Bell's Self-Reported Illness from Chemical Odors in Young Adults without Clinical Syndromes or Occup

Bell's Self-Reported Illness from Chemical Odors in Young Adults without Clinical Syndromes or Occup

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Unformatted text preview: Self- without Clinical Syndromes or Occupational Exposures IRIS R. BELL reported illness from Chemical Odors in Young Adults Department of Psychiatry University of Arizona Health Sciences Center Tucson, Arizona GARY E. SCHWARTZ Department of Psychology University of Arizona Health Sciences Center Tucson, Arizona JULIE M. PETERSON Department of Psychiatry University of Arizona Health Sciences Center Tucson, Arizona DIAN E AM E N D Department of Psychology University of Arizona Health Sciences Center Tucson, Arizona ABSTRACT. The present survey of young adult college students investigated the prevalence of self-reported illness from the smell of the five following common environmental chem- icals (cacosmia): (I) pesticide, (2) automobile exhaust, (3) paint, (4) new carpet, and (5) perfume. Sixty-six percent of 643 students reported feeling ill from one or more of the five chemicals; 15% identified the smell of at least four chemicals as making them ill. Ratings of illness from pesticide correlated weakly but significantly with ratings for the largest num- ber of individual symptoms (9 of 11); daytime tiredness and daytime grogginess both cor- related at high levels of significance with illness ratings {on a 5—point scale} for four of the five chemicals. The most cacosmic group (CS) included significantly more women (79%) than the noncacosmic group (NS) (49%); women overall were more cacosmic than men (p < .001), even with the significant covariate of depression. Ratings of cacosmia correlated only weakly with scores for depression (r = 0.16), anxiety (r = 0.08), and trait shyness {r = 0.18) in the total sample. On stepwise multiple regression with cacosmia score as the de- pendent measure, shyness accounted for 5.8% of the variance, while depression, anxiety, sense of mastery, and repression did not enter the equation. Histories of physician-diag- nosed hay fever, but not asthma, were more frequent in the CS (16%) than in the NS group (5%). Without the confounds of chronic illness or specific treatment programs, these data are similar to patterns described clinically for a subset of patients with multiple chemical sensitivities (MCS), including previous data on increased nasal resistance in MCS. The find— ings also suggest a limited relationship between degree of self—reported cacosmia and trail shyness, possibly on the basis of Iimbic hyper-reactivity. Psychological variables did not otherwise account for any of the variance in self-rated illness from chemical odors in this nonclinical sample. THE PROBLEM of nonatopic, self-reported chronic sensitivities to multiple environmental chemical agents, such as pesticides, solvents, formaldehyde, and petro- leum derivatives, is a growing public health concern.“5 Patients who claim multiple chemical sensitivity (MCS) often become disabled by symptoms that include diffi- culty concentrating, headache, fatigue, depression, irri- tability, joint and muscle pain, nausea, dizziness, and nasal stuffiness."3'6 Clinically, many MCS patients also report multiple food sensitivities, and they use avoid- ance of chemical substances as a primary treatment modality.” Although previous studies have found high- Archives of Environ mental Health er rates of depression and somatization in MCS patients than in normal controls,3""7"""3 the confounds of chronic illness, disability, litigation Claims, and sampling bias make it difficult to determine whether MCS actually in- volves a higher prevalence of the latter phenomena, let alone whether MCS and affective spectrum disorders are linked in a causal fashion in either direction.‘”” Some MCS patients are highly educated individuals, among whom is a preponderance of women (> 70%1’, but sampling biases within clinical settings again may be misleading in the interpretation of demographics. Kilburn has noted that the human nervous system may be the most sensitive part of the body to environ- mental toxicant exposures.”'” A large body of animal research in neurotoxicity indicates that low levels of many environmental chemicals can cause acute and chronic changes in both behavior and the electrical ac- tivity of the central nervous system."