Olfactory Reference Syndrome

Individuals who experience difficulties with Olfactory reference syndrome (ORS) often describe difficulties with odours they believe they are emitting that are foul even though they are not. Many people with ORS will isolate themselves from others and perform other behaviours to eliminate or decrease the smell.

Like genital staring OCD, there is a social component that is influenced by a core fear of being alone. If a person with ORS is to evaluate their thinking it may involve fearing the outcome that they will be socially judged for their odours and as a result be alone. In my opinion, the ORS is a protective feature to prevent this situation from occurring. If the person obsesses about their odours then the outcome would be less likely to occur. Common examples of ORS include foul body odour, bad breath and sweat smells.

Two subtypes of Olfactory Refraction Syndrome

People who report smelling an odour

There are people who have ORS and who report smelling an odour on their bodies. There are also reports of people who report smelling non-bodily odours on their bodies as well.

People who do not smell and odour:

Katherine Phillips PHD, an article in the 2008 IOCDF OCD newsletter, highlights a critical point. She indicates that those who do not smell an odour are likely to misinterpret people's gestures, comments, and behaviours of others to be negatively related to their body odour.

When working with clients, it's important to rule out any medical conditions that may present as ORS. This may mean ruling out olfactory hallucinations, post COVID symptoms, or epilepsy.

How I Work with Patients with Olfactory Reference Syndrome

As with most types of OCD concerns, there is a fear that most people believe they can't cope with. We usually identify this fear by observing what it would mean for them if they had to live with knowing their fear might come true. With ORS patients, it would be having to live with an odour and other people being exposed to it. Most of the time, many people with ORS believe that they would be socially outcasted and judged for emitting and odour. One of the goals of therapy is to figure out how to manage this outcome - (even if they are part of the subtype group that doesn't actually smell). Part of the process of living with ORS is continuing to live your life not knowing if you smell or not and expecting that you are emitting an odour and that you can tolerate the outcome of any negative social situation that comes about. This doesn't mean you stop brushing your teeth or showering, but this does mean that you take reasonable steps to maintain your hygiene no more than what is considered normative. Part of living with this uncertainty is learning to let go of the rituals that you have that are keeping the fear maintained.

In reality, there is likely some smell that is being emitted from all of us at any given time. This is a fact that we all have to live with knowing or not knowing if we smell and carry on until we can manage with it. Part of the process of learning to manage ORS is to challenge the negative thinking you have about ongoing smells with yourself and others and learn to live with the uncertainty of not fully knowing how you smell and if you will be perceived by others as someone who smells.