To most people, believing you smell when you don't would probably seem like less of a problem than oozing a foul BO without noticing.
But for those suffering from olfactory reference syndrome — a false belief that you smell bad — the delusion can have serious consequences. So serious, in fact, that psychiatrists are now considering whether it should have its own entry in the Diagnostic and Statistical Manual of Mental Disorders — the bible for assessing mental woes.
"I think it's a very secret and hidden disorder, because these patients tend to be very ashamed of themselves," Dr. Katharine Phillips, of Brown University in Providence, R.I., told Reuters Health. "I have been so struck by the intense suffering that the patients experience."
Phillips, who presented her findings Tuesday in New Orleans at the American Psychiatric Association annual meeting, said as many of two-thirds of her patients had thought about suicide. Many stay at home — repeatedly sniffing themselves, showering, and washing their clothes — because they are too ashamed to go out, thinking their mouth, armpits or genitals reek.
At this point, nobody knows how common olfactory reference syndrome is.
"Most people haven't heard about it even though it's been described for over a century" said Phillips. But because those who suffer from it tend to isolate themselves, "it may not be a rare disorder."
An early study from the 1970s suggested that as many as 5 percent of people with the disorder may commit suicide. While that number — higher than for any other mental illness — hasn't been confirmed, Phillips says it warrants attention.
The delusions seem to set in during a person's teens. Many of Phillips' patients had tried and failed non-medical therapy and it's unclear at the moment what drugs work.
"I think there is a real need for treatment studies of this disorder," Phillips said.