‘""’ In particular, the olfactory and limbic systems, which participate di- rectly and indirectly in the regulation of cognitive, af- fective, autonomic, endocrine, and immune functions, could serve as an initial common pathway for poly— symptomatic syndromes reported in MCSW'H“ In sol- vent-exposed workers, for example, Ryan et al.25'3" found that a history of cacosmia, i.e., an altered sense of smell and feeling ill from certain chemical odors, predicted poorer performance on verbal and visual memory tasks. MCS patients perform less efficiently on verbal and visual memory tasks that do patients with chronic fatigue syndrome,H and sick building syn- drome patients have greater deficits in attention and concentration than do normals?7 Additional data on MCS suggest that sueh patients may have increased nasal resistances at baseline and during chemical expo- sures” as well as greater amounts of electroencephalo- graphic parietal beta activity than do normal controls.q Despite these objective findings, identification of a pa- tient who may be chemically sensitive still relies pri- marily on self-report. As a first step in studying the cen— tral nervous system phenomenology and possible mechanisms of MCS, the present study surveyed a non- clinical young adult population of college students for self-reported cacosmia (i.e., feeling ill from chemical odors), symptoms, and affective status. Materials and methods Subjects were undergraduate students of both sexes enrolled in an introductory psychology class at the Uni- versity of Arizona. As part of a class requirement for participation in ongoing research projects, they com— pleted a packet of questionnaires on numerous topics toward course credit. A four-page questionnaire on personality and health was the component used in this study. It included a 5-item cacosmia screen (ratings for pesticides, car exhaust, drying paint, new carpet, and perfume on a 5—point scale as to whether or not the smell of each substance made subjects “feel ill" in any way); the 37-item Weinberger Adjustment Inventory (short form), which includes subscale scores on validi- ty, depression, anxiety, and repressionm"; the Marlow- Crowne Social Desirability Scalef'u which generates January/February 1993 [Vol. 48 (No. 1)] scores from true-false questions on repression as a per- sonality trait"1 (i.e., systematic response bias toward de- nying negative information about oneself at an uncon- scious level); a S-item shyness index drawn from previ- ously published studies of shyness and hay fever (items were as follows: shyness with strangers; liking parties with many people; shyness with peers during child- hood; childhood school phobia; pounding heart, blushing, or stomach butterflies around unfamiliar peo- ple)”'”; the Pearlin-Schooler Mastery Scale34 (high scores indicate a sense of being in control of one’s own fate); and a brief health and 11-symptom frequency checklist. The symptoms that represented common clinical complaints in MCS patients"2"‘ included irritability, in- somnia, difficulty concentrating, memory trouble, day- time grogginess, daytime tiredness, headache, joint or muscle pain, indigestion, constipation, and ringing in the ears. However, ratings of specific symptoms in this study were requested for the subjects' general status, separate from and without reference to the ratings of ill- ness from specific chemicals. Trait shyness was evaluat- ed because it manifests with avoidant behaviors that may result from hyperreactivity of the amygdala and ventromedial hypothalamusfa‘" central nervous sys- tem structures that have both been previously implicat- Table 1.—Mean Scores for Illness from Smells of Specific Chemicals, Frequency Ratings for Specific Symptoms, and Psychological Variables over All Students (N = 643) Specific chemicals! frequency ratingsl psychological variables Pesticide 3.1 i 1.4 Automobile exhaust 3.2 i 1.5 Paint 2.5 i 1.3 New carpet 2.2 i 1.2 Perfume 2.1 i 1.3 Irritability 2.3 i 1.0 lointfmuscle pain 2.3 1: 1.2 Daytime tiredness 2.9 i 0.9 Constipation 1.8 i 1.0 Indigestion 2.0 i 1.0 Headaches 2.7 i 1.2 Trouble sleeping at night 2.3 i 1.1 Memory trouble 2.3 i 1.0 Difficulty concentrating 2.3 1 1.0 Daytime sleepinessfgrogginess 2.9 i 1.0 Ringing in ears 2.0 j; 1.0 Shyness Index15725) 12.6 j; 3.7 Weinberger Depression (3—15) 7.4 i 2.7 Weinberger Anxiety [3—151 913 i 2.8 Sense of Mastery (7‘28) 14.5 i 5.0 Weinberger Repression 123—1151 75.6 i 11.8 Marlowe-Crowns: Repression (0—33) 14.5 1 5.0 Notes: The range of possible values for illness from the smell of each chemical and for frequency oi each symptom was 1-5. Values in parentheses represent the possible range for the re- mainder of the variables. Higher values mean increasingly L greater score for each item. J 7 ed in regulating reSponsivity to environmental chemi— cals and foods?