Olfactory Reference Syndrome – Symptoms and Treatment

Olfactory Reference Syndrome (ORS), also known as Autodysomophobia and Bromosis, is characterized by excessive, irrational fear that one is emitting a foul or unpleasant odor. The obsession may be an exaggerated, disproportionate concern with a natural body smell, or mayinvolve an entirely imagined odor. ORS goes beyond normal concern with one’s hygiene, and may significantly impair academic and professional functioning, as well as interpersonal relationships. In extreme cases, individuals with Olfactory Reference Syndrome may quit work and avoid social situations in an effort to avert the embarrassment they imagine they will experience when others detect the alleged odor.

Common Olfactory Reference Syndrome obsessions include:

• Exaggerated fear of having extremely bad breath (halitophobia)
• Thoughts of having a foul, noticeable anal odor
• Belief in having a foul, noticeable vaginal odor
• Fear of having a foul overall body odor
• Fear of having an unnatural, non-human or chemical odor
• Believing others’ behaviors or comments are related to the imagined odor (e.g., another’s cough, sneeze, or turning of the head is due to the alleged odor)

Common Olfactory Reference Syndrome compulsions include:

• Repetitive showering and other grooming behaviors
• Excessive use of deodorants, perfumes, and mouthwash
• Repeatedly checking the source of the alleged odor
• Seeking reassurance from others that there is no odor
• Avoidance of social situations for fear that others will notice the smell
• Multiple visits to doctors regarding the odor

As demonstrated above, Olfactory Reference Syndrome has obsessive-compulsive features that are quite similar to both OCD and BDD. In fact, ORS is considered by many to be a sub-type of OCD or BDD, and does not currently exist as a separate diagnostic category in the Diagnostic and Statistical Manual (DSM-IV) published by the American Psychiatric Association. Regardless of the diagnostic terminology used, it is important to note that the cyclical process by which the symptoms in Olfactory Reference Syndrome intensify is the same as in OCD and BDD. In this process, called the Obsessive-Compulsive Cycle, the compulsive and avoidant behaviors that individuals employ in an effort to reduce their anxiety actually reinforce and worsen their obsessions. To learn more about this process, click here. 

Treatment of Olfactory Reference Syndrome

Because of these many similarities, some of the Cognitive-Behavioral Therapy (CBT) methods that are so effective in treating OCD are also employed in the treatment of Olfactory Reference Syndrome. The primary technique used in both OCD and ORS treatment is a type of Cognitive-Behavioral Therapy called Exposure and Response Prevention (ERP). Another CBT technique that is extremely valuable is called “Cognitive Restructuring”, in which clients learn to challenge the validity of their distorted thoughts related to their odor.

Additionally, a variant of ERP has been developed that has also been found to be extremely effective for the treatment of Olfactory Reference Syndrome. This method, called imaginal exposure involves writing short stories based on the client’s olfactory obsessions. These stories are then used as ERP tools, allowing the client to experience exposure to feared situations that he/she imagines (e.g., smelling extremely bad at an important event such as a wedding or job interview). When combined with standard ERP for the above-noted compulsions, and other CBT techniques such as Cognitive Restructuring, imaginal exposure can greatly reduce the frequency and magnitude of intrusive olfactory obsessions, as well as the individual’s sensitivity to the thoughts and mental images experienced in Olfactory Reference Syndrome.

One of the most effective CBT developments for the treatment of Olfactory Reference Syndrome is Mindfulness-Based Cognitive-Behavioral Therapy. The primary goal of Mindfulness-Based CBT is to learn to non-judgmentally accept uncomfortable psychological experiences. From a mindfulness perspective, much of our psychological distress is the result of trying to control and eliminate the discomfort of unwanted thoughts, feelings, sensations, and urges. In other words, our discomfort is not the problem – our attempt to control and eliminate our discomfort is the problem. For an individual with Olfactory Reference Syndrome, the ultimate goal of mindfulness is to develop the ability to more willingly experience their uncomfortable thoughts, feelings, sensations, and urges, without responding with compulsions, avoidance behaviors, reassurance seeking, and/or mental rituals.  To learn more about Mindfulness Based CBT for the treatment of Olfactory Reference Syndrome, click here.

