Olfactory reference syndrome ( ORS ) is a psychiatric condition in which there is a persistent false belief and preoccupation with the idea of emitting abnormal body odors which the patient thinks are foul and offensive to other individuals. People with this condition often misinterpret others' behaviors , e.g. sniffing , touching their nose or opening a window , as being referential to an unpleasant body odor which in reality is non-existent and cannot be detected by other people.
77-1027: LCSD may refer to: Left cardiac sympathetic denervation Leisure and Cultural Services Department , a department of Government of Hong Kong School districts in the United States Lamar County School District in Georgia Lamar County School District in Mississippi Leflore County School District in Mississippi Lewis and Clark School District in North Dakota Liverpool Central School District of Liverpool, New York Longwood Central School District of Suffolk County, New York Logan City School District of Utah Topics referred to by
154-500: A family history of mental illness or other conditions in ORS is unclear, because most reported cases have lacked this information. In some cases, there has been reported psychiatric and medical conditions in first degree relatives such as schizophrenia, psychosis, alcoholism, suicide, affective disorders, obsessive compulsive disorder, anxiety, paranoia, neurosis, sociopathy, and epilepsy . Sometimes more than one family member had
231-518: A Case Study treatment of ORS using EMDR which was successful using a trauma model formulation rather than an OCD approach. When untreated, the prognosis for ORS is generally poor. It is chronic, lasting many years or even decades with worsening of symptoms rather than spontaneous remission. Transformation to another psychiatric condition is unlikely, although very rarely what appears to be ORS may later manifest into schizophrenia, psychosis, mania, or major depressive disorder. The most significant risk
308-403: A complaint related to smell, and vice versa. These conditions, collectively termed chemosensory dysfunctions, are many and varied, and they may trigger a person to complain of an odor than is not present; however, the diagnostic criteria for ORS require the exclusion of any such causes. They include pathology of the right hemisphere of the brain, substance abuse , arteriovenous malformations in
385-520: A consequence of the surgery. The Finnish Office for Health Care Technology Assessment concluded more than a decade ago in a 400-page systematic review that ETS is associated with an unusually high number of significant immediate and long-term adverse effects. Quoting the Swedish National Board of Health and Welfare statement: "The method can give permanent side effects that in some cases will first become obvious only after some time. One of
462-400: A few days or weeks at most), and a recovery, evidence indicates, will not be complete. Sympathectomy works by disabling part of the autonomic nervous system (and thereby disrupting its signals from the brain), through surgical intervention, in the expectation of removing or alleviating the designated problem. Many non-ETS doctors have found this practice questionable chiefly because its purpose
539-417: A given task or in particular situations due to obsessive thoughts concerning body odor. 95% of persons with ORS engage in at least one excessive hygiene, grooming or other related repetitive practice in an attempt to alleviate, mask and monitor the perceived odor. This has been described as a contrite reaction, and repetitive, counterphobic, "safety", ritual or compulsive behaviors. Despite these measures,
616-445: A great many different medical conditions which are reported to potentially cause a genuine odor, and these are usually considered according to the origin of the odor, e.g. halitosis (bad breath), bromhidrosis (body odor), etc. These conditions are excluded before a diagnosis of ORS is made. Although there are many different publications on topics like halitosis, the symptom is still poorly understood and managed in practice. It
693-488: A history of at least one suicide attempt. 5.6% died by suicide. Psychiatric co-morbidity in ORS is reported. Depression, which is often severe, may be a result of ORS, or may be pre-existing. Personality disorders , especially cluster C , and predominantly the avoidant type , may exist with ORS. Bipolar disorder , schizophrenia, hypochondriasis, alcohol or drug abuse and obsessive compulsive disorder may also be co-morbid with ORS. The causes of ORS are unknown. It
