Olfactory Reference Syndrome Characteristics and Treatment

Similar but not identical to bromidrophobia, or the fear of body odor, and the Japanese Jiko-shu-kyofu, olfactory reference syndrome refers to a preoccupation with one's own natural scents. The differences between the three disorders are subtle and often confusing.

What Is Olfactory Reference Syndrome?

If you have olfactory reference syndrome, you are constantly afraid of emitting a foul odor. Olfactory reference syndrome generally focuses on one of a few specific obsessions, although some people have more than one obsession simultaneously. Your particular obsession may also change over time.

• Bad breath
• Vaginal scent
• Anal odor
• Armpit smell
• Overall foul bodily stench
• Chemical aroma
• Belief that others are reacting to your scent

Although everyone reacts slightly differently, most people with olfactory reference syndrome experience at least some of the following symptoms:

• Repetitive showering and other hygiene behaviors
• Over-use of grooming products
• Repeated checking behaviors
• Asking friends or relatives about the seriousness of the odor
• Avoiding social situations due to a fear of emitting an odor
• Missing work or school because of the fear
• Suicidal ideation

Olfactory Reference Syndrome vs. Bromidrophobia

Compulsive grooming rituals are common in both disorders. The main difference is that people with bromidrophobia do not tend to develop a particular obsession. In bromidrophobia, the fear is more generalized, while in olfactory reference syndrome, it is more specific. Additionally, some people with bromidrophobia fear body odors in others as well as themselves.

Olfactory Reference Syndrome vs. Jiko-shu-kyofu

Olfactory reference syndrome currently appears in DSM-5 under “Other Specified Obsessive Compulsive Disorders” as Jikoshu-kyofu, a subset of the culturally-bound Japanese form of social phobia, taijin kyofusho. It translates as "fear of body odor." The primary difference is cultural. While Western culture is primarily concerned with individual needs, Japanese culture is geared toward the needs of the group.

Both bromidrophobia and olfactory reference syndrome focus on the embarrassment that body odors bring to the person who has them. Jiko-shu-kyofu focuses on the embarrassment that others would feel in the presence of someone with an offensive odor.

Medical Conditions

Phobias and other psychological disorders are never diagnosed when a medical condition causes the symptoms. Additionally, a fear is considered rational and appropriate when it is in proportion to the situation. Some medical conditions cause pronounced bodily odors, including halitosis and bacterial vaginosis.

It is important to get a full medical workup before making a definitive diagnosis of olfactory reference syndrome, bromidrophobia or jiko-shu-kyofu.

Link to Obsessive-Compulsive Disorder

Olfactory reference syndrome is heavily linked to OCD, and many clinicians feel that it should be considered an OCD subtype. Some also conceptualize this syndrome as related to body dysmorphic disorder. As in all forms of OCD, obsessive thoughts and compulsive behaviors tend to create self-replicating loops. The harder you try to avoid the source of your anxiety, the more you tend to dwell on it, creating a cycle that is tough to break.

Treatments

Like other forms of OCD, olfactory reference syndrome generally responds well to a variety of brief therapy techniques including cognitive-behavioral therapy. Replacing your fearful thoughts with more positive ones and intentionally changing your repetitive behaviors can break the cycle of obsession. Olfactory reference syndrome is often life-limiting, but with hard work and professional guidance, there is no need to continue to suffer.