A Debilitating Olfactory Phobia

It may be the most common syndrome you never heard of. Sufferers of a disabling psychiatric condition called Olfactory Reference Syndrome (ORS) are convinced that they emit horrible smells and, as a result, often isolate themselves or even attempt suicide.

“These patients suffer tremendously,” says Dr. Katharine Phillips, a professor of psychiatry and human behavior at Rhode Island Hospital and Brown University in Providence. “They are preoccupied with the belief that they are emitting a foul or offensive body odor which is not perceived by others.” Although the syndrome has been known around the world for more than a century, Dr. Phillips says that ORS is surprisingly minimally studied. “It’s not a well-known disorder.”

Dr. Phillips and her colleagues initiated a study to analyze the features of Olfactory Reference Syndrome in twenty patients at Rhode Island Hospital, and discovered that they spent an average of 3-8 hours per day preoccupied with their belief that they smelled bad. Eighty-five percent of them were fully convinced that they emitted a foul odor, although in reality they did not. Nearly seventy-five percent held an overblown view of the notice others took of them, misinterpreting such unrelated acts as another person scratching his nose or opening a window as evidence of their offensive odor. Many also engaged in repetitive activities, such as depleting an entire bar of soap in a single day.

The syndrome left many people feeling isolated, with three-quarters reporting that they avoided social interactions because of their “smell” and forty percent reporting having been housebound for at least a week. More than two-thirds had contemplated suicide, one-third had attempted suicide and more than half had been hospitalized for psychiatric reasons. Many also had major depressive disorder and social phobia.

Cultural standards likely played a significant role in the development of the disorder, according to Dr. Bryan Page, chairman of anthropology and a professor of psychiatry at the University of Miami Miller School of Medicine. In the United States, where people tend to be very concerned with cleanliness, Miller believes the phobia may be more prevalent.

The American Psychiatric Association is currently considering whether the syndrome deserves to be defined as its own official disorder.