Do you ever notice a strong cigarette odor without seeing anyone around you actively smoking? You may be experiencing phantosmia, or olfactory hallucinations, a condition that causes you to detect smells that aren’t actually present.
For most people, olfactory hallucinations bring up unpleasant smells like burning rubber, garbage, chemicals, and cigarette smoke—not exactly things you want to get a whiff of. There are a few underlying causes, and once you figure out what’s really going on, you can learn how to treat it.
What is phantosmia?
Phantosmia is a condition that causes you to notice smells that don’t actually exist in your environment. Often, the term is used interchangeably with “olfactory hallucinations.” Depending on the frequency and intensity, the condition can lead to a lot of distress. Phantosmia, which can occur in one or both nostrils, is just one of many smell disorders that fall under the umbrella of dysosmia, or disordered smell perception. Phantosmia can go away on its own or require treatment, and much of what determines that has to do with underlying causes.
What causes phantosmia?
Phantosmia can be the result of a number of physical causes, and many of them aren’t reason for alarm and will go away on their own. However, sometimes experiencing phantom smells like cigarette smoke is an indicator of a more serious health condition. Here are some of the possible explanations:
- Common illnesses: These include allergies, Covid-19, sinus infections, colds, and other respiratory infections. Phantom smells are also a rare type of migraine aura.
- Exposure to certain substances: Things like new fabrics or detergents, or even dirty air vents, can lead to olfactory hallucinations. Likewise, if you smoke cigarettes regularly, you may also experience the phenomenon.
- Brain issues: While they’re less common causes, brain tumor and stroke could lead to phantosmia. (If you think something neurological could explain your symptoms, it’s important to contact a medical provider as soon as possible.)
- Certain medications: Insulin or cholesterol-lowering drugs have led some patients taking them to report phantom smells.
- Parkinson’s and Alzheimer’s: Some patients with these conditions report a level of “olfactory dysfunction”—aka problems with smell.
- Mental health disorders: Phantom smells could affect some people with obsessive-compulsive disorder (OCD). Likewise, schizophrenia could also cause what are called “smell hallucinations.”
It’s important to point out that olfactory hallucinations can also be what scientists call idiopathic—which means the exact cause isn’t known. If you are smelling cigarette smoke or other odors in your environment without the source being present, it doesn’t necessarily mean you have one of the conditions above.
Think a mental health issue could be the cause of your symptoms? We can help. Book a free call.
How common is phantosmia?
Smell disorders affect 19% of the population over the age of 20 and 25% of the population over 53, according to Harvard Health. But that accounts for smell disorders more broadly—so the percentage of phantosmia cases is notably smaller. A separate study found that among all olfactory issues, phantosmia accounts for 10% to 20% of cases.
That said, the prevalence of phantosmia is relatively unknown because many people never seek treatment, or are treated for the underlying cause of the disorder without reporting phantosmia as a symptom. It’s important to note that people who detect smells that aren’t in your environment from time to time are not considered to be phantosmia sufferers.
How some illnesses mess with your sense of smell
Disruption to the nasal passages can lead to thinking you smell something that’s not actually there — but how does it happen? Here’s a quick science lesson: The ability to smell comes from what’s called olfactory sensory neurons, which are located high inside of the nose. Those neurons communicate directly with the brain. If there are disruptions to these neurons or the part of the brain that receives the signal (the temporal lobe), phantosmia may occur. That’s why colds and allergies, which clog the nose, are known to cause olfactory hallucinations. In less common cases, brain trauma or tumors put pressure on the temporal lobe and also cause phantosmia.
What are the symptoms of phantosmia?
As discussed above, phantosmia is primarily characterized by noticing smells in your environment when the perceived source isn’t present. But you may notice other symptoms, which will be determined by your underlying cause. Here are some examples:
- Those who experience phantosmia because of a respiratory infection may have accompanying cold symptoms like a stuffy nose or fever that are related to the illness.
- If your olfactory hallucinations are the result of head trauma or migraines, you may experience severe headaches.
- For those who experience phantosmia due to OCD, two key symptoms of the disorder will also be present. People with OCD have unwanted or intrusive thoughts, ideas, urges, feelings and/or sensations that recur, also known as “obsessions.” And to deal with the discomfort brought on by the obsession, they engage in repetitive actions or mental rituals, aka “compulsions.”
How does OCD lead to thinking you smell cigarette smoke when there is none?
OCD is an incredibly convincing disorder, which can cause intrusive thoughts and sensations—including the sensation of smell—to feel very real.
Let’s take one illustrative example: Someone may have an OCD obsession revolving around the fear of fire or fear of being burned. April Kilduff, MA, LCPC, LMHC, an OCD expert, explains: “Their intrusive thoughts might involve their home or belongings going up in flames because of improperly discarded cigarettes. In this case, their fear might be accompanied by the sensation of the smell of cigarettes,” explain
For people with OCD, these intrusive sensations can significantly interfere with daily functioning, making