TO THE EDITOR
Pierre Janet, in his conceptualization of obsessions and compulsions, described an inability to achieve perfection. This phenomenon characterizes both obsessive compulsive personality disorders (OCPD) and OCD. Available literature indicates that two main factors of OCPD, order/control and hoarding/indecision, were identified among OCPD patients. Hyper-control and orderliness, cleanliness other than perfectionism are often awkward and dysfunctional in these subjects. Yet, OCPD manifestations are generally considered ego-syntonic and are perceived by affected individuals as appropriate and correct. In many OCPD subjects perfectionism does not represent a maladaptive variant as a rule. In any case, there are several effects of orderliness behaviors that result in an underrated emotion of pleasure, even thought subjects are aware of its pathological nature. This is the case of a peculiar manifestation of orderliness. Clinicians involved in the treatment of OCPD are aware of how their patients often refer to a prompt mood improvement upon encountering good scents in general, or fresh laundry borax on their clothes, pillows or home settings. In medical terminology parosmia is defined as an olfactory dysfunction to properly identify an odor’s “natural” smell, while euosmia is a form of parosmia in which a neutral odor is transcribed into a pleasant odor. Here we refer to psychic euosmia in the mean of an overstated psychological predisposition for a real pleasant (not neutral) smell that elicits an immediate sense of pleasure, order and calm. It could be seen as the opposite reaction of irritability of sensory experiences called misophonia. For OCPD patients, congenial odors resemble a sensation of freshness, not simply an essence or perfume.
Some may argue that this is exactly the counterpart of chaos, of disgust, that was associated to contamination and moral purity. Disgust-sensitivity is a well-know framework in cognitive models of OCD, but it fits to OCPD too, perhaps better. From a biological perspective unpleasant odors activate insula and caudate. More, enlarged gray matter volume of the left medial orbital gyrus was found by using the Sniffin’ Sticks test. The prompt reactions to a pleasant odor might be explained by the involvement of rhinencephalon and its proximity to mood-related limbic circuits, which bypass the cognitive awareness.
To our knowledge there are no studies regarding neurobiological abnormalities or clinical aspects that investigate the correlates of psychic euosmia in OCD and OCPD subjects. As an explanation in mental health, researchers and clinicians are automatically looking at pathological aspects of phenomena. In his nonconforming paper Bentall stressed that psychopathologists tautologically are not concerned about elation and joy Hence we posit that a pathological issue, as an overrepresented psychic euosmia, should not have a positive emotional consequence in reason of being pathological per se. Thus, cleanliness may not preclude a subject to enjoy a good smell, even if we are representing smells that resemble freshness, in other words order. A potentially even more important argument is given by the continuum of personality disorders and their variability. Not all personality characteristics led to disturbed behaviors. In this way, having OCPD traits could be not dysfunctional at all, and many individuals with OCPD traits deal with head positions in their activities. In evolutionary perspectives having the ability to differentiate between unpleasant and pleasant odors should have made the difference in surviving. On the other hand, psychic euosmia could be considered a normal reaction, but in our clinical experience it is over-represented among OCPD subjects with marked orderliness and disgust. Therefore, detecting psychic euosmia might vicariously confirm the relevance of disgust as a cognitive driver of OCPD. Hereby we support research to characterize psychic euosmia as a feature of orderliness and cleanliness for OCPD.