Olfactory reference syndrome: what is it and what are its symptoms?

the Olfactory reference syndrome it is a psychiatric disorder, characterized mainly by the fact that the sufferer is firmly convinced that it gives off a bad body odor. But are there hallucinations in such a disorder? And the delusions?

Throughout this article we will try to answer these questions. In addition, from different studies, we will explain in detail what this disorder consists of, what are some of the etiological hypotheses raised, its symptoms and, finally, the treatments used to combat it.

    Olfactory reference syndrome

    Olfactory reference syndrome (ORS) consists of a hallucinatory psychiatric disorder. It is mainly characterized by a persistent concern about smell, as well as other symptoms such as discomfort and anxiety. On the social level, it is accompanied by behaviors of avoidance and social isolation.

    This syndrome is a variety of somatic-type delusional disorder. The person with Olfactory Reference Syndrome vehemently believes that they have a foul odor and that others may notice the odor.

    At the clinical level, it is therefore a delirium combined with a hallucination (although there is controversy over the existence of these symptoms, as we will see later). In the DSM-5 (Diagnostic Manual of Mental Disorders), it is proposed to classify ORS as an independent disorder.

    Due to the characteristics of the syndrome, most patients with olfactory reference syndrome do not consult psychiatrists or psychologists, but other types of professionals, such as dermatologists, dentists, dermatologists or even surgeons, in because of their “obsession” with the wrong body. smell they give off.


    The prognosis for the standard olfactory syndrome has always been considered unfavorable; However, a 2012 review, conducted by authors Begum and McKenna, found that two-thirds of patients (out of a sample of 84) either partially improved or fully recovered.

    demographic data

    The prevalence of ORS is higher in men than in women. Specifically, single men predominate. As for the age of onset, it goes from late adolescence to early adulthood.


    As for the origin of the olfactory or olfactory reference syndrome, it was Pryse-Phillips who, in 1971, published a long list of cases. Philips separated the ORS cases from cases with similar symptoms, belonging to schizophrenic, affective or organic psychosis.

    the causes

    As for the cause of the benchmark olfactory syndrome, it is actually unknown, as in many other psychiatric disorders. however, yes there are etiological hypotheses, which refer to certain serotoninergic and dopaminergic dysfunctions in the brains of people with ORS.

    These dysfunctions are related to the repetitive cleaning and examining behaviors that these patients display, similar to those of people with obsessive-compulsive disorder (OCD).

    Other causal hypotheses point to certain mismatches in certain regulatory genes, such as Hoxb8 and SAPAP3 (linked to the limbic lobe and the basal ganglia).

    On the other hand, there are also cases of people with olfactory reference syndrome who suffered from some type of brain injury as well as temporal lobe epilepsy. However, all of these assumptions are basic neurobiological assumptions, and none has been found to be 100% responsible for ORS.

    Social and psychological factors

    As for the more psychological and social causes, in half of the cases of ORS there is a precipitating event just before the onset of symptoms of the disease. These events usually involve some sort of disparaging warning from others.

    Stress can also be the root cause of this disorder, along with obsessive, suspicious, and paranoid personality (and in extreme cases, obsessive personality disorder or paranoid personality disorder).


    What symptoms accompany the olfactory reference syndrome? Let’s take a look at the 4 main symptoms in addition to the suffering inherent in the disorder..

    1. Concern for body odor

    The main symptom of olfactory referral syndrome is a significant concern regarding body odor; that is, the person vehemently believes that they have a bad odor.

    However, there is controversy as to whether this concern is delusional in all cases of syndrome or not. It is also unclear whether or not there is still hallucination associated with this concern.

    Hallucination and / or delirium?

    In relation to these controversies on the presence or absence of delirium and hallucination, a recent review (2012) by the authors Begum and McKenna, revealed that 22% of patients with olfactory reference syndrome exhibited an olfactory hallucination associated with a concern of bad smell (against 75% of the original list of Pryse-Phillips, which presented this hallucination).

    Regarding the presence or absence of delirium, this review reflects how 52% of patients had it; in the rest of the patients, however, the worry was based on an idea that oscillated between the overdone idea and the obsessive idea.

    2. Be ashamed

    Another symptom of ORS is an intense feeling of shame towards others; thus, the person suffers because he is convinced that it stinks, and that in addition, others notice it. That’s why she feels deeply embarrassed, and things are going badly.

    On the other hand, according to studies, more than 75% of patients with olfactory reference syndrome interpret the actions and words of others in relation to themselves. In other words, we think that patients speak badly and criticize them.

    3. Constant review

    People with ORS spend a lot of time reviewing their body odor because they are “obsessed” with smelling more. They also exhibit other compulsive behaviors in order to disguise that they are in a place or to disguise their own scent.

    4. Social isolation

    The above symptoms end up causing the person to be socially isolated, which also results in social and professional incapacity, and great difficulty in leading a “normal” life.

    In fact, on the initial list of cases compiled by Pryse-Phillips, only 3% of people with olfactory reference syndrome led active social lives.


    As regards the treatment of the olfactory reference syndrome, there are generally two types of treatment: psychological and pharmacological.

    At the psychological level, psychotherapy is used. Although it can be worked on from different orientations, cognitive behavioral therapy is recommended, in order to eliminate the cognitive distortions associated with body odor, as well as review and checking behaviors.

    EMDR (Eye Movement Desensitization and Reprocessing) therapy has also been used. Specifically, a 2008 study, conducted by McGoldrick, Begum and Brown, reveals the success of 5 patients with this therapy, a therapy which, however, is not useful in other psychotic images.

    Pharmacologically, antipsychotics and antidepressants are useds. For its part, a study reveals that 33% of patients with reference olfactory syndrome treated with antipsychotics had obtained very positive results; the same was true for 55% of patients treated with antidepressants.

    Bibliographical references:

    • Begum, M. and McKenna, PJ (2011). Olfactory reference syndrome: a systematic review of the world literature. Psychol Med, 41: 453-61.

    • Bizamcer AN, Dubin WR, Hayburn B. (2008). Olfactory reference syndrome. Psychosomatics, 49: 77-81.

    • Creuat, L., Cáceres-Tac, I. and Calizaya, JR (2012). On a case of olfactory referential syndrome. Clinical case. Acts Esp Psychiatry, 40 (4): 234-8.

    • McGoldrick T, Begum M, Brown KW. (2008). EMDR and olfactory reference syndrome. A series of cases. EMDR Journal, 2: 63-8.

    • Phillips KA, Gunderson C, Gruber U, Castle D. (2006). Body odor delusions; the olfactory reference syndrome. A: Brewer W, Castle D, Pantelis C, eds. Smell and brain. New York: Cambridge University Press, 334-53.

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