Olfactory Reference Syndrome: What is it and What Are Its Symptoms?

He Olfactory reference syndrome It is a psychiatric disorder, characterized mainly because the person who suffers from it is vehemently convinced that they give off a bad body odor. But are there hallucinations in such a disorder? And delusions?

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

Olfactory reference syndrome

The Olfactory Reference Syndrome (ORS) consists of a hallucinatory psychiatric disorder It is mainly characterized by a persistent worry about smell, along with other symptoms such as shame and distress. At a social level, it is accompanied by avoidance behaviors and social isolation.

This syndrome is a variety of delusional disorder, of a somatic type. The individual with Olfactory Reference Syndrome strongly believes that he or she gives off a foul odor, and that others can notice this odor.

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

Due to the characteristics of the syndrome, the majority of patients with Olfactory Reference Syndrome do not consult psychiatrists or psychologists, but rather other types of professionals, such as: dermatologists, dentists, dermatologists or even surgeons, due to their “obsession” with the disease. body odor they give off.

Forecast

The prognosis of Olfactory Reference Syndrome had always been considered unfavorable; However, a 2012 review by authors Begum and McKenna showed that two-thirds of patients (out of a sample of 84) partially improved or completely recovered.

Demographics

The prevalence of ORS is higher among men than among women. Specifically, single men predominate. Regarding the age of onset, this ranges between the end of adolescence and the beginning of adulthood.

Origin

Regarding 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 type psychoses.

Causes

As for the cause of Olfactory Reference Syndrome, it is actually unknown, as in many other psychiatric disorders. However, Yes, there are some etiological hypotheses, which refer to certain serotonergic and dopaminergic dysfunctions in the brain of people with ORS

These dysfunctions are related to the repetitive cleaning and checking behaviors that these patients show, similar to those shown by people with Obsessive Compulsive Disorder (OCD).

Other causal hypotheses are in line with certain imbalances in some regulatory genes, such as Hoxb8 and SAPAP3 (related to the limbic lobe and basal ganglia).

On the other hand, there are also cases of people with Olfactory Reference Syndrome who have suffered some type of brain injury, as well as temporal lobe epilepsy. However, all of these are hypotheses based on neurobiological bases, and there is none that has been proven to be 100% the cause of ORS.

Social and psychological factors

Regarding the more psychological and social causes, in half of the cases of ORS there is a precipitating event just before the onset of the symptoms of the disorder. Such events usually involve some type of denigrating reprimand from others.

Stress can also be at the basis of this disorder, as well as an obsessive, distrustful and paranoid personality (and in extreme cases, an obsessive personality disorder or a paranoid personality disorder).

Symptoms

What symptoms accompany Olfactory Reference Syndrome? Let’s look at the 4 main symptoms, in addition to the suffering inherent to the disorder

1. Concern about body odor

The main symptom of Olfactory Reference Syndrome is a significant concern regarding body odor; That is, the person vehemently believes that it gives off a bad smell.

However, there is controversy regarding whether this concern is delusional in all cases of the Syndrome or not. It is also not clear whether there is always a hallucination associated with said worry or not.

Hallucination and/or delirium?

In relation to these controversies about the presence or not of delirium and hallucination, a recent review (2012) by authors Begum and McKenna found that 22% of patients with Olfactory Reference Syndrome manifested an olfactory hallucination associated with concern about bad smell (vs. 75% of the original Pryse-Phillips list, who had this hallucination).

Regarding the presence or not of delirium, this review reflects how 52% of the patients had it; In the rest of the patients, however, the worry was based on an idea that oscillated between an overvalued idea and an obsessive idea.

2. Feeling of shame

Another symptom of ORS is an intense feeling of shame towards others; Thus, the person suffers because he is convinced that he smells bad, and that others notice it. That is why she feels deeply ashamed, and has a hard time.

On the other hand, according to studies, more than 75% of patients with Olfactory Reference Syndrome interpret other people’s gestures and words in relation to themselves. That is, patients believe that they are being talked down to and criticized.

3. Constant checking

People who suffer from ORS spend a lot of their time checking their body odor, since they are “obsessed” with whether they smell more. They also manifest other compulsive behaviors in order to hide the fact that they are in a place, or to hide their own smell.

4. Social isolation

The above symptoms end up causing the person to become socially isolated, which also translates into social and work disability, and great difficulties in leading a “normal” life.

In fact, of the original list of cases drawn up by Pryse-Phillips, only 3% of those affected by Olfactory Reference Syndrome led an active social life.

Treatment

Regarding the treatment of Olfactory Reference Syndrome, we find, broadly speaking, two types of treatment: psychological and pharmacological.

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

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

At a pharmacological level, antipsychotics and antidepressants are used s. For its part, a study reveals that 33% of patients with Olfactory Reference Syndrome treated with antipsychotics had obtained very positive results; The same occurred with 55% of patients treated with antidepressants.