Abstract
Patient 1, a 38-year-old man, complained of an anal odor for about 20 years. Patient 2, 16-year-old man, complained of a loose anus and emission of a bad-smelling gas for 6 months. When they noticed the casual actions of those around them, such as smoking, opening a window, backing away from them, they were convinced that they had just emitted an offensive smell, and interpreted the movements of those around them as reactions to the odor. Because of this conviction, they avoided social situations. Such delusional behaviors can be conceptualized as "operants". Avoiding social situtions reduces the fear that people are averse to them, so it is reinforced. The casual actions of those around them are "discriminative stimuli" to the operants. Th,refore, they were instructed to confirm that they did not smell offensive by directly questioning those around them. However, neither was able to do this. in Patient 1, after receiving clomipramine(60-105 mg/day) for 2 weeks, the delusion of body odor was attenuated, and he was able to behave as instruction, As a result, he told us that he had not emitted the odor, and no longer avoided social situations. However, clomipramine was not effective for Patient 2. He rejected our instruction throughout, and the delusion persisted.
