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Olfactory Reference Syndrome

Olfactory Reference Syndrome — Symptoms & Treatment

Have you ever been in a situation where someone approached you and talked to you and when that person walked away, you find yourself thinking making sure that that no one is looking, then putting put your hand to your mouth to check if your breath smells bad? Does that ring a bell to you?

What is Olfactory Reference Syndrome?

Olfactory Reference Syndrome (ORS) is a psychological condition that is characterized by excessive, irrational fear and a false belief that one is emitting an unpleasant or foul odor. This medical condition is also known as Bromosis or Autodysomophobia, and it goes beyond excessive concern for hygiene and oftentimes is accompanied by distress, embarrassment, and shame. This condition may significantly impair social relationships, occupational, and professional functioning. In extreme cases, people with Olfactory Reference Syndrome may develop social isolation and social phobia.

What Causes Olfactory Reference Syndrome (ORS)?

There is no conclusive cause identified yet regarding what exactly causes ORS. But research shows ORS may be associated with key traumatic experiences concerning smell or odor and stress factors unrelated to smell.

Olfactory Reference Syndrome & Obsessive-Compulsive Disorder?

ORS shares some characteristics with Obsessive-Compulsive Disorder. In fact, a majority of the ORS symptoms reported by patients meet criteria for the obsessions and compulsions that comprise OCD. As such, due to its obsessive and compulsive behavioral features, some psychologists even consider ORS as a subtype of OCD. In addition, ORS also have similarities to BDD or Body Dysmorphic behavior. To date, Olfactory Reference Syndrome does not fall within an existing standard psychiatric diagnostic category; it is not included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

ORS Treatment

Because of the significant similarities of OCD and ORS, CBT or Cognitive Behavioral Therapy (a method used in OCD treatment) is also employed in ORS treatment. The primary technique used in CBT is the ERP or Exposure and Response Prevention therapy. Aside from CBT, medication may also be administered. Selective serotonin reuptake inhibitors (SSRIs) are a classification of medication used to treat OCD and may also be considered effective for the treatment of ORS.

Common Olfactory Reference Syndrome Obsessions Examples

  • Extreme fear of having a bad breath
  • Irrational thoughts of having a foul and noticeable anal odor
  • Excessive thoughts of having a foul vaginal odor
  • Unreasonably extreme fear of having an unpleasant overall body odor
  • Imaginary or imposed fear of having an unnatural, non-human or chemical odor
  • Misinterpreting that others’ behaviors, actions, or comments are related to the imagined odor (for instance, sniffing, coughing, sneezing, touching the nose or turning of the head)
  • Repetitive showering and other ritual grooming behaviors
  • Too much use of deodorants, breath fresheners, and various perfume products
  • Repetitively checking or investigating the source of the presumed unpleasant odor
  • Constant seeking of reassurance from others that there is no odor
  • Avoidance of social and intimate situations due to embarrassment and fear that others will notice the imagined smell
  • Multiple visits to doctors regarding odor complaints

Other Common OCD Sub-Types

It is not uncommon for an individual suffering from one OCD sub-type to also suffer from other sub-types. Treating co-occurring sub-types simultaneously is important in finding balance and healing from OCD.