Convinced You Smell When Others Can't?Olfactory Reference Syndrome

Most people check themselves now and then. For some, the worry hardens into a fixed belief that they give off a bad smell, even though others can’t detect it.¹ Doctors call this olfactory reference syndrome (ORS).

A recognized condition

The current international disease classification, ICD-11, lists ORS as its own diagnosis among the obsessive-compulsive and related conditions.¹ How common it is isn’t known, but an expert in the field writes that it’s more common than generally recognized.¹

What it looks like

The best-described group is 20 patients assessed in a US study; 60% were women and the average age was 33.²

Feature	Share of patients
Worry focused on the mouth	75%2
Worry focused on the armpits	60%2
Worry focused on the genitals	35%2
At least one repetitive behavior, like extra showering	95%2
Housebound for a week or more	40%2

The most common behaviors are sniffing yourself, showering over and over and changing clothes often.¹

Treatments for the smell didn’t help

In that group, 44% had sought medical, surgical or dental treatment for the odor, and a third got it. It didn’t work for any of them.² People may see dentists and ear, nose and throat specialists about breath they believe is bad.¹ A procedure can reduce sweat, but it can’t reach a belief.

Can people with ORS smell it?

The studies disagree. In the 20-patient group, 85% said they actually smelled the odor.² A review of 84 published cases found most couldn’t smell it, or only now and then.³ Either way, others don’t detect it.¹

Treatment and outlook

There are no controlled trials.¹ The evidence comes from case reports and small series:

• In the 84-case review, over two-thirds improved or recovered, more often with antidepressants and talking therapy than with antipsychotic medicines.³
• Case reports describe improvement with cognitive behavioral therapy and other behavioral approaches.¹

Where the line falls

Only a clinician can decide whether worry has become a condition. Signs worth taking seriously:

• Showering or changing clothes many times a day
• Avoiding work, friends or dates because of a smell
• Reading ordinary gestures, like someone opening a window, as proof
• Buying treatment after treatment without relief

In the 20-patient group, 68% had had suicidal thoughts.² If thoughts of harming yourself come with the worry, call or text 988 in the US, or your local emergency number.

For the breath version, see bad breath others can’t smell. For why your own nose is unreliable, see can you smell your own body odor?

Try: “I’m convinced I smell, even though people tell me I don’t. I shower four or five times a day and I’ve stopped going to the gym. Could this be anxiety, and who can help?”

Arms Up covers this in Chapter 10, “Hot Under Pressure,” in a section called “When the Worry Takes Over.” It suggests describing what the worry makes you do, how many showers and changes of clothes and the places you’ve stopped going, since those are what a clinician needs to hear. See the book.