770-519: A noteworthy condition. Neuroimaging has been used to investigate ORS. Hexamethylpropyleneamine oxime single-photon emission computed tomography (HMPAO SPECT) demonstrated hypoperfusion of the frontotemporal lobe in one case. That is to say, part of the brain was receiving insufficient blood flow. In another, functional magnetic resonance imaging was carried out while the person with ORS listened to both neutral words and emotive words. Compared to an age and sex matched healthy control subject under
847-418: A part or manifestation of other psychiatric conditions, mainly due to the overlapping similarities. Similarly, there is controversy with regards how the disorder should be classified. As ORS has obsessive and compulsive features, some consider it as a type of obsessive–compulsive spectrum disorder , while others consider it an anxiety disorder due to the strong anxiety component. It is also suggested to be
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#1732847887818924-538: A possible indication for surgery), reflex hyperhidrosis, altered/erratic blood pressure and circulation, defective fight or flight response system, loss of adrenaline, eczema and other skin conditions resulting from exceptionally dry skin, rhinitis, gustatory sweating (also known as Frey's syndrome). Other long-term adverse effects include: Other side effects are the inability to raise the heart rate sufficiently during exercise with instances requiring an artificial pacemaker after developing bradycardia being reported as
1001-447: A precipitating event, or gradual. The defining feature of ORS is excessive thoughts of having offensive body odor(s) which are detectable to others. The individual may report that the odor comes from: the nose and/or mouth, i.e. halitosis (bad breath); the anus; the genitals; the skin generally; or specifically the groin, armpits or feet. The source(s) of the supposed odor may also change over time. There are also some who are unsure of
1078-485: A recognized after effect of sympathectomy, when the growing sympathetic nerves innervate salivary glands, leading to excessive sweating regardless of environmental temperature through olfactory or gustatory stimulation. In addition, patients have reported lethargy, depression, weakness, limb swelling, lack of libido, decreased physical and mental reactivity, oversensitivity to sound, light and stress and weight gain (British Journal of Surgery 2004; 91: 264–269). ETS has both
1155-573: A specific entry for ORS, or use the term, but in the "persistent delusional disorders" section, states delusions can "express a conviction that others think that they smell." ORS has also never been allocated a dedicated entry in any edition of the American Psychiatric Association 's Diagnostic and Statistical Manual of Mental Disorders . In the third edition (DSM-III), ORS was mentioned under "atypical somatoform disorders ". The revised third edition (DSM-III-R) mentions ORS in
1232-485: A type of body dysmorphic disorder or, as it involves a single delusional belief, some suggest that ORS is a monosymptomatic hypochondriacal psychosis ( hypochondriacal type of delusional disorder , see monothematic delusion ). The World Health Organization 's 10th revision of the International Statistical Classification of Diseases and Related Health Problems ( ICD-10 ) does not have
1309-438: Is about someone's fear that his or her body, or its functions, is offensive to other people. There are four subtypes of taijin kyōfushō. 17% of these individuals have "the phobia of having foul body odor", the subtype termed jikoshu-kyofu. Although taijin kyōfushō has been described as a culture-bound syndrome confined to east Asia (e.g. Japan and Korea), it has been suggested that the jikoshu-kyofu variant of taijin kyōfushō
1386-426: Is around 20–21 years, with almost 60% of cases occurring in subjects under 20 in one report, although another review reported an older average age for both males (29) and females (40). The term olfactory reference syndrome was first proposed in 1971 by William Pryse-Phillips. Prior to this, published descriptions of what is now thought to be ORS appear from the late 1800s, with the first being Potts 1891. Often
1463-446: Is closely related or identical to ORS, and that such a condition occurs in other cultures. However, some Western sources state that jikoshu-kyofu and ORS are distinguishable because of cultural differences, i.e. Western culture being primarily concerned with individual needs, and Japanese culture primarily with the needs of the many. Hence, it is claimed that ORS mainly focuses on the affected individual's embarrassment, and jikoshu-kyofu
1540-411: Is common over the long term. The rates of severe compensatory sweating vary widely between studies, ranging from as high as 92% of patients. Of those patients that develop this side effect, about a quarter in one study said it was a major and disabling problem. 35% of people affected have to change their clothes several times a day as a result. A severe possible consequence of thoracic sympathectomy
