Your BO Might Be Linked to a Mental Health Issue
Most people assume body odor (BO) comes down to sweat, hygiene, or a garlic-heavy dinner. That’s usually true. Plenty of things can make a person smell a little off. It could be exercise, stress, food, infections, or hormone shifts. In some cases, however, the problem isn’t physical at all. It’s mental.
Body odor anxiety could be a sign of Olfactory Reference Syndrome (ORS), a little-known mental health condition that makes people believe they smell bad when they don’t. While everyone deals with sweat and odor now and then, this disorder goes way beyond regular BO worries. No one else smells anything, but the belief that they do can take over someone’s life.
Olfactory Reference Syndrome (ORS)
Image via Unsplash/kjpargeter
ORS is considered a psychiatric condition and has a lot in common with obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD). People with it feel convinced they’re giving off a strong, offensive smell, often from their breath, armpits, or genitals.
Some say they actually smell the odor themselves. Some don’t smell anything, but are certain others do. If someone sniffs, coughs, or opens a window, it fuels the belief that the stench is real by acting as proof. The actions might be innocent, but in the mind of someone with ORS, they feel targeted.
Now, plenty of people have fleeting worries about smelling bad. ORS is different. People can spend hours each day obsessing over it. They may shower five times a day, scrub their skin raw, switch outfits constantly, chew gum until their jaw aches, or avoid going out at all. They might stop dating and working, and probably avoid seeing friends.
The International OCD Foundation describes it as an underrecognized disorder that causes serious distress and often goes undiagnosed. One study found that over two-thirds of people with ORS have experienced suicidal thoughts. Around a third have attempted suicide. Clearly, bad breath is not the real culprit. It indicates a mental health crisis.
Here’s where things get messy. Because the symptoms seem physical, people usually start with physical solutions. They go to dentists, dermatologists, gastroenterologists, and even surgeons. Some have their tonsils or sweat glands removed. In these cases, nothing changes, since the smell was never there to begin with.
ORS often manifests in adolescence or young adulthood, but it can affect anyone. It’s hard to pin down its prevalence because people are reluctant to talk about it. The fear of being perceived as “gross” runs deep. Some try to manage the anxiety on their own, which also doesn’t tend to work.
Signs You Might Be Dealing With ORS, Not Actual BO
Common compulsive behaviors with ORS include:
- Constantly sniffing yourself
- Showering multiple times a day
- Switching clothes frequently
- Overusing perfume, mouthwash, gum, or deodorant
- Asking people if you smell bad
- Avoiding public places out of fear that you stink
People with ORS also often have low self-esteem, high social anxiety, and symptoms of depression.
Some people with ORS genuinely smell something foul. These are called olfactory hallucinations. Instead of coming from the environment or other people, the smell is created by the brain. This can happen in ORS, but also in certain neurological conditions like temporal lobe epilepsy or migraines. That’s why medical evaluation is still important to rule out other issues. In ORS, the difference is that the person believes the odor comes from their own body, and there’s no evidence that it exists.
Common compulsive behaviors include smelling oneself (80 percent), repeated tooth brushing (40 percent), over-washing clothes, and comparing one’s body odor to others. Many use perfume, mouthwash, deodorant, or mints in heavy amounts. Almost half restrict what they eat in hopes that a cleaner diet will make the imaginary odor disappear.
Mental health professionals often use medications like SSRIs alongside cognitive behavioral therapy (CBT). These help reduce the obsessive thoughts and the need for constant rituals. Some doctors also recommend combining antidepressants with antipsychotic medication when delusional beliefs are stronger. That combination has shown promise, even in tough cases.
CBT is especially helpful for rewiring the distorted thought patterns. For example, instead of interpreting a person’s sneeze as disgust, CBT helps someone see it as a coincidence. Instead of checking their body repeatedly, they learn to sit with the discomfort.
Of course, not all body odor issues are mental. Sometimes, you actually do smell. Hormones, infections, diet, diabetes, medications, stress, and even supplements can shift how someone smells. So can poor hygiene or medical conditions like hyperhidrosis or kidney problems. That’s why people should still talk to their doctor if something smells off. But if tests keep coming back normal, and the fear doesn’t fade, it might be time to consider something else.
Why This Matters
Body odor is weirdly personal. It’s tied to identity, confidence, and how we imagine others see us. ORS grabs onto those insecurities and warps them. It tells people they’re repulsive and that no one wants them around. And that’s where the real harm lives—not in sweat or bacteria, but in isolation, fear, and false beliefs that go untreated.