Organoleptic reference syndrome (ORS)
In most cases, ORS is a delusional belief (complete conviction of emitting malodor).
In some cases, ORS has a non-delusional form (good insight, overvalued ideation).
In most cases, ORS patients are concerned about the social implication of emitting malodor (experiencing shame, embarrassment, and anxiety or avoiding social situations).
Social phobia is typically associated with an act (speaking, eating, writing, etc.) rather than body odors.
Obsessive compulsive disorder (OCD)
Most cases of ORS show excessive, repetitive compulsive behaviors that are aimed at checking or eliminating the perceived odor.
Only few cases of OCD are delusional, and ideas of reference (how the condition is perceived by others) are much less common.
Body dysmorphic disorder (BDD)
Core belief of a bodily defect that leads to social avoidance. Preoccupation and frequent seeking of medical (nonmental) treatment to alleviate the perceived problem.
The core beliefs, repetitive behaviors, and treatment responses may differ. Currently, limited to physical defects.
Preoccupation with the body, obsessional thinking, and repetitive behavior (seeking medical diagnosis and treatments).
Hypochondriasis is characterized by a core fear of having a serious disease.
Back to Halitophobia
Despite the many resembling features stated above, there is one key difference between body odors and breath odors. Unlike other bodily odors, a person cannot normally smell his own breath. This physiological fact, on the one hand, and the relatively large prevalence of breath odors might explain the high proportion of patients who express an exaggerated concern of having a breath odor problem (i.e., Halitophobia). In a study on social phobia conducted in 1997 in Canada on a population of 1,206 subjects [Stein M, unpublished data from a community survey (Stein et al. 2000)], 15.8% worried “a lot” about how their breath smelled, 2.8% had seen a professional about their breath, and 2.7% claimed that their breath concern interfered with their lives (e.g., socially, professionally).
Based on clinical experience and research, halitophobic patients often:
Present with a high degree of certainty and conviction that they suffer from bad breath. The descriptions of which are often exaggerated (e.g., very foul smell that can be sensed across the room).
Possess a lot of information on the subject of bad breath, often nonscientific in nature.
Have had frequent consultations with various medical specialists (e.g., dentists, ENT, gastroenterologists, etc.).
Practice a high degree of oral hygiene, often obsessively (although they often claim that it does not alleviate the odor).
Exhibits a high level of grooming and attention to external appearance.
Are sometimes secretive concerning their perceived problem, often confiding in no one over the course of years of distress. They may encounter difficulty in discussing the situation with anyone, including the professional at the consultation. They sometimes break down in tears at the initial consultation. They often bridle and express anger, disbelief, and disappointment when told that their complaint of bad breath has not been verified by the clinical examination.