1617-788: Is corposcindosis (split-body syndrome), in which the patient feels that they are living in two separate bodies, because sympathetic nerve function has been divided into two distinct regions, one dead, and the other hyperactive. Additionally, the following side effects have all been reported by patients: Chronic muscular pain, numbness and weakness of the limbs, Horner's Syndrome, anhidrosis (inability to sweat), hyperthermia (exacerbated by anhidrosis and systemic thermoregulatory dysfunction), neuralgia, paraesthesia, fatigue and amotivationality, breathing difficulties, substantially diminished physiological/chemical reaction to internal and environmental stimuli, somatosensory malfunction, aberrant physiological reaction to stress and exertion, Raynaud’s disease (albeit
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#17328478878181694-484: Is different from Wikidata All article disambiguation pages All disambiguation pages Left cardiac sympathetic denervation Endoscopic thoracic sympathectomy ( ETS ) is a surgical procedure in which a portion of the sympathetic nerve trunk in the thoracic region is destroyed. ETS is used to treat excessive sweating in certain parts of the body ( focal hyperhidrosis ), facial flushing , Raynaud's disease and reflex sympathetic dystrophy . By far
1771-421: Is essential to consciousness, in regulating attention and information processing, memory and emotion. ETS patients are being studied using the autonomic failure protocol headed by David Goldstein, M.D. Ph.D., senior investigator at the U.S National Institute of Neurological Disorders and Stroke. He has documented loss of thermoregulatory function, cardiac denervation, and loss of vasoconstriction . Recurrence of
1848-424: Is focused on the fear of creating embarrassment in others. In this article, jikoshu-kyofu and ORS are considered as one condition. Synonyms for ORS, many historical, include bromidrosiphobia, olfactory phobic syndrome, chronic olfactory paranoid syndrome, autodysomophobia, delusions of bromosis, hallucinations of smell and olfactory delusional syndrome. By definition, the many terms which have been suggested in
1925-531: Is frequently placed on multiple consultations to reduce the risk of misdiagnosis, and also asking the individual to have a reliable confidant accompany them to the consultation who can confirm the reality of the reported symptom. ORS patients are unable to provide such confidants as they have no objective odor. Various organic diseases may cause parosmias (distortion of the sense of smell). Also, since smell and taste are intimately linked senses, disorders of gustation (e.g. dysgeusia —taste dysfunction) can present as
2002-475: Is frequently reported. Individuals with ORS may present to dermatologists , gastroentrologists , otolaryngologists , dentists , proctologists , and gynecologists . Despite the absence of any clinically detectable odor, physicians and surgeons may embark on unnecessary investigations (e.g. gastroscopy ), and treatments, including surgery such as, among others, thoracic sympathectomy and tonsillectomy Such treatments generally have no long-term effect on
2079-418: Is little evidence for this. Persons with ORS have none of the other criteria to qualify for a diagnosis of schizophrenia. It has been suggested that various special investigations may be indicated to help rule out some of the above conditions. Depending upon the case, this might include neuroimaging, thyroid and adrenal hormone tests, and analysis of body fluids (e.g. blood) with gas chromatography . There
2156-583: Is no agreed treatment protocol. In most reported cases of ORS the attempted treatment was antidepressants , followed by antipsychotics and various psychotherapies . Little data are available regarding the efficacy of these treatments in ORS, but some suggest that psychotherapy yields the highest rate of response to treatment, and that antidepressants are more efficacious than antipsychotics (response rates 78%, 55% and 33% respectively). According to one review, 43% of cases which showed overall improvement required more than one treatment approach, and in only 31% did
