has also found its way into English-language publications. Thus, the clinical picture was detached from the Japanese context and has since been known as Olfactory Reference Syndrome. The disorder is a rather rare content form of delusion. Meanwhile, self-smell delusion is no longer a separate, monosymptomatic disorder, but is placed in the context of mental disorders such as obsessive-compulsive disorder, schizophrenia, and psychosyndromes.
Causes
The causes of self-odor mania may be cultural and individual learned misperceptions. In addition, various primary disorders can lead to the symptomatic picture of self-odor mania. Paranoid schizophrenia is sometimes the best known disorder with delusional symptomatology. In the case of paranoid schizophrenia, the delusion is usually ego-systonic. That is, patients perceive the bad self-odor as an absolutely logical and self-evident part of their personality. As a symptom in the context of obsessive-compulsive personality disorder, the self-odor delusion can be equally ego-systonic. I-dystonia, on the other hand, is often present for the delusion in the context of obsessive-compulsive disorder. In this case, the patients are aware that their idea of bad self-odor is not coherent. In some cases, the self-odor delusion has also been attributed to brain-organic damage. In this context, for example, degenerative diseases come into question as the primary cause of the delusional disorder. There are often smooth transitions between the possible causes. Patients with self-odor delusions suffer from a relatively characteristic set of misperceptions and misjudgments. They believe they smell repulsively. This impression is entirely subjective and different from objective reality. Many patients speak of abnormal odor sensations of their own person, which occur mainly in relation to their environment. They often feel that the gestures, facial expressions, and behavior of other people in contact with them are inevitably related to their repulsive body odor. They often obsessively search for organic diseases that can explain the subjectively perceived stench of their body. They resort excessively to perfumes and other means to combat their odor. Because they are plagued by social anxiety due to their odor, shame and social withdrawal often set in. Depending on the primary cause, the delusion is associated with other symptoms and is perceived as either personality-associated or personality-disruptive.
Diseases with this symptom
- Catatonic schizophrenia
- Schizophrenia
- Obsessive-compulsive personality disorder
- Brain tumor
- Paranoid schizophrenia
- Obsessive-compulsive disorder
- Dementia
- Brain hemorrhage
- Schizoaffective disorder
- Organic psychosyndrome
- Brain inflammation
- Concussion
Diagnosis and course
The self-smell delusion has been treated mainly in the context of case collections. A diagnosis according to ICD-10 or DSM is hardly feasible due to the fluid cause transitions. In principle, the diagnosis is made by a psychologist or psychotherapist, although in some cases a neurologist is consulted for the diagnosis. Causative disorders of the brain organ system can be detected by imaging such as CT or MRI.Since the self-smell delusion usually stands in the context of other illnesses of the psyche and thus corresponds only to a symptom, it is often consulted as a delusion symptomatology for the occupation of larger clinical pictures such as the obsessive-compulsive disorder. The prognosis for patients depends on the overarching disorder. Ego-systonic delusional symptomatology is usually less treatable than ego-dystonic delusional symptomatology because of the lack of recognition of its inconsistency.
Complications
Self-odor delusion is a mental disorder that is very difficult to treat. Patients believe they have a very unpleasant self-smell and treatment is usually with pills. Although this treatment can curb the cause of this disorder, it does not cure this mental disorder. Psychotherapy would be appropriate here, but many patients refuse it. This therapy would be particularly important, because it makes clear that body odor is by no means repulsive to fellow human beings and that the perception of those affected must be changed. A cure is achieved in the rarest cases, simply because the patient has to “cooperate”. The symptoms can be contained by the medication, the patient is thus “immobilized” with the tablets. However, he is far from cured, moreover, the causes of this disease are very different. These diseases are accompanied by many misperceptions, the patients have their own opinion, which is miles away from reality. Sufferers draw wrong conclusions from other people’s gestures, they firmly believe that these people’s facial expressions and gestures are related to their unpleasant smell. They often look for organic diseases to explain the repulsive smell. Although this “stench” is felt only subjectively, people with this disease withdraw more and more and hardly participate in social life.
When should you go to the doctor?
