사회공포증의 임상고찰 (III)

A Clinical Study of Social Phobia (ill)

This is a clinical report on 30 cases of social phobics suffering particulary from the fear of self emitting odor who had visited our clinic at Koryo General Hospital during the period between Jan. 1983 and Dec. 1988. We discussed the patients’ demographic and clinical characteristics and its relation to sociocultural background. The results were as follows * 1. Demographic characteristics. (1) The proportion of sex was 19 male(63.3%) to 11 female(36.7 %). (2) Students were the major group, 19 cases(63.3 %)’ in social status. (3) Ten patients were the last-borns. (4) Sixteen cases(53.3 %) reported that they had hard time in relationship with their father. (5) General appearance of the patients were clean, neat and tidy. 2. Symptom-related characteristics. (1) The average symptom onset age was 18 which was lower than that of other social phobic symptom, and noticiably lower than that of an Olfactory reference syndrome(25.4 years). (2) Patients them selves cannot smell the odor, however, they only know it almost intuitively by other’s facial expression, sniffing, coughing, gesture or avoiding behavior. (3) They complained of variety of disgusting (foul) smells such as fishy smell, stink, rotten smell, smell of the axillary area, smell of sweat and foul breath. (4) The sites of the bad smells were also varied such as anus, axilla, mouth, nose, sexual organ, groin, hair, whole body and clothes. (5) At the beginning, the symptom developed among acquaintances, and yet gradually it moves to the close members, eg. family and close friends. (6) The patients had tried various ways to remove or lessen the bad smell but with little avail. (7) Eighty-one % (24 cases) of the patients had been treated by various means ; eg. plastic surgery, herb medication, dermatologic care, etc, before they came to visit a psychiatrist. (8) Possible precipitating events at the symptom onset were identified in nearly half of the cases. (9) Most of the patients complained of having hard time in their study, work or social activities owing to their phobic symptoms. (10) Seventeen cases out of 19，who have been treated in individual or group therapy, improved remarkably without undue social difficulties. (11) Some sociocultural aspects of the clinical pictures were discussed, particularly in relating to ORS * Firstly, regarding the content of smell, ORS showed sexual and excretional nature, that lead to having more sense of humiliation and inferiority. Accordingly, ORS patients avoided social situation in order not to violate social code and etiquette. However, our cases of the fear of self emitting odor complained of various kinds of foul odors, but not much of sexual or excretional nature. They tend to be so much other oriented and other conscience that they fear the smell make others unpleasant, thus they try to avoid others, and even believe that they did harm to others already, and the others avoid patients in return. As for treatm ent result, ORS takes chronic and recurrent course, however, our cases shows good response to treatm ent. This seemingly important difference is due to our treatm ent orientation and methodology, in that we view it as a form of social phobia, and treated accordingly