2233-1169: Is no odor, although the negative response is usually interpreted instead as politeness rather than truth, and avoidance behaviors such as habitually sitting at a distance from others, minimizing movement in an attempt "not to spread the odor", keeping the mouth closed and avoiding talking or talking with a hand in front of the mouth. Persons with ORS tend to develop a behavior pattern of avoidance of social activities and progressive social withdrawal. They often avoid travel, dating, relationships, break off engagements and avoid family activities. Due to shame and embarrassment, they may avoid school or work, or repeatedly change jobs and move to another town. Significant developments may occur such as loss of employment, divorce , becoming housebound, psychiatric hospitalization, and suicide attempts. According to some reports, 74% of persons with ORS avoid social situations, 47% avoid work, academic or other important activities, 40% had been housebound for at least one week because of ORS, and 31.6% had experienced psychiatric hospitalization. With regards to suicide, reports range from 43 to 68% with suicidal ideation, and 32% with
2310-555: Is recognized that symptoms such as halitosis can be intermittent, and therefore may not be present at the time of the consultation, leading to misdiagnosis. Individuals with genuine odor symptoms may present with similar mindset and behavior to persons with ORS. For example, one otolaryngologist researcher noted "behavioral problems such as continuous occupation with oral hygiene issues, obsessive use of cosmetic breath freshening products such as mouthwashes, candies, chewing gums, and sprays, avoiding close contact with other people, and turning
2387-427: Is still being offered as a treatment for plantar hyperhidrosis, or as a treatment for patients who have a bad outcome (extreme 'compensatory sweating') after thoracic sympathectomy for palmar hyperhidrosis or blushing; however, extensive sympathectomy risks hypotension . Endoscopic sympathectomy itself is relatively easy to perform; however, accessing the nerve tissue in the chest cavity by conventional surgical methods
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2464-444: Is suicide. When treated, the prognosis is better. In one review, the proportion of treated ORS cases which reported various outcomes were assessed. On average, the patients were followed for 21 months (range: two weeks to ten years). With treatment, 30% recovered (i.e. no longer experienced ORS odor beliefs and thoughts of reference), 37% improved and in 33% there was a deterioration in the condition (including suicide) or no change from
2541-551: Is thought that significant negative experiences may trigger the development of ORS. These have been considered as two types: key traumatic experiences related to smell, and life stressors present when the condition developed but which were unrelated to smell. In one review, 85% of reported cases had traumatic, smell-related experiences, and 17% of cases had stress factors unrelated to smell. Reported smell-related experiences usually revolve around family members, friends, co-workers, peers or other people making comments about an odor from
2618-428: Is to destroy functionally disordered , yet anatomically typical nerves. Exact results of ETS are impossible to predict, because of considerable anatomic variation in nerve function from one patient to the next, and also because of variations in surgical technique. The autonomic nervous system is not anatomically exact and connections might exist which are unpredictably affected when the nerves are disabled. This problem
2695-434: The autonomic nervous system , like the essential fight-or-flight response . It reduces the physiological responses to strong emotions, such as fear and laughter, diminishes the body's physical reaction to both pain and pleasure, and inhibits cutaneous sensations such as goose bumps . A large study of psychiatric patients treated with this surgery showed significant reductions in fear , alertness and arousal . Arousal
2772-417: The belief a result of the olfactory hallucination. In one review, the individual with ORS was unreservedly convinced that he or she could detect the odor themselves in 22% of cases, whilst in 19% there was occasional or intermittent detection and in 59% lack of self-detection was present. Some distinguish delusional and non-delusional forms of ORS. In the delusional type, there is complete conviction that
2849-427: The body in its ideal state (see homeostasis ). Because these nerves also regulate conditions like excessive blushing or sweating, which the procedure is designed to eliminate, the normative functions these physiological mechanisms perform will be disabled or significantly impaired by sympathectomy. There is much disagreement among ETS surgeons about the best surgical method, optimal location for nerve dissection, and
2926-531: The brain, and temporal lobe epilepsy. Social anxiety disorder (SAD) and ORS have some demographic and clinical similarities. Where the social anxiety and avoidance behavior is primarily focussed on concern about body odors, ORS is a more appropriate diagnosis than avoidant personality disorder or SAD. Body dismorphic disorder (BDD) has been described as the closest diagnosis in DSM-IV to ORS as both primarily focus on bodily symptoms. The defining difference between
