Olfactory reference syndrome: what is it and what are its symptoms?

He Olfactory referral 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. In addition, based on different studies, we will explain in detail what this disorder consists of, what are some of the etiological hypotheses raised, its symptoms and, finally, the treatments used to fight it.

• Recommended article: "Delusions: what they are, types and differences with hallucinations"

Olfactory referral syndrome

Olfactory reference syndrome (ORS) consists of a hallucinatory psychiatric disorder. It is mainly characterized by a persistent concern about the smell, along with other symptoms such as embarrassment and anxiety. At a social level, it is accompanied by avoidance behaviors and social isolation.

This syndrome is a variety of delusional disorder, somatic type. The individual with Olfactory Reference Syndrome vehemently believes that he gives off a foul odor, and that others can detect said odor.

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

Due to the characteristics of the syndrome, most patients with Olfactory Reference Syndrome do not consult psychiatrists or psychologists, but rather another types of professionals, such as: dermatologists, dentists, dermatologists or even surgeons, due to their "obsession" with bad body odor that 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 fully recovered.

Demographics

The prevalence of ORS is higher among men than among women. Specifically, single men predominate. Regarding the age of onset, this ranges from the end of adolescence to 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 ORS cases from cases with similar symptoms, belonging to psychoses of the schizophrenic, affective or organic type.

Causes

As for the cause of Olfactory Reference Syndrome, it is actually unknown, as in many other psychiatric disorders. However, 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 displayed by these patients, similar to those displayed by people with Obsessive Compulsive Disorder (OCD).

Other causal hypotheses are in line with certain mismatches 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 these are neurobiologically based hypotheses, and there is none that has been shown to be a 100% 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 often involve some form of denigrating admonishment from others.

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

Symptoms

What symptoms accompany Olfactory Reference Syndrome? We are going to see 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 he gives off a bad smell.

However, there is controversy as to 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 such a preoccupation, or not.

Hallucination and/or delusion?

In relation to these controversies about the presence or absence of delusions and hallucinations, a recent review (2012) by the authors Begum and McKenna found that 22% of the patients with olfactory reference syndrome manifested an olfactory-type hallucination associated with concern about bad odor (vs. 75% of the original Pryse-Phillips list, which presented such a hallucination).

Regarding the presence or absence of delirium, in said review it is reflected that 52% of the patients had it; in the rest of the patients, however, the concern was based on an idea that oscillated between the overvalued idea and the obsessive idea.

2. feeling of shame

Another typical symptom of ORS is an intense feeling of shame with respect to others; Thus, the person suffers because she is convinced that she smells bad, and that, in addition, 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 the gestures and words of others in relation to oneself. That is to say, the patients believe that they speak ill of them and that they criticize them.

3. constant check

People with ORS spend a lot of their time checking their body odor, as they are "obsessed" with smelling more. They also manifest other compulsive behaviors in order to hide that they are in a place, or to hide their own smell.

4. Social isolation

The above symptoms end up causing the person to isolate themselves socially, which translates also in a social and work disability, and in great difficulties to carry out a life "normal".

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

Treatment

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

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

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

At the pharmacological level, antipsychotics and antidepressants are useds. 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.

Bibliographic references:

• Begum, M. and McKenna, P.J. (2011). Olfactory reference syndrome: a systematic review of the world literature. Psycho Med, 41:453-61.

• Bizamcer AN, Dubin WR, Hayburn B. (2008). Olfactory reference syndrome. Psychosomatics, 49:77-81.

• Cruzado, L., Cáceres-Taco, E. and Calizaya, J.R. (2012). About a case of olfactory referential syndrome. Clinical case. Actas Esp Psiquiatr, 40(4):234-8.

• McGoldrick T, Begum M, Brown KW. (2008). EMDR and Olfactory Reference Syndrome. A case series. Journal of EMDR, 2:63-8.

• Phillips KA, Gunderson C, Gruber U, Castle D. (2006). Delusions of body malodour; the olfactory reference syndrome. In: Brewer W, Castle D, Pantelis C, eds. Olfaction and the Brain. New York: Cambridge University Press, 334-53.