They change their clothes frequently. They shower repeatedly, sometimes using a whole bar of soap in one go. Some even swallow perfume.

They think they smell bad, but they don’t.

Olfactory reference syndrome is a rare psychiatric disorder, but it can lead to isolation, depression, and suicide. It’s also a little-noticed, little-studied syndrome. But now a study to appear in Depression and Anxiety has looked at twenty sufferers and reviewed current literature on the disorder to determine its general characteristics.

Psychiatrists have known about the disorder’s symptoms for over a century, but treatment and diagnosis are difficult, in part because the syndrome doesn’t currently have its own classification in Diagnostic and Statistical Manual of Mental Disorders (DSM)–the handbook of mental health professionals. The manual combines the syndrome with other disorders, such as social phobia, delusional disorder, body dysmorphic disorder, and obsessive-compulsive disorder. The new study gives recommendations for updating the next version of the manual, and suggests adding this disorder to an appendix of conditions that need further research.

As reported by HealthDay News, nineteen of the study’s twenty volunteers exhibited at least one compulsive behavior, like repeated self-sniffing or showering. On average, they spent eight hours a day thinking about their smell. Fearing social interactions, forty percent had been housebound for over a week.

Many patients thought the smell came from their mouth, but they were also concerned with their armpits, genitalia, anus, feet, and skin, according to a MedPage Today article.

Katharine Phillips, a coauthor of the study and a professor of psychiatry and human behavior at Brown University, presented these and other findings on Tuesday at the American Psychiatric Association annual meeting. She told Reuters Health:

“I think it’s a very secret and hidden disorder, because these patients tend to be very ashamed of themselves…. I have been so struck by the intense suffering that the patients experience.”

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Image: flickr / mysza831