3003-451: The condition as a form of delusional disorder, as seems to occur in the DSM, is inappropriate. In one review, in 57% of cases the beliefs were fixed, held with complete conviction, and the individual could not be reassured that the odor was non existent. In 43% of cases the individual held the beliefs with less than complete conviction, and was able to varying degrees to consider the possibility that
3080-476: The dental literature to refer to subjective halitosis complaints (i.e. when a person complains of halitosis yet no odor is detectable clinically) can also be considered under the umbrella of ORS. Examples include halitophobia, non-genuine halitosis, delusional halitosis, pseudo-halitosis, imaginary halitosis, psychosomatic halitosis, and self halitosis. Diagnostic criteria have been proposed for ORS: The differential diagnosis for ORS may be complicated as
3157-504: The disorder shares features with other conditions. Consequently, ORS may be misdiagnosed as another medical or psychiatric condition and vice versa . The typical history of ORS involves a long delay while the person continues to believe there is a genuine odor. On average, a patient with ORS goes undiagnosed for about eight years. Repeated consultation with multiple different non-psychiatric medical specialists (" doctor shopping ") in an attempt to have their non-existent body odor treated
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3234-420: The distress and concern may typically be out of proportion to the reality of the problem. Genuine halitosis has been described as a social barrier between the individual and friends, relatives, partners and colleagues, and may negatively alter self-esteem and quality of life. Similar psychosocial problems are reported in other conditions which cause genuine odor symptoms. In the literature on halitosis, emphasis
3311-447: The exact origin of the odor. The odor is typically reported to be continuously present. The character of the odor may be reported as similar to bodily substances, e.g. feces , flatus , urine , sweat , vomitus , semen , vaginal secretions ; or alternatively it may be an unnatural, non-human or chemical odor, e.g. ammonia , detergent , rotten onions , burnt rags, candles, garbage, burning fish, medicines, old cheese. Again,
3388-619: The first administered treatment lead to some improvement. Pharmacotherapies that have been used for ORS include antidepressants , (e.g. selective serotonin reuptake inhibitors , tricyclic antidepressants , monoamine oxidase inhibitors ), antipsychotics , (e.g. blonanserin , lithium , chlorpromazine ), and benzodiazepines . The most common treatment used for ORS is SSRIs. Specific antidepressants that have been used include clomipramine . Psychotherapies that have been used for ORS include cognitive behavioral therapy , eye movement desensitization and reprocessing . Dunne (2015) reported
3465-733: The first and fifth thoracic vertebrae. The most common indications for thoracic sympathectomy are focal hyperhidrosis (that specifically affects the hands and underarms), Raynaud syndrome , and facial blushing when accompanied by focal hyperhidrosis. It may also be used to treat bromhidrosis , although this usually responds to non-surgical treatments, and sometimes people with olfactory reference syndrome present to surgeons requesting sympathectomy. There are reports of ETS being used to achieve cerebral revascularization for people with moyamoya disease , and to treat headaches, hyperactive bronchial tubes, long QT syndrome , social phobia, anxiety, and other conditions. ETS involves dissection of
3542-501: The head away during conversation" as part of what was termed " skunk syndrome" in patients with genuine halitosis secondary to chronic tonsillitis . Another author, writing about halitosis, noted that there are generally three types of persons that complain of halitosis: those with above-average odor, those with average or near-average odor who are oversensitive, and those with below-average or no odor who believe they have offensive breath. Therefore, in persons with genuine odor complaints,
3619-455: The head, opening a window, facial expressions, sniffing, touching nose, scratching head, gestures, moving away, avoiding the person, whistling. Commonly, when being in proximity to others who are talking among themselves, persons with ORS will be convinced that the conversation is about his or her odor. Even the actions of animals (e.g. barking of dogs) can be interpreted as referential to an odor. Persons with ORS may have trouble concentrating at
