Olfactory reference syndrome: demographic and clinical features of imagined body odor

Gen Hosp Psychiatry. Jul-Aug 2011;33(4):398-406. doi: 10.1016/j.genhosppsych.2011.04.004. Epub 2011 May 26.


Objective: Olfactory reference syndrome (ORS) - preoccupation with a false belief that one emits a foul or offensive body odor - has been described around the world for more than a century. However, only a few small studies have systematically assessed ORS's clinical features.

Method: Twenty patients with ORS were systematically assessed using semistructured measures.

Results: Subjects' mean age was 33.4±14.1; 60% were female. Preoccupation most often focused on the mouth (75%), armpits (60%) and genitals (35%). Bad breath (75%) and sweat (65%) were the most common odor descriptions. Currently, 85% of subjects had delusional ORS beliefs, 77% had referential thinking and 85% reported actually smelling the odor. Ninety-five percent of subjects reported performing one or more ORS-related repetitive behaviors (e.g., excessive showering). Forty percent had been housebound for at least 1 week because of ORS symptoms, 68% had a history of suicidal ideation, 32% had attempted suicide and 53% had been psychiatrically hospitalized. Forty-four percent of subjects had sought nonpsychiatric medical, surgical or dental treatment for the perceived odor, and one third had received such treatment, which was ineffective in all cases.

Conclusion: ORS appears to be characterized by high morbidity and seeking of nonpsychiatric treatment.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Human Body*
  • Humans
  • Male
  • Middle Aged
  • Odorants*
  • Patient Acceptance of Health Care
  • Phobic Disorders / diagnosis
  • Phobic Disorders / physiopathology*
  • Syndrome
  • Young Adult