Olfactory Reference Syndrome

Olfactory Reference Syndrome (ORS) is characterized by an irrational belief that one’s body emits a foul or offensive odor. The obsession may be an excessive preoccupation with a natural bodily smell (fecal odor, general body odor, genital odors, bad breath, etc.) or a nonbodily smell (garbage, rotten eggs, ammonia, etc.). Most individuals with ORS focus on one odor, but some are concerned with several odors simultaneously or different odors over time. Some individuals believe that they smell the odor themselves, and all individuals with ORS believe that others smell the odor. They often interpret others’ behaviors as a response to their perceived body odor. Gestures, such as sneezing, scratching one’s head, and covering one’s face, as well as comments, such as “Do you think it’s stuffy in here?” can be misinterpreted.

Due to anxiety and embarrassment, people with ORS often engage in ritualistic and avoidant behaviours. Some common rituals include repeated checking for body odor; excessive showering; frequently changing clothes; excessive use of colognes, perfumes, deodorants, or mints; and asking others for reassurance about the perceived odor. Typical avoidant behaviours include avoiding social situations, avoiding enclosed areas, and standing or sitting far away from others. Due to these behaviours, individuals with ORS often avoid dating, may frequently change schools or jobs, and may become housebound. People with ORS often are depressed and have suicidal thoughts and actions.

Some research suggests that ORS can be treated using the same techniques that are helpful in treating OCD and other obsessive-compulsive spectrum disorders. Exposure and Response Prevention (E/RP), which is a form of Cognitive-Behavioral Therapy (CBT), consists of exposure to avoided social situations while refraining from behaviors intended to check, eliminate, or camouflage the perceived odor. In addition, another form of CBT called Cognitive Restructuring can be used to challenge faulty beliefs about others’ reactions. There is also some research to indicate that medications, such as a type of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), and antipsychotics can be helpful in treating ORS symptoms.