This stinks!
Some people frequently worry about body odor, even when they smell perfectly fine.
Sometimes it gets so bad that they perceive other people’s gestures — such as sniffing, touching their nose or opening a window — as confirmation that they stink. Even worse, they may miss work, skip a fun event or socially withdraw because of it.
Olfactory reference syndrome (ORS) is a little-known psychiatric condition where patients are preoccupied with the unfounded belief that they emit terrible body odor, causing them anxiety, embarrassment and severe distress.
People with ORS may engage in excessive hygiene practices to dispel the imaginary odor and — when the belief that they smell persists — recede into avoidant behavior.
Luckily, new research provides hope for treatment. Université de Montréal Ph.D. candidate Morganne Masse published a paper in the fall describing two cases of the condition.
The first patient was a 63-year-old man who struggled with ORS since 20 — when symptoms typically appear. He claimed to have a nauseating odor and an unpleasant sensation in his mouth.
He was still able to maintain romantic relationships and a social life, but avoided public transit and events.
The second patient — a 53-year-old man — had a much more severe case, one that led him to completely socially withdraw and left him unable to hold a job. He also experienced hallucinations and thoughts of suicide.
He believed a poop smell emanated from his mouth and rectum.
Masse recently noted that one of the challenges of ORS is that it’s difficult to diagnose when the patient is convinced the body odor is real.
“People with ORS have often gone from doctor to doctor before being referred to psychiatry,” Masse said last week. “They will consult numerous specialists — dentists, dermatologists — to try to eliminate the odors they believe they emit.”
She pointed out that the two patients in her study “spent years seeing various doctors and trying drug therapies before receiving an accurate diagnosis.”
It’s unclear how many people have ORS. Addressing it typically involves a combination of psychotherapy and medication.
Cognitive-behavioral therapy (CBT) has been effective in helping individuals challenge and reframe their distorted beliefs about body odor. Additionally, certain antidepressants have shown promise in reducing the obsessive concerns associated with ORS.
“CBT has been shown to reduce dysfunctional thoughts and anxiety, while antidepressants are also recommended, often in combination with CBT,” Masse said.
“Another approach is to address the delusional component of ORS similarly to the way we treat the positive symptoms of psychosis. Isolated case studies suggest the efficacy of combining antidepressants and antipsychotics, although the latter are generally less effective.”