3696-562: The imagined odor ( thoughts of reference ). In one review, ideas of reference were present in 74% of cases. Usually, these involve misinterpretations of comments, gestures and actions of other people such that it is believed that an offensive smell from the individual is being referred to. These thoughts of reference are more pronounced in social situations which the individual with ORS may find stressful, such as public transport, crowded lift, workplace, classroom, etc. Example behaviors which are misinterpreted include coughing, sneezing, turning of
3773-425: The individual's belief in an odor symptom. If non-psychiatric clinicians refuse to carry out treatment on the basis that there is no real odor and offer to refer the patient to a psychologist or psychiatrist, persons with ORS typically refuse and instead seek "a better" doctor or dentist. Conversely, some have suggested that medical conditions which cause genuine odor may sometimes be misdiagnosed as ORS. There are
3850-422: The individual. The suggested diagnostic criteria mean that the possibility of ORS is negated by a diagnosis of schizophrenia in which persistent delusions of an offensive body odor and olfactory hallucinations are contributing features for criterion A . However, some reported ORS cases were presented as co-morbid. Indeed, some have suggested that ORS may in time transform into schizophrenia, but others state there
3927-418: The latter cases, the belief arises via misinterpretation of the behavior of others or with the rationale that a disorder of smell which prevents self detection of the odor (i.e. anosmia ) exists. In the cases where the non-existent odor can be detected, this is usually considered as phantosmia ( olfactory hallucination ). Olfactory hallucination can be considered the result of the belief in an odor delusion, or
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#17328478878184004-420: The main sympathetic trunk in the upper thoracic region of the sympathetic nervous system , irreparably disrupting neural messages that ordinarily would travel to many different organs, glands and muscles. It is via those nerves that the brain is able to make adjustments to the body in response to changing conditions in the environment, fluctuating emotional states, level of exercise, and other factors to maintain
4081-405: The main sympathetic chain. Another technique, the clamping method, also referred to as 'endoscopic sympathetic blockade' (ESB) employs titanium clamps around the nerve tissue, and was developed as an alternative to older methods in an unsuccessful attempt to make the procedure reversible. Technical reversal of the clamping procedure must be performed within a short time after clamping (estimated at
4158-481: The most common complaint treated with ETS is sweaty palms ( palmar hyperhidrosis ). The intervention is controversial and illegal in some jurisdictions. Like any surgical procedure, it has risks; the endoscopic sympathetic block (ESB) procedure and those procedures that affect fewer nerves have lower risks. Sympathectomy physically destroys relevant nerves anywhere in either of the two sympathetic trunks , which are long chains of nerve ganglia located bilaterally along
4235-414: The nature and extent of the consequent primary effects and side effects. When performed endoscopically as is usually the case, the surgeon penetrates the chest cavity making multiple incisions about the diameter of a straw between ribs. This allows the surgeon to insert the video camera (endoscope) in one hole and a surgical instrument in another. The operation is accomplished by dissecting the nerve tissue of
4312-565: The normal risks of surgery, such as bleeding and infection, conversion to open chest surgery, and several specific risks, including permanent and unavoidable alteration of nerve function. It is reported that a number of patients - 9 since 2010, mostly young women - have died during this procedure due to major intrathoracic bleeding and cerebral disruption. Bleeding during and following the operation may be significant in up to 5% of patients. Pneumothorax (collapsed lung) can occur (2% of patients). Compensatory hyperhidrosis (or reflex hyperhidrosis)
4389-400: The odor is real. In the non-delusional type, the individual is capable of some insight into the condition, and can recognize that the odor might not be real, and that their level of concern is excessive. Others argue that reported cases of ORS present a spectrum of different levels of insight. Since sometimes the core belief of ORS is not of delusional intensity, it is argued that considering
