Olfactory Reference Syndrome: Somatic Delusions

Photo Credit: Thomas Leuthard

Olfactory Reference syndrome (ORS) has been defined in the DSM-V (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) as a somatic delusion characterized by the intense belief that one is malodorous. These delusions often lead sufferers to believe others are being offended by the odor but will not verbalize this to them.

The disorder or “symptom” is so severe that the person may begin to exhibit anxiety and depression symptoms or even hallucinations.

This article will discuss ORS and include two short videos on two of the reasons for why somatic delusions occur.

While researching the topic of somatic delusions 2 years ago, while counseling a 60 year old client with similar symptoms, I learned that the disorder is very complicated because a person’s delusion may occur as a result of a neurological condition (i.e., a brain tumor) and not a psychiatric one. Somatic delusions can occur because of neurological anomalies and a lack of appropriate treatment (see video below). Sadly, most people believe that delusions automatically mean psychosis. The reality is that some delusions (and even hallucinations) occur for many reasons which may not be psychiatric.

Psychiatric Symptoms of ORS

However, in my case with the 60 year old client, it was strictly a psychiatric condition that met criteria for delusional disorder. My client’s mood was congruent with the delusion (i.e., the mood was low and dejected because of the delusion) but was not bizarre (i.e., unlikely to occur in the real world). Because of a long history of medical challenges and trauma, this woman became paranoid and delusional about her health and the care provided by healthcare professionals. After referring her to a psychiatrist who could better handle her symptoms and prescribe medication, it became clear to me that she also struggled with auditory and olfactory hallucinations after she confessed a voice had been telling her not to trust mental health professionals.

Sadly, ORS is one of the most complicating, emotionally charged, and psychologically draining conditions to live with and treat. Helping clients cope often includes a team approach with medication and stress management. Without proper medication management and counseling, ORS can also include hallucinations.

Hallucinations that complicate ORS include:

  • Hearing voice: Your doctor may call this an “auditory hallucination.”
  • Seeing things: This is also known as a “visual hallucination.”
  • Smelling  things: The technical name for this is “olfactory hallucination.”
  • Tasting things: These are called “gustatory hallucinations.”
  • Feel things: These are called tactile hallucinations.

Neurological symptoms of ORS

When someone is struggling with ORS and is having hallucinations, the clinical picture becomes more complicated. For example, consider a person who strongly believes that they smell like rotting fish (i.e., the delusion) and also believes  a voice (i.e., the hallucination) is telling them that they smell like rotting fish. This person, who perplexes family, friends, and maybe healthcare professionals, may begin to fully believe the “voice” and ignore what others are telling them. The auditory hallucinations can cause the person to believe the delusion even further. Sadly, medication may not help the person to fully recover. We cannot medicate a strong, firmly held belief. However, we can medicate hallucinations but strong medication will be needed including a consistent schedule of therapy sessions.

To learn more about neurological symptoms, see the video below: