What is Olfactory Reference Syndrome (ORS)?

What is Olfactory Reference Syndrome (ORS)?

People suffering from Olfactory Reference Syndrome (ORS) are overwhelmingly preoccupied with the false belief that they are giving off an offensive body odor (BO) and will be perceived negatively because of it. ORS is often accompanied by depression, shame, anxiety, and embarrassment. Avoidance of social situations, school, or work is very common. It is important to emphasize that individuals with ORS do not give off an odor, but rather it is the false belief and fear that they do.

ORS is under recognized and understudied, in addition it has similarities to Social Anxiety, Body Dysmorphic Disorder (BDD), and Obsessive Compulsive Disorder (OCD), which can make it even more difficult to differentiate between symptoms. According to the DSM-V, although ORS is not considered as a distinct diagnosis, it can be classified as an “Other Specified Obsessive Compulsive and Related Disorder.”

Most common BO preoccupations:

  • Flatulence (who cut the cheese?)
  • Fecal or anal odors
  • General BO (i.e. sweat, armpit, under breast)
  • Halitosis or Bad Breath
  • Genital odors
  • Semen
  • Urine
  • Smelly hands and feet

And sometimes people suffering from ORS report a preoccupation with unsavory smells other than BO such as ammonia, detergents, rotten onions, candles, burned rags, etc. (you get the point).

Who does it effect?

Actually, it might be even more common than you think (and often goes undiagnosed). It has been reported around the world in places like Africa, Japan, Europe, South America, Canada, and the Middle East, for over a century.

Most people begin experiencing symptoms in their mid 20s or later; some might even report it as early as their teens. It appears to be more common in women on this side of the hemisphere (Western) and is reported more often in men in the East.

Do I have it? What are some of the signs to look for?

Experts believe ORS sufferers can continue to experience symptoms for years (even decades) and when left untreated tend to worsen over time. Recognizing ORS can sometimes be very difficult! People often hide their symptoms because they are embarrassed by them.

Here are some things to keep an eye out for:

  • Persistent false belief of giving off BO (and belief that other people can smell it too)
  • Time consuming: preoccupation lasts for at least an hour a day
  • “Safety” and avoidance behaviors cause significant distress or impairment seen in social, school or the workplace
    • Excessive showering or washing
    • Excessive use of perfumes or body care products (soap, body washes, deodorant)
    • Using gum/mints and mouthwash throughout the day
    • Changing clothes frequently
    • Hiding oneself when interacting with others, such as turning away, covering face, sitting away from others
    • Excessive checking or masking of supposed BO
    • Avoid social activities, intimate relationships, traveling
    • Change jobs frequently
    • Become housebound (or even move to another town altogether)
    • Excessive “cure seeking” non-psychiatric doctor visits i.e. dentists, surgeons, ENT specialists, proctologist, or gastroenterologists
    • “Referential thinking” – a belief that others are talking or noticing me.

Individuals with ORS may struggle with co-occurring symptoms and psychological conditions, such as depression (85%), social phobia (65%), and use of drugs and alcohol (50%). A high percentage of individuals with ORS struggle significantly leading to suicidal thoughts, suicidal attempts, and hospitalizations.

What kind of help is out there for it?

Cognitive behavioral therapy (CBT) can be very effective in treating ORS. Initial treatment includes conducting a thorough assessment, strengthening motivation and readiness for change, targeting depression and/or suicidal thoughts, and thoroughly educating the patient about the treatment. Cognitive therapy consists of challenging the faulty beliefs associated with ORS, such as “I smell so awful that no one will want to be around me, I know others stay away from me because of the way I smell etc.” Behavioral therapy can consist of targeting the avoidance behaviors by guiding the patient to gradually face the situations frequently avoided while decreasing safety and checking behaviors (such as excessive showering or washing and the use of beauty/body products).

Mindfulness-based cognitive therapy (MBCT) is another useful approach that focuses on increasing awareness of the present and not giving importance to negative and  maladaptive beliefs.  After all, these are not “fixed realities or reflections of truth;” essentially reducing reacting to such false beliefs. MBCT has been seen to be effective in treating persistent depression which is a common co-occurring condition for ORS sufferers.

Effective medication therapy is limited however, Selective Serotonin Reuptake Inhibitors (SSRIs), a class of antidepressants have been seen to be the most helpful. All therapeutic medications should be prescribed and monitored by a trained licensed medical professional.