4466-778: The odor symptom is reported to still offend other people. Example ORS behaviors include: repetitive showering and other grooming behaviors, excessive tooth brushing, or tongue scraping (a treatment for halitosis), repeated smelling of oneself to check for any odor, over-frequent bathroom use, attempts to mask the odor, with excessive use of deodorants , perfumes , mouthwash , mint, chewing gum, scented candles, and soap; changing clothes (e.g. underwear), multiple times per day, frequent washing of clothes, wearing several layers of clothing, wrapping feet in plastic, wearing garments marketed as odor-reducing, eating special diets, dietary supplements (e.g. intended to reduce flatulence odor), repeatedly seeking reassurance from others that there
4543-399: The odor was not existent. Other symptoms may be reported and are claimed to be related to the cause of the odor, such as malfunction of the anal sphincter, a skin disease, "diseased womb", stomach problems or other unknown organic disease . Excessive washing in ORS has been reported to cause the development of eczema . People with ORS misinterpret the behavior of others to be related to
4620-523: The original symptoms due to nerve regeneration or nerve sprouting can occur within the first year post surgery. Nerve sprouting, or abnormal nerve growth after damage or injury to the nerves can cause other further damage. Sprouting sympathetic nerves can form connections with sensory nerves, and lead to pain conditions that are mediated by the SNS. Every time the system is activated, it is translated into pain. This sprouting and its action can lead to Frey's syndrome ,
4697-492: The person's vagina in the context of a sexual assault, and revulsion about menarche and brother's sexual intimacy. It has been suggested that a proportion of such reported experiences may not have been real, but rather early symptom of ORS (i.e. referential thoughts). Examples of non smell-related stressful periods include guilt due to a romantic affair, being left by a partner, violence in school, family illness when growing up (e.g. cancer), and bullying. The importance of
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#17328478878184774-430: The person, which causes embarrassment and shame. Examples include accusation of flatulence during a religious ceremony, or being bullied for flatulence such at school, accidental urination in class, announcements about a passenger needing to use deodorant over speaker by a driver on public transport, sinusitis which caused a bad taste in the mouth, mockery about a fish odor from a finger which had been inserted into
4851-505: The pre-treatment status. Cases have been reported from many different countries around the world. It is difficult to estimate the prevalence of ORS in the general population because data are limited and unreliable, and due to the delusional nature of the condition and the characteristic secrecy and shame. For unknown reasons, males appear to be affected twice as commonly as females. High proportions of ORS patients are unemployed, single, and not socially active. The average age reported
4928-417: The procedure on people under 20 years of age. Sympathectomy developed in the mid-19th century, when it was learned that the autonomic nervous system runs to almost every organ, gland and muscle system in the body. It was surmised that these nerves play a role in how the body regulates many different body functions in response to changes in the external environment, and in emotion. The first sympathectomy
5005-474: The recovery time from the surgery and increased its availability. Today, ETS surgery is practiced in many countries throughout the world predominantly by vascular surgeons. British Journal of Surgery 2004; 91: 264–269 Olfactory reference syndrome This disorder is often accompanied by shame , embarrassment , significant distress , avoidance behavior, social phobia and social isolation . The onset of ORS may be sudden, where it usually follows after
5082-403: The reported character of the odor complaint may change over time. Halitosis appears to be the most common manifestation of ORS, with 75% complaining of bad breath, alone or in combination with other odors. The next most common complaint was sweat (60%). Although all individuals with ORS believe they have an odor, in some cases the individual reports they cannot perceive the odor themselves. In
5159-401: The same conditions, the individual with ORS showed more activation areas in the brain when listening to emotionally loaded words. This difference was described as abnormal, but less pronounced as would be observed in the brain of a person with a psychotic disorder. Although the existence of ORS is generally accepted, there is some controversy as to whether it is a distinct condition or merely