“""“W‘Z‘l The cacosmia, symptom checklist, Weinberger, and shyness scales, as well as additional questions concerning limiting foods high in sweets, fats, salt, or breads, feeling ill from missing meals, feeling ill from opiate drugs and sleeping better after drinking milk before bedtime, all employed Likert- rating scales with a 1- to 5-point range. Scores on the illness ratings from the five chemicals, 11 symptoms, five shyness questions, and four food limitation items were summed to generate composite scores respectively for those variables. Data analysis was performed on a 386$X microcomputer with SPSS- PC 4.01, using one-way analyses of variance with post- hoc Student-Newman—Keuls comparisons, analyses of covariance, Pearson correlation coefficients, stepwise multiple regression, and chi-square tests. Missing val- ues were dropped from individual analyses. A probabil- ity level of p < .05 was taken for statistical significance. Results A total of 643 students (average age 18.6 i 2.3 y; 64.5% women, 35.5% men) completed the question- naires and scored at least 7 on the Weinberger validity subscale as a check on the conscious veracity of the an- swers. The mean cacosmia score for the whole sample was 13.1 i 5.1 (possible range 5—25); mean symptom score was 26.1 i 6.2 (possible range 11—55). The means for individual chemicals, symptoms, and the psychological variables over all subjects are summar- ized in Table 1. Prevalence of more traditional diagnos- es in the total sample was 8% hay fever, 12% asthma, 7% migraine, 4% ulcers, and 1% hypothyroidism. Sixty-six percent (n = 427) of the entire sample rated themselves as feeling ill to a moderate or marked de- gree (score of 4 or 5) from the smell of at least one of the five chemicals, including 19% from one chemical, 18% from two chemicals, 14% from three chemicals, and 15% (n = 97) from the smell of at least four chemi- cals. Within those extremely cacosmic subjects, the percentages who identified each of the chemicals as problematic were 98% pesticide, 90% paint, 70% car exhaust, 69% new carpet, and 64% perfume. The en- tire sample was then divided into seven approximately equally sized subgroups (each group representing 13—17% of the sample) on the basis of total cacosmia scores: extremely cacosmic and noncacosmic sub» groups were defined, respectively, as the top 14% (CS) and bottom 13% (N5) of the sample on the total cacos- mia score. Women were present in increasing numbers in the seven subgroups as the amount of self-reported chemical sensitivity increased, x’16) = 26.6, p < .001. The CS subgroup included 79% women, whereas the NS subgroup had only 49% women, x10) = 16.3, p < .0001. Overall all subjects, women were more cacos- mic than men, 13.7 i 5.2 versus 12.1 i 4.9, PH, 534] = 6.2, p < .05, even with a significant covariate for de- pression, F[1, 534} = 8.0, p < .01. Age did not differ systematically among the seven subgroups or between the CS-NS extremes. 1A :9 ,2 5 E m Chamlcai Senslllvlly Group I B 2 3 V) L5 m I} 'i.’ u 0 a Chemical Sensitivity Group 1C is I 11 " s I}: is U! E I: >\ J: In n to I 2 s s a a 1 Chemical Sanaltivlty Group Fig. 1. Total scores for number of symptoms (1A), Weinberger de- pression subscale (13), and shyness index (1C) for subgroups re- porting increasingly greater degrees of cacosmia (N = 643). * Post—hoc Student-Newman-Keuls comparisons (p < .05): Fig. 1A (symptoms): subgroup I" > 1, 2 and 6 > 1; Fig. 113 (depression): sub- group 7 >1, 2; Fig. 1C (shyness): subgroup 7 >1, 2 and 5 >1. Hay fever, but not asthma, migraine, ulcers, or thy- roid disease, was more common with increasing cacos- mia; CS subjects had 16% hay fever versus 5% in the NS subgroup, x‘(1) = 5.1, p < .05. Over the entire sample, ratings on illness from all of the chemicals ex- cept perfume correlated well with one another at a lev— el of .4 to .6; perfume