Behavioral treatment of phobic avoidance in multiple chemical sensitivity

Rs, Guglielmi; Dj, Cox; Da, Spyker

doi:10.1016/0005-7916(94)90020-5

Cited by 71 publications

(52 citation statements)

References 16 publications

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“…car exhaust, cigarette smoke, and trash odors), but some scents trigger flashbacks whereas others do not? Such a differential response might result from several different causes: memory dissociation; stimulus generalization (for instance, perhaps the odor that served as the original conditioned stimulus elicits a flashback whereas other odors -sensitivity to which was acquired by stimulus generalization, Guglielmi et al, 1994 -do not evoke a flashback); or, too, a general sensitization to odor may occur as a result of earlier traumas, and hence, there are no traumas associated with certain smells to which the individual demonstrates sensitivity. How does one classify those patients who have olfactory-triggered panic attacks in the absence of flashback?…”

Section: Discussion Mechanisms Generating Olfactory Panic Among Khmermentioning

confidence: 99%

Olfactory-Triggered Panic Attacks among Khmer Refugees: A Contextual Approach

Hinton

Pich²,

Chhean

et al. 2004

Transcult Psychiatry

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One hundred Khmer refugees attending a psychiatric clinic were surveyed to determine the prevalence of olfactory-triggered panic attacks as well as certain characteristics of the episodes, including trigger (i.e. type of odor), frequency, length, somatic symptoms, and the rate of associated flashbacks and catastrophic cognitions. Forty-five of the 100 patients had experienced an olfactorytriggered panic attack in the last month. Trauma associations and catastrophic cognitions (e.g. fears of a 'wind attack,' 'weakness,' and 'weak heart') were common during events of olfactory panic. Several case examples are presented. A multifactorial model of the generation of olfactory panic is adduced. The therapeutic implications of this model for the treatment of olfactory panic are discussed. KeywordsCambodians; olfactory; panic attacks; panic disorder; post-traumatic stress disorderThe human ritual of renewal meant relearning old habits from her 'former' or preAuschwitz life: how to use a toothbrush, toilet paper, handkerchief, knife, and fork; how to smile, first with the lips, then with the lips and eyes; how to recapture forgotten odors and tastes, like the smell of rain.Implicit in the procedure of renewal, however, annealed to it with the epoxy of disruptive memory, is the 'counter-time' of Auschwitz, where the rain stank of diarrhea and beat down on the camp, the victims, 'the soot of the crematoriums and the odor of burning flesh.' (Langer, 1991, p. 3) In this quotation, Langer highlights the salience of olfaction in the Holocaust traumatic ontology and its centrality in attempted recovery. Traumatic events are encoded into memory by auditory, olfactory, and visual cues (e.g. Ledoux, 1996;van der Kolk, 1996). The sensory modality of olfaction -whose afferent tracts connect directly to the limbic system -seems to play a pre-eminent role in emotion and alerting to threat (Ledoux, 1996). Though sights and sounds are commonly assessed triggers of flashbacks (Kline & Rausch, 1985), odor cues in individuals diagnosed with post-traumatic stress disorder (PTSD) and panic disorder have been NIH Public Access

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Section: Discussion Mechanisms Generating Olfactory Panic Among Khmermentioning

confidence: 99%

Olfactory-Triggered Panic Attacks among Khmer Refugees: A Contextual Approach

Hinton

Pich²,

Chhean

et al. 2004

Transcult Psychiatry

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“…Patients who accept that panic responses may be at least a contributing factor to their symptoms might be responsive to intervention with psychotherapy to enable their desensitization (deconditioning of responses to odors and other triggers) and/or may be helped by anxiolytic medications, relaxation training, and counseling for stress management. A response to such intervention has been reported anecdotally (39,40,41), although randomized, placebo-controlled studies of such an approach have not been reported. Indeed, although panic responses were common in the group of IEI subjects we studied, only 1 among the 26 study subjects who had panic responses was agreeable to having a referral to a psychiatrist or psychologist.…”

Section: Discussionmentioning

confidence: 99%

Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder.

Tarlo

Poonai

Binkley

et al. 2002

Environ Health Perspect

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Idiopathic environmental intolerance (IEI), also known as multiple chemical sensitivity, is a clinical description for a cluster of symptoms of unknown etiology that have been attributed by patients to multiple environmental exposures when other medical explanations have been excluded. Because allergy has not been clearly demonstrated and current toxicological paradigms for exposure-symptom relationships do not readily accommodate IEI, psychogenic theories have been the focus of a number of investigations. A significantly higher lifetime prevalence of major depression, mood disorders, anxiety disorders, and somatization disorder has been reported among patients with environmental illness compared with that in controls. Symptoms often include anxiety, lightheadedness, impaired mentation, poor coordination, breathlessness (without wheezing), tremor, and abdominal discomfort. Responses to intravenous sodium lactate challenge or single-breath inhalation of 35% carbon dioxide versus a similar breath inhalation of clean air have shown a greater frequency of panic responses in subjects with IEI than in control subjects, although such responses did not occur in all subjects. Preliminary genetic findings suggest an increased frequency of a common genotype with panic disorder patients. The panic responses in a significant proportion of IEI patients opens a therapeutic window of opportunity. Patients in whom panic responses may at least be a contributing factor to their symptoms might be responsive to intervention with psychotherapy to enable their desensitization or deconditioning of responses to odors and other triggers, and/or may be helped by anxiolytic medications, relaxation training, and counseling for stress management.

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“…More severe symptoms of depression or anxiety should be medically managed with psychotropics. Based on our experience, if psychiatric medications are used, they must be given at very low doses and then titrated up to give these patients time to adjust to potential side effects, which are anecdotally reported to be more problematic in these individuals and others with medically unexplained physical symptoms (48).…”

Section: Discussionmentioning

confidence: 99%

A 37-Year-Old Mechanic with Multiple Chemical Sensitivities

Kipen¹,

Fiedler²

2000

Environmental Health Perspectives

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A 37-year-old heating, ventilation, and air-conditioning mechanic developed respiratory, musculoskeletal, and central nervous system symptoms associated with a variety ofodorous environmental chemicals. Organic disease was not evident, but the patient was distressed by these symptoms and was at risk for becoming disabled by them. His symptoms fit broadly into the condition recognized as multiple chemical sensitivity. Multiple We recommended a methacholine challenge, which was declined by the patient; we also recommended counseling to improve his understanding of and his response to his symptoms. We informed the patient that we did not feel he was disabled and that he could continue to work using a respirator as required. We informed his employer that he was able to use a respirator, and should be permitted to wear one on the job at his own discretion.

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Behavioral treatment of phobic avoidance in multiple chemical sensitivity

Cited by 71 publications

References 16 publications

Olfactory-Triggered Panic Attacks among Khmer Refugees: A Contextual Approach

Olfactory-Triggered Panic Attacks among Khmer Refugees: A Contextual Approach

Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder.

A 37-Year-Old Mechanic with Multiple Chemical Sensitivities

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