5236-405: The same term [REDACTED] This disambiguation page lists articles associated with the title LCSD . If an internal link led you here, you may wish to change the link to point directly to the intended article. Retrieved from " https://en.wikipedia.org/w/index.php?title=LCSD&oldid=1247560280 " Category : Disambiguation pages Hidden categories: Short description
5313-497: The side effects might be increased perspiration on different places on your body. Why and how this happens is still unknown. According to the research available about 25-75% of all patients can expect more or less serious perspiration on different places on their body, such as the trunk and groin area, this is Compensatory sweating ". In 2003, ETS was banned in its birthplace, Sweden, due to inherent risks, and complaints by disabled patients. In 2004, Taiwanese health authorities banned
5390-441: The skin, mouth, rectum or vagina." In the fifth edition (DSM-5), ORS again does not appear as a distinct diagnosis, but it is mentioned in relation to taijin kyōfushō (対人恐怖症, "disorder of fear of personal interaction"). The variants of taijin kyōfushō (shubo-kyofu "the phobia of a deformed body" and jikoshu-kyofu "fear of foul body odor") are listed under 300.3 (F42) "other specified obsessive compulsive and related disorders", and
5467-414: The text, stating that "convictions that the person emits a foul odor are one of the most common types of delusion disorder, somatic type." The fourth edition (DSM-IV), does not use the term ORS but again mentions such a condition under "delusional disorder, somatic type", stating "somatic delusions can occur in several forms. Most common are the person's conviction that he or she emits a foul odor from
5544-642: The two is that in BDD the preoccupation is with physical appearance, not body odors. Similarly, where obsessive behaviors are directly and consistently related to body odors rather than anything else, ORS is a more appropriate diagnosis than obsessive–compulsive disorder, in which obsessions are different and multiple over time. ORS may be misdiagnosed as schizophrenia. About 13% of people with schizophrenia have olfactory hallucinations. Generally, schizophrenic hallucinations are perceived as having an imposed, external origin, while in ORS they are recognized as originating from
5621-404: The vertebral column (a localisation which entails a low risk of injury) responsible for various important aspects of the peripheral nervous system (PNS). Each nerve trunk is broadly divided into three regions: cervical ( neck ), thoracic (chest), and lumbar (lower back). The most common area targeted in sympathectomy is the upper thoracic region, that part of the sympathetic chain lying between
5698-605: Was demonstrated by a significant number of patients who underwent sympathectomy at the same level for hand sweating, but who then presented a reduction or elimination of feet sweating, in contrast to others who were not affected in this way. No reliable operation exists for foot sweating except lumbar sympathectomy, at the opposite end of the sympathetic chain. Thoracic sympathectomy will change many bodily functions, including sweating , vascular responses, heart rate , heart stroke volume , thyroid , baroreflex , lung volume , pupil dilation, skin temperature and other aspects of
5775-504: Was difficult, painful, and spawned several different approaches in the past. The posterior approach was developed in 1908, and required resection (sawing off) of ribs. A supraclavicular (above the collar-bone) approach was developed in 1935, which was less painful than the posterior, but was more prone to damaging delicate nerves and blood vessels . Because of these difficulties, and because of disabling sequelae associated with sympathetic denervation, conventional or "open" sympathectomy
5852-528: Was never a popular procedure, although it continued to be practiced for hyperhidrosis, Raynaud's disease , and various psychiatric disorders. With the brief popularization of lobotomy in the 1940s, sympathectomy fell out of favor as a form of psychosurgery . The endoscopic version of thoracic sympathectomy was pioneered by Goren Claes and Christer Drott in Sweden in the late 1980s. The development of endoscopic "minimally invasive" surgical techniques has decreased
5929-448: Was performed by Alexander in 1889. Thoracic sympathectomy has been indicated for hyperhidrosis (excessive sweating) since 1920, when Kotzareff showed it would cause anhidrosis (total inability to sweat) from the nipple line upwards. A lumbar sympathectomy was also developed and used to treat excessive sweating of the feet and other ailments, and typically resulted in impotence and retrograde ejaculation in men. Lumbar sympathectomy
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