correlated with the other chemi- cals at a level of .3 to .4. The chemicals with the largest number of ratings of absolutely no associated illness were perfume (321/643, 50%) and new carpet (253i 643, 39%). The symptoms whose ratings correlated, al- beit weakly, at the highest levels of significance with four of the five chemicals (all except new carpet) were daytime tiredness (range of r = 0.11 to r = 0.13, p < Archives of Environmental Health .01 or better) and daytime grogginess (r = 0.12 to r = 0.18, p < .001). The chemical whose ratings correlated significantly, albeit weakly, with the greatest number of individual symptoms (9 of 11 symptoms; all except memory problems and tinnitus) was pesticide (range of r = 0.07 to r = 0.18, p < .05 or better). Total cascosmia scores correlated weakly but signifi- cantly with depression (1' =- 0.16, p < .001), anxiety (r = 0.08, p < .05), and shyness (r s 0.18, p < .001). One-way analyses of variance showed a main effect for cacosmia subgroups on symptom scores (F[6, 607] = 3.6, p < .01), depression (F[6, 619] = 2.7, p < .05), and shyness index (F[6, 625] = 4.0, p < .001) (Fig. 1), but not on anxiety (H6, 622] = 1.5, p > .10), mastery (H6, 614] = 0.8, p > .10), Weinberger repression (H6, 591] = 0.7, p > .10), or Marlow-Crowne repression (F[6, 544] = 0.5, p > .10). On analysis of covariance, group differences on total symptom scores did not remain sig- nificant (F[1, 598] = 1.6, p > .10) after covariation for depression (F[1,698] = 237.5, p < .001). However, group differences on depression were no longer signifi- cant (F[6, 609] = 1.0, p > .10) when shyness was first covaried (F[1, 609] = 64.1, p < .0001). Even with de- pression as a significant covariate (F[1, 591] = 63.4, p < .001) and hay fever as a nonsignificant factor, shy- ness was still significantly higher in the more cacosmic subjects (F[1, 591] ——H 2.7, p < .05). Stepwise multiple regression (Tables 2 and 3) over the whole sample showed that (a) for the total symp- tom scores, depression accounted for 27%, repression for 3.1%, mastery for 1.6%, cacosmia sensitivity for 1.2%, and anxiety for 0.70% of the variance; shyness, hay fever, and sex did not enter the equation; and (b) for cacosmia scores, shyness accounted for 5.8%, sex for 1.7%, hay fever for 1.5%, and total symptom scores for 1.1% of the variance, whereas depression, anxiety, sense of mastery, and repression did not enter the equation. The most cacosmic group reported significantly more self-imposed limitations on eating certain foods (com- posite score for limiting foods high in sweet, salt, fat, and bread) (12.9 i 4.0 vs. 10.3 i 4.8 F[1, 166] = 14.3, p < .001), feeling worse from missing meals (2.6 i 1.4 vs. 2.0 i 1.4, F[1, 169] = 9.4, p < .01), and from tak- ing opiate drugs (2.0 i 1.4 vs. 1.6 j; 1.2, F[1, 163] = 4.3, p < .05) than did the least cacosmic subjects. However, the CS group rated themselves as sleeping significantly better than did the NS group after drinking either cold or warm milk before going to bed (2.1 :1: 1.2 vs. 1.3 i 0.86,F[1,169] = 22.7,p < .001; 1.8 :1; 1.2 vs. 1.3 i 0.86, F[1, 169] = 12.4, p < .001, respectively). Discussion These data in a nonclinical, nonoccupational popula- tion of well-educated young adults suggest that a sub- stantial proportion (approximately 15%) reported feel- ing ill from smelling multiple common environmental chemicals. The findings are consistent with descriptive information in certain patient groups with multiple chemical sensitivity,‘ i.e., the present CS group includ- ed significantly more women than men, reported high- er frequencies of hay fever, and responded to foods similarly to MCS patients. Contrary to findings in sev- eral MCS clinical studies, depression and anxiety corre- lated only weakly with cacosmia scores in the present sample. Recently, Kipen and Fiedler” have reported depression to be much less prevalent in their series of MCS patients from an occupational medicine clinic than investigators in other settings have noted. Taken together with the evidence that depressive and anxiety disorders are a concomitant diagnosis for 5% to 45% of traditional medical illnesses38 and that 65% to 71% of depressed patients have concomitant chronic medical conditions,” depression and anxiety disorders in MCS patients may simply be secondary to or epiphenomena of chronic illness rather than primary to