Using these CBT tools, clients learn to challenge their body odor fears, as well as the compulsive and avoidant behaviors they use to cope with their excessive odor-related anxiety. If you would like to learn more about Cognitive Behavioral Therapy for the treatment of Olfactory Reference Syndrome and related anxiety-based conditions, click here.

Individual Therapy for the Treatment of Olfactory Reference Syndrome

The OCD Center of Los Angeles offers individual therapy for the treatment of adults, children, and adolescents with Olfactory Reference Syndrome, with a strong emphasis on Cognitive Behavioral Therapy (CBT). We have 14 therapists on staff, and offer services six days a week, including evenings and Saturdays. If you would like to discuss treatment options at the OCD Center of Los Angeles, please call one of our client coordinators at (310) 824-5200 (ext. 4), or click here to email us.

Group Therapy for the Treatment of Olfactory Reference Syndrome

In addition to individual therapy, the OCD Center of Los Angeles also offers six weekly, low-fee, therapy/support groups for adults with OCD, Olfactory Reference Syndrome, and related conditions. These groups are led by our professional staff therapists, and use the same treatment protocol as our individual Cognitive-Behavioral Therapy program. To learn more about our weekly groups for adults with OCD, Olfactory Reference Syndrome, and related conditions, click here.

Telephone and Online Therapy for the Treatment of Olfactory Reference Syndrome

The OCD Center of Los Angeles also offers webcam based online therapy and telephone therapy to clients around the world suffering with Olfactory Reference Syndrome. Telephone and online therapy are cost-effective options for clients who have physical and/or psychological limitations that restrict their ability to come to our office, and for those in remote areas who cannot find specialized Olfactory Reference Syndrome treatment close to their home. Telephone and internet therapy have repeatedly been found to be safe and effective in numerous research studies, and have been legal in California since 1997. If you would like to learn more about our telephone and online therapy program for the treatment of Olfactory Reference Syndrome, please click here.

Intensive Treatment for Olfactory Reference Syndrome

We also offer intensive Olfactory Reference Syndrome treatment for adults, adolescents, and children. This program is designed to meet the needs of those for whom standard outpatient treatment for ORS is either unavailable or insufficient. Our intensive outpatient program is ideal for clients from other states or countries who cannot find effective treatment near to their homes, and for those whose symptoms require a more rigorous treatment protocol. To learn more about our intensive outpatient treatment for Olfactory Reference Syndrome, click here.

About the OCD Center of Los Angeles

The OCD Center of Los Angeles is a private outpatient treatment center specializing in Cognitive Behavioral Therapy (CBT) for the treatment of OCD and related conditions, including ORS. We have 13 therapists on staff, all of whom are either licensed or registered, and all of whom specialize in CBT.  We treat adults, adolescents, and children, and offer services six days a week, including evenings and Saturdays.

Our Southern California office is located in Brentwood.

If you are experiencing any of the above Olfactory Reference Syndrome symptoms, and would like to discuss treatment options at the OCD Center of Los Angeles, please call one of our client coordinators at (310) 824-5200 (ext. 4), or click here to email us.

Please note that the above is not meant to replace a complete and thorough evaluation by a licensed Cognitive-Behavioral therapist or other qualified mental health professional. As with OCD, some individuals with Olfactory Reference Syndrome may benefit from medication, and may therefore require a psychiatric evaluation. Likewise, a psychiatric assessment may be necessary to differentiate between ORS and other psychological conditions. If a psychiatric evaluation is indicated, the OCD Center of Los Angeles can refer you to a qualified psychiatrist in our area. Furthermore, it is imperative to make the distinction between Olfactory Reference Syndrome and other medical conditions. For this reason, a medical examination may be a necessary part of ORS treatment.