OCD Center Los Angeles 10921 Wilshire Blvd. #502 Los Angeles, CA 90024 (310)335-5443
     
 

Specializing in the Treatment of OCD, Olfactory Reference Syndrome, and Related Conditions

  
     
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Olfactory Reference Syndrome - Symptoms and Treatment
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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 may involve 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 initial treatment for Olfactory Reference Syndrome includes a type of Cognitive Therapy called Olfactory Reference Syndrome"Cognitive Restructuring". After the client has attained some gains with this approach, he or she graduates to using a variant of the Exposure and Response Prevention (ERP) techniques used in treating OCD. To learn more about Cognitive-Behavioral Therapy for the treatment of Panic Disorder, click here.


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, sometimes called "imaginal exposure," involves using short stories based on the client's olfactory obsessions. These stories are audiotaped and 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, this type of 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.


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 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.


We also offer four, age-specific, therapy/support groups for children and adolescents with OCD, Olfactory Reference Syndrome, and related anxiety conditions. These groups are held monthly, and are limited to six participants. To learn more about our therapy/support groups for children and adolescents with OCD, Olfactory Reference Syndrome, and related conditions, click here.


If you are experiencing any of the above Olfactory Reference Syndrome symptoms, and would like to discuss individual or group therapy for the treatment of ORS at the OCD Center of Los Angeles, you can call us at (310) 335-5443, or click here to email us. If you live outside Southern California, we recommend that you contact a licensed Cognitive-Behavioral therapist in your local area.

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The Body Dysmorphic Disorder (BDD) Clinic at Massachusetts General Hospital is currently conducting an online survey on Olfactory Reference Syndrome. This brief survey is conducted online and requires approxinmately 30-45 minutes to complete. If you are excessively worried about your body odor, and would like to participate in this study, please click here.


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 necessary.
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