the disease process itself. Clinical research suggests that depression and a poor sense of control over external circumstanc~ es facilitate complaints of—and suffering from—pain Table 2,—Stepwise Multiple Regression for Gender, Hay Fever, Psychological Variables, and Composite Cacosmia Scores as Predictors of Total Symptom Scores in Young Adult College Students [N = 643) Variable Gender Hay fever Shyness index Depression 0.274 Anxiety 0.007 Sense of mastery 0.016 Marlowe-Crowne repression 0.031 Composite cacosmia 0.012 Ianuary/Fehruary 1993 [VoL 48 (No. 1)] Not in equation Not in equation Not in equation Estimated Regression standard coefficient error Z statistic Table 3.—Stepwise Multiple Regression for Gender, Hay Fever, Psychological Variables, and Total Symptom Scores as Predictors of Composite Cacosmia Scores in Young Adult College Students (N = 643} Change in R2 0.01? 0.015 0.058 Not in equation Not in equation Not in equation Not in equation 0.011 Gender Hay fever Shyness index Depression Anxiety Sense of mastery Marlowe-Crowne repression Total symptom scores and panic.4°"” Thus, dysphoric affective states can amplify discomfort from, but not necessarily account for, a given clinical syndrome. Consistent with the latter point, the current data showed that depression ac— counted for 27% of the variance in total symptom ratings but for none of the variance in total cacosmia scores. In contrast with earlier studies,”42 the term cacosmia has been used in the current investigation to describe "illness" from chemical odors without requiring sub— jects either to designate specific odor—induced sympto- matology such as headache, dizziness, and nausea or to report avoidance of subsequent exposures as a result of chemically induced illness. As a result, our “cacosv mics” could be much less severely affected by chemi- cals than those characterized in the industrial literature by Emmett“2 or by Ryan et al.,25 who employed more stringent criteria. However, subsequent unpublished survey data in our laboratory from a different cohort of college undergraduates indicate that students frequent- ly list eye, nose, throat, and re5piratory irritation, nau» sea, and headache as the symptoms they experience when they feel ill from the odor of the five chemicals surveyed. More detailed characterization of subjective experiences in this form of cacosmia in nonclinical, nonoccupational populations would be indicated. The finding that shyness accounted fora very limited portion of the variance in chemical sensitivity (5.8%) suggests that shyness may be one of multiple factors in vulnerability to chemical sensitivity for a small subset of individuals. The olfactory-limbic kindling model for MCS that Bell and Miller have proposed could accom- modate this possibility."2'2“ Kindling is a special type of time—dependent sensitization in which repeated, inter- mittent, subthreshold stimuli (electrical or chemical) in- duce an amplification of neuronal responses to a con- vulsive endpoint.”46 The olfactory bulb, amygdala, and hippocampus are among the limbic brain struc- tures most susceptible to kindling. The amygdala, for example, is not only a major participant in responses to 10 Estim ated sta nda rd error Regression coefficient 2 statistic olfactory stimuli, but also a regulator of social behav- iors in animals (e.g., shyness, social avoidance)”37 Once kindling has occurred, the same low-level stim- ulus that originally evoked little electrophysiological re- sponse now triggers a full seizure; the phenomenology has some similarities to the mechanisms of memory for- mation in the limbic hippocampus. The mechanisms of kindling and time-dependent sensitization are not well understood, but drugs that block the actions of excita- tory amino acid neurotransmitters such as glutamate can impede development of kindling.