Olfactory Reference Syndrome

Olfactory Reference Syndrome is characterized by a distressing or impairing belief by a person that they emit a foul or offensive body odour. The odour is imagined, slight or imperceptible to others[1].

Patients with Olfactory Reference Syndrome are preoccupied, usually for many hours a day, with a distressing or impairing belief that they emit one or more foul or offensive body odours, which are not perceived by others or are actually only slight. They may believe, for example, that they have very bad breath or emit foul-smelling sweat from their armpits or other areas of their skin. Other worries include emitting a smell of urine, flatulence, or unpleasant odours from the genital area. Occasionally, patients believe that they emit odours like old cheese, garbage or rotten food.

The preoccupation with body odour is usually accompanied by repetitive bahaviours, such as smelling themselves, excessive showering, changing clothes and/or reassurance seeking. These behaviours attempt to alleviate the substantial distress caused by the preoccupation with body odour. Most people with Olfactory Reference Syndrome also make efforts to camouflage the perceived odour, for instance with perfume, deodorant, mouthwash and/or bubblegum.

This disorder often results in shame, embarrassment, significant distress, avoidance behaviour, social phobia, and social isolation.

Insight is usually poor or absent. Very few recognize that their belief about the body odour is inaccurate. Thus many patients hope to find treatment to aleviate their problems, such as tonsillectomy for perceived halitosis, proctectomy (anus removal) for perceived anal/flatulence odour.

Cases have been reported from around the world. It is difficult to estimate the prevalence of this condition because data is limited and unreliable. Males appear to be affected twice as commonly as females.

Olfactory Reference Syndrome shares clinical features of both Obsessive-Compulsive Disorder and Social Anxiety Disorder[2]. This suggests that the comorbidity of Obsessive-Compulsive Disorder and Social Anxiety Disorder most likely explains the development of Olfactory Reference Syndrome.

There is no agreed treatment for Olfactory Reference Syndrome. Treatment often includes antidepressants, followed by antipsychotics, and various psychotherapies. Antidepressants seem to be more helpful than antipsychotics.

[1] Phillips, Menard W: Olfactory reference syndrome: Demographic and clinical features of imagined body odour in General Hospital Psychiatry - 2011
[2] Tada: Olfactory Reference Syndrome: Its Relationship to Comorbidity of Social Anxiety Disorder and Obsessive-Compulsive Disorder in Journal of Nervous and Mental Disease - 2023