Abstract
BackgroundPathologic subjective halitosis is known as a halitosis complaint without objective confirmation of halitosis by others or by halitometer measurements; it has been reported to be associated with social anxiety disorder. Olfactory reference syndrome is a preoccupation with the false belief that one emits a foul and offensive body odor. Generally, patients with olfactory reference syndrome are concerned with multiple body parts. However, the mouth is known to be the most common source of body odor for those with olfactory reference syndrome, which could imply that the two conditions share similar features. Therefore, we investigated potential causal relationships among pathologic subjective halitosis, olfactory reference syndrome, social anxiety, and preoccupations with body part odors.MethodsA total of 1360 female students (mean age 19.6 ± 1.1 years) answered a self-administered questionnaire regarding pathologic subjective halitosis, olfactory reference syndrome, social anxiety, and preoccupation with odors of body parts such as mouth, body, armpits, and feet. The scale for pathologic subjective halitosis followed that developed by Tsunoda et al.; participants were divided into three groups based on their scores (i.e., levels of pathologic subjective halitosis). A Bayesian network was used to analyze causal relationships between pathologic subjective halitosis, olfactory reference syndrome, social anxiety, and preoccupations with body part odors.ResultsWe found statistically significant differences in the results for olfactory reference syndrome and social anxiety among the various levels of pathologic subjective halitosis (P < 0.001). Residual analyses indicated that students with severe levels of pathologic subjective halitosis showed greater preoccupations with mouth and body odors (P < 0.05). Bayesian network analysis showed that social anxiety directly influenced pathologic subjective halitosis and olfactory reference syndrome. Preoccupations with mouth and body odors also influenced pathologic subjective halitosis.ConclusionsSocial anxiety may be a causal factor of pathologic subjective halitosis and olfactory reference syndrome.
Highlights
Pathologic subjective halitosis is known as a halitosis complaint without objective confirmation of halitosis by others or by halitometer measurements; it has been reported to be associated with social anxiety disorder
The participants were divided based on the results of the pathologic subjective halitosis scale, with the normal group composed of scores from 10 to 13, moderate group of scores from 14 to 21, and the severe group of Median (25th percentile, α coefficient d 75th percentile, range)
The present study indicated that the causes that pathologic subjective halitosis and olfactory reference syndrome had in common were social anxiety and preoccupation with body odor (Fig. 2)
Summary
Pathologic subjective halitosis is known as a halitosis complaint without objective confirmation of halitosis by others or by halitometer measurements; it has been reported to be associated with social anxiety disorder. Descriptions of which have existed for over a century [5], is a preoccupation with the false belief that one emits a foul or offensive body odor This syndrome has been defined as a psychiatric condition characterized by a persistent preoccupation with body odor accompanied by shame, embarrassment, significant distress, avoidance behavior, and social isolation [6]. Patients with this condition are preoccupied with concerns about multiple body parts [5, 7]. Olfactory reference syndrome may present in patients with obsessive-compulsive disorder or social anxiety disorder, and has reportedly been more prevalent in social anxiety disorder than in obsessive-compulsive disorder [8]
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