Do they smell me or not?

One of the main conflicts caused by having an unusual and difficult to control odor is that not everyone can detect it. It appears that all persons that have been diagnosed with trimethylaminuria (TMAU) have gone through the unfortunate experience of a family member or health professional having told them that “it’s all in your head” or that they are suffering from delusions. But it is most probable that these individuals don’t detect the odor because not everyone has the same olfactory sensitivity.

The chemoreceptors of the olfactory system: The amount of chemoreceptors that an animal possess in its olfactory mucosa is indicative of its olfactory sensitivity. Odor produces tolerance, that is, after perceiving certain odors for a certain period of time, we stop detecting it, since the receptors are impregnated and saturated with that substance, and stop sending the signal to the brain. [Translated from Spanish into English by Maria de la Torre]

The main turmoil produced by these contradictions after being exposed to those who do smell the odor and those who don’t, is result of the tendency for a sufferer to develop an intense, oppressive, and paralyzing state of anxiety and depression. It is the current mental health opinion that mental health treatment should be focused on reducing this anxiety, obsessive-compulsive behavior, and depression, as opposed to not in trying to convince the patient the he or she does not have discernment abilities to interpret reality. It is important that the professionals and family members understand that not everyone has the same olfactory sensitivity, thus not everyone can detect an odor that others may detect and react towards.

John Gever, Senior Editor, MedPage Today sums up in his article "DSM-5 What's In, What's Out" (May 10, 2012) the results of the debate of whether Olfactory Reference Syndrome should be included in the DSM-5 edition of the American psychiatry's diagnostic guide. ORS is in the "What didn't make it" category, and furthermore, it "will be placed in Section III with hope of attracting more research."

Olfactory sensitivity is similar in children and young adults, but there is a decline starting in the thirties…For this reason, the age for optimum olfactory capacity is around 33-34 years, since it is at this time that the olfactory sensitivity is still sufficiently intact, and the learning process combine to render the maximum olfactory perception (Cainet et. al., 1994)[Translated from Spanish into English by Maria de la Torre]

Many persons affected with body odor manifest an intermittent strong odor and alternate between mild and strong odor, influenced by diet, hormonal changes, stress, metabolic enzymes deficiencies, etc. The odor may very well be triggered from time to time and then suddenly disappear (or at least is not detected as easily), and appears to not be constant. At the same time, the odor itself changes, for example, according to chemistrydaily.com, trimethylamine (TMA) in low concentration emits a rotten fish odor, and at high concentration it is more like ammonia, since TMAU is a strong base. Therefore it is possible that one person’s olfactory system perceives a fish odor and not ammonia due to saturation and tolerance.

The social reactions against sufferers and the inconsistent triggers of odor are the two most potent factors in creating a state of anxiety and chronic and acute social phobia.

1. Over the past decade we have encountered many patients who have odour problems on a mild, transient, and periodic basis… it “is not merely a rare recessive disorder but rather a spectrum of phenotypes of transient or mild malodour…” 1999 letter in the Lancet, about ‘periodic’ trimethylaminuria by Dr. Stephen C Mitchell.
2. Only 7% of a group has anosmia to trimethylamine (TMA) 1975 paper, Specific anosmia to trimethylamine: The fishy primary odor
3. Dr. José Martínez Vidal, Head of Otolaryngologist Services of the Complexo Hospitalario Universitario de A Coruña (CHUAC) (university of Coruña, Santiago de Compostela, Spain), states that throughout his career he has had frequent cases of patients who have lost their sense of smell (develop anosmia) with age, the same as with other senses such as sight or hearing. He also talks about persons who suffer from hyperosmia, a disorder of the nervous system that involves an increased exaggerated sensitivity toward odors.
4. Trimethylamine (TMA) in low concentration has a fishy odor and ammonia like odor in high concentration. Human Metabolome Database.

Original post in Spanish
María de la Torre
President and Executive Director

www.meboresearch.org
maria.delatorre@meboresearch.org

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