It is normal to be concerned about your own well-groomed appearance. This includes checking a possible body odor. This check is even desirable, because body odor from others is almost always perceived as repulsive. It is also known that one’s own body odor is perceived less intensely by oneself than by others. As with the use of perfume, a habituation effect also occurs for one’s own naturally existing odor. However, anyone who is constantly worried about smelling unpleasantly, even though those around them confirm the opposite when asked and there are no other reactions to indicate this, should think about visiting a doctor. It is possible that there is an organic health disorder. The first contact person should be the family doctor. In general, he has known his patient for years and can adequately assess his concern. Self-smell delusion or perceived self-smell can have a health background or be due to certain medications. Sometimes the personal environment is too polite to respond honestly to inquiries. If necessary, the family doctor will arrange for further examinations by specialists, especially psychiatrists, psychologists or psychotherapists. Self-odor delusion may in fact be based on a psychological disorder. Often, the person affected lacks self-awareness. Here, family and friends are needed to organize medical treatment for a person suffering from self-smell delusion.
Treatment and therapy
Treatment for patients with self-odor mania depends on the overriding cause. Depending on the underlying disorder, various therapeutic approaches may be used. One of these is conservative drug treatment. This form of treatment is not suitable for addressing the root cause and only counteracts the symptom itself. Patients may be temporarily symptomless with drug treatment. However, this symptomlessness is not equivalent to a cure, since the cause is not counteracted. Medications such as neuroleptics or clomipramine are used for symptomatic treatment. Which medication is more suitable is decided with the primary disease. A causal form of treatment is psychotherapy, which in the case of self-odor mania usually takes the form of group therapy or at least in combination with group therapy.In addition, cognitive behavioral therapy can be offered in individual cases, in which the patient’s own body odor is re-evaluated and their perception is changed. The treatment form of cognitive behavioral therapy is particularly suitable for culturally or otherwise educationally induced causes. In the context of brain-organic damage, the priority is to treat the causative disease. For degenerative diseases, there are no curative but at least disease-delaying drugs available. Sometimes the most difficult to treat is self-smell delusion in the context of schizophrenia. A causal cure is not usually achieved in this context. However, antipsychotics can attenuate acute phases.
Outlook and prognosis
Self-odor mania is a purely psychological problem, which is why self-odor mania should also be treated by a psychologist. The affected person does not really suffer from the bad smell, but only imagines this symptom. This leads to social anxiety and exclusion. The affected person tries to interpret every gesture and every remark of other people to their own body odor and therefore always interprets that their own odor is not pleasant for other people. This leads to stressful situations, especially when the person comes into contact with many people. Often the affected person looks for a cause in organic diseases of the body and imagines certain diseases. The result is frequent visits to doctors, although there is no real problem. This can also lead to neglect of the workplace, for example, which can lead to problems with the employer. A much worse symptom is the constant perfuming and washing of the body in a self-odor mania. This is to avoid that the own body has an unpleasant odor. However, the permanent washing damages the natural protective layer of the skin and causes itching of the skin. In any case, self-odor mania should be treated with the help of a doctor. The treatment may take several months.
Prevention
Self-odor mania can have numerous causes. The symptom can be prevented only to the extent that these causes can be prevented. Since degenerative brain diseases and likewise diseases such as schizophrenia often have hereditary causative factors, full prevention is virtually impossible.
What you can do yourself
In most cases, self-odor mania is a psychological problem. Therefore, a consultation with a psychologist should always be arranged in order to identify the causes of the self-odor mania and thus be able to combat it specifically. Very often, the self-odor mania leads to compulsive washing and perfuming. This should be limited in any case, because this behavior destroys the natural protective layer of the skin. Ideally, the affected person should refrain from taking perfume and other washing products with them when they are out and about. Perfuming and washing is only necessary before leaving the home. Should the self-odor mania become stronger again, this often has certain triggers, which include stress in particular. Stress should be avoided, it is also useful to seek distractions so that the self-smell mania can be bypassed. Talking to other people about one’s problem is always helpful. A doctor can identify the causes of the problem and treat it specifically. Unfortunately, with the self-odor mania, there are few self-help remedies that the affected person can take or perform themselves. If the skin is already irritated by compulsive washing and perfuming, it is high time to seek the advice of a doctor.
