Olfactory Reference Syndrome

You know who you are. You exhibit a subtle double-take when someone turns away from you when you walk by; then you put your hand to your mouth when you think no one is looking to see if your breath smells.

But do you know if you have Olfactory Reference Syndrome?

You lean forward in your chair at Starbucks while reading "Psychology Today," and with as much subtlety as your cleverness allows, you slip your right hand into your left armpit. Not long after, with what you remain convinced is continued subtlety, you bring that latte up towards your face. However, instead of taking a drink, the coffee becomes a nuisance as you bring the fingers holding the coffee cup to your nose. You are sniffing for the degree of odor of your armpits this morning.

But do you know if you have Olfactory Reference Syndrome?

Olfactory Reference Syndrome (ORS) is a condition in which those affected have an excessive preoccupation with the concern that body odor may be foul or, on a good day, unpleasant. One can imagine the accompanying feelings of shame and embarrassment, avoidant behavior, and perhaps social isolation. Many thought leaders in the world of Psychology consider ORS a type of Body Dysmorphic Disorder, tangled up with resultant obsessive and compulsive rituals such as repeatedly locking oneself in a restroom stall in the course of a work day to investigate odors that society's norms dictate are best investigated in private.

Some compulsive behaviors seen in individuals with ORS:
• Repetitive showering and other ritualistic grooming behaviors.
• Excessive use of deodorants, mouthwash, breath mints, and various perfumed products.
• Repeated investigations of the source of the presumed foul odor.
• Asking loved ones how severe the odor is.
• Avoiding social and intimate situations due to embarrassment.
• Frequent utilization of the health care system in the quest to ameliorate the odor.
• Excessive wardrobe changes.

All of these behaviors add stress to those who have ORS, and often those who have regular contact with them. Unfortunately, stress can result in biochemical changes in the body that actually produce real odor.

Bacterial vaginosis is a condition that is characterized by an alteration in the normal vaginal flora, resulting in high concentrations of bacteria that cause characteristic odors. A potential factor that influences the susceptibility to such infection is the degree of stress experienced by an individual.

Exposure to chronic stress may impair immune functioning, and has been found to be associated with multiple indicators of decreased immune functioning, including increased incidences of the common cold, and progression of HIV. A study published a few years back in the "American Journal of Obstetrics and Gynecology" set out to discover whether stress also plays a role in the onset of bacterial vaginosis.

Participants in this study underwent pelvic examinations with assessment of clinical symptoms. In addition, they completed self-report forms which asked questions about hygiene practices, sexual behaviors and demographic characteristics. Perceived psychosocial stress was assessed with a Perceived Stress Scale.

Interestingly, the researchers showed that stress plays a significant role in the degree and the occurrence of bacterial vaginosis, independent of behavior and demographic characteristics. It appears, therefore, that the effect of stress on bacterial vaginosis may be mediated by stress-related changes in the immune system, as opposed to changes in behavior as the result of stress.

Imagine this vicious circle of perceived and conceived vaginal odor, further tightening its grip on the psychosocial well-being of the afflicted.

Given that there is not a lot of data on the epidemiology of ORS, it is not surprising that treatment options have not been studied in robust clinical trials. Anecdotes about the effectiveness of cognitive behavioral therapy and anti-depressant therapy can be found in the literature.

And the next time that co-worker smells his ear wax, well, maybe its time to rearrange the cubicles.