“7 Factors that lower seizure threshold, such as estrogen in women,48 would be expected to facilitate kindling-sensitization“9 and might help explain the disproportionate number of women with cacosmia or with MCS.24 Within clinical pathology, kindling most closely resembles temporal lobe epilepsy in humans and other primates, a seizure disorder that is associated with interictal hyperosmia.50 Consequently, one might expect affective, sensory, au- tonomic, endocrine, immune, motor, andfor cognitive manifestations, dependent in part on the limbic areas that have been kindled and the functions they regulate. Adamec” has developed an animal model for shy- ness that has demonstrated an inherent electrophysio- logical hyper-reactivity of the amygdala in characteristi- cally shy or avoidant cats. This increased firing in turn sets off heightened responses in the ventromedial hy- pothalamus (the so-called “satiety center" of the brain, which also monitors autonomic and immune responses). Moreover, experimental partial kindling of the amygdala causes an increase in avoidant behaviors in either ini- tially shy or aggressive cats. A number of environmen- tal chemicals, especially pesticides, has been shOWn to kindle the amygdala in animals.“””"18 As a result, the shyness noted in relationship to cacosmia in the pres- ent study might constitute a predisposition toward or a result of partial kindling by certain environmental chemicals. Shy individuals with inherently hyper-reac- tive amygdalas at at baseline might be even more likely to undergo adverse neurobiological responses to cer- Archives of Environmental Health tain environmental chemical exposures. Shyness, there- fore, could be a permissive, but neither a necessary nor sufficient, factor in the development of cacosmia and perhaps MCS. Notably, behavioral or psychological phenomena such as trait shyness, depression, or even multiple so- matic complaints often indicate neurophysiological or neurochemical dysfunction.“"“"5"53 The present shy- ness findings do not necessarily equate with a “psycho- genic” etiology for chemical sensitivities, a point that has been overlooked in much of the current debate on MCS.“*7*“"“ By consensus and design, the current system of diagnosis in American psychiatry, the Diagnostic and Statistical Manual iii-Revised (DMS Iii—R), provides only descriptive labels for symptom patterns (e.g., “major depression"); for most psychiatric disorders, it assigns no etiological meanings to those labels (i.e., neither “psychogenic” or “neurochemical” nor “reserpine—in- duced”). Ninety percent of the variance in the present cacosmia scores remains unexplained by our available data, most of which relied on "psychological" varia- bles. Because not all types of psychological factors were explored in this study (e.g., other personality traits, suggestibility), it is conceivable that other psy- chological variables might have been more salient in explaining cacosmia. Nonetheless, the data imply that a search for at least some specific biological factors in cacosmia and perhaps chemical sensitivity would be appropriate to explain a large proportion of the variance. It is also possible that the Weinberger subscales for depression and anxiety were relatively insensitive to detect true psychopathology in the highly cacosmic group. On the other hand, the long form of the Wein- berger scale (84 items), from which the items of the short form are derived, has been shown to differentiate significantly higher levels of depression and anxiety in young adult outpatients at a community health clinic as compared with a nonclinical sample of young adult college students.25 Thirty-five percent of the most ex- tremely cacosmic subjects in this sample, versus 21% of the least cacosmic subjects, fell into the upper 20% of scores on overall emotional distress for normal young adults based on the norms for the Weinberger short form. Thus, although the self-report on the short form of the Weinberger may be a less sensitive measure of psychological state than an in-person structured psy- chiatric interview, the Weinberger scale did identify psychological distress in the cacosmic students. As not- ed above, the dysphoria related more to self-reported symptom severity than to cacosmia. Because these iB-y—old students were enrolled in col- lege and reported a low prevalence of several tradition- al medical diagnoses, it is highly unlikely that the large numbers in each group represent clinically ill or dis- abled individuals. Unlike previous studies of patient groups, it is also doubtful that these students as a whole had any reason to project blame for shyness, depres- sion, or specific symptoms on adverse chemical reac- tions; as nonpatients, they would not have received any prior education by physicians (e.g., “clinical ecolo- gists”) to espouse certain beliefs about chemicals and lanuary/February1993WoI. 48 (No. 1)} health. Their reports of sleeping better after drinking milk tend to discount a systematic bias toward report- ing only adverse effects of chemicals and foods. At the same time, they were similar to clinical MCS patients with self-reported food sensitivities who claim transient worsening of symptoms on missing meals and improv- ing after eating specific foods."'23 The lack of systematic differences as a function of self-reported cacosmia in repression on either the Weinberger or Marlow-Crowne scale further reinforces the validity of these findings. That is, if repression scores had differed between groups with different self- reported cacosmia, the results may have reflected sim- ply a questionnaire response bias toward more cacos- mic subjects admitting more negative information about themselves than did nonsensitive subjects."| Re- pressors also tend to report higher rates of certain so- matic disorders but lower rates of psychiatric illnesses than do nonrepressors.“53 However, in the absence of such repressor findings and the use of subjects with val- id Weinberger subscale scores, these data provide a subjectively accurate picture of the health and person- ality patterns of the participants. The study is limited by its survey format and the lack of data on subjective associations between specific symptoms and self-reported illness from each chemi- cal. At the same time, the data highlight the importance of distinguishing self-reports of feeling ill from chemi- cals from self-reports of symptoms themselves; depres- sion appears to play different roles in subjective assess- ment of cacosmia as opposed to specific symptoms. This sample is also not representative of several other types of patient groups, usually from occupational set- tings or toxic waste sites, with different sex distributions and onset of MCS only after initially high-dose chemical exposures.‘-i2”"'5“ However, the fact that the patterns of findings in this college student sample are similar to those reported in certain clinical MCS populations is striking. Despite the methodologic limitations, we may have identified one potential group that already reports feel- ing ill from chemicals as teenagers and may be at great- er risk of developing MCS clinical syndromes later. This study does not address factors involved in the possible evolution of cacosmia into MCS, that is, the identifica- tion of oneself as a patient with a clinically significant set of symptoms ascribed to chemical exposures that lead to major lifestyle changes.“4 Until a strong relation- ship between the current cacosmia findings and the later development of MCS is demonstrated, the clinical rele— vance of the present observations will remain uncertain. Acute double-blind laboratory tests of central nervous sys- tem reactivity to low-level chemical exposures, e.g., using evoked potentials,55 topographic EEG, SPECT, and PET measures,54 neuropsychological tests,“"3““"'35’2"'Sb as well as prospective studies of illness onset in the cacosmic and noncacosmic groups would be valuable at this point. ********** Submitted for publication lanuary 21, 1992; revised; accepted for publication june 22, 1992. 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Solvent- associated olfactory dysfunction: not a predictor of deficits in learn- ing and memory. Am I Psychiatry 1991; 148:751—56. _ archives of no Envrronmental Health ORDER FORM El YES! I would like to order a one-year subscription to Archives of Environmental Health, published bimonthly. I understand payment can be made to Heldrcf Publications or charged to my VISAfMastchard (circle one). DSWDO annual rate ACCOUNT‘ SIGNATURE NAMEIINSTITUTION__—_—__.__—_—— ADDRESS____—_______ EXPIRATION DATE ' For 47 years, this noted jour- : nal has provided objective documentation of the effects I of environmental agents on human health. In one single source Archives of Environ- mental Health: An Interna- tional Journal brings to- gether the latest research from such varying fields as epidemiology, toxicology, biostatistics, and biochemis- ClTYISTATEIZIP_______—_#—— COUNTRY__—_—_.—_—— ADD $16.00 FOR POSTAGE OUTSIDE THE U.S. ALLOW 6 WEEKS FOR DELIVERY OF FIRST ISSUE. 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Bell's Self-Reported Illness from Chemical Odors in Young Adults without Clinical Syndromes or Occup

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