I have a severe sensitivity to smells. Exterminators say their products are non-smelling, but I walk into my office and know the exterminator has been there. I worked in an area where MEK was used -- though nowhere near me -- and the smell drove me crazy. They will be tarring the parking lot where I work soon, and I'm getting nervous about not being able to work. Xanax seems to stop the smelly problem, but my doctor here says I should go to a psychiatrist as he will not prescribe Xanax or Valium. Is there something wrong with me mentally?

L.

Is there something wrong with you mentally? Well, yes. All physical problems can have a psychological overlay. For example, it is well known that if a person with a chronic pain syndrome is also depressed, treatment of the depression will also lead to subjective improvement of the pain syndrome. Similarly, a particular symptom (hoarseness, for example) may be very distressing until a doctor examines the patient and declares, "This is just laryngitis," or, "This is due to reflux." What the patient hears is: "This is not cancer." Matter solved. Fear dissipates. The patient declares, "Hell, I can live with this!"

Some folks seem to be very sensitive to particular smells. Solvents (such as MEK, or methyl ethyl ketone) and cigarette smoke are common offenders. This is an obnoxious symptom, but what you do with this symptom is the issue here.

My advice for problems such as this: Attack it from two directions at once. This is a "which came first, the chicken or the egg" problem. Are you suffering emotional distress because of a very real physical problem, or is your emotional distress magnifying what would otherwise be a fairly trivial physical problem? You don't need to answer this question if you address both problems simultaneously.

First of all, you should discuss this problem with your internist, and you should also consider seeing an ear, nose and throat doctor (ENT). There may be some correctable problem at work here. For example, many medications cause dysosmia (a disordered sense of smell). Some hormonal problems can cause distortion of the sense of smell, too. Unfortunately, your problem is not terribly common. There's much more information available on hyposmia (decreased sense of smell) and anosmia (complete loss of the sense of smell).

Next, you should perhaps see a psychiatrist. I don't blame your doctor for not wanting to prescribe Xanax (alprazolam); there's a bewildering array of mood-altering drugs on the market, and most non-psychiatrists have a hard time keeping track of all of them. A psychiatrist could determine your need for such a medication, monitor you for side effects if you take it, and also help you deal with the emotional side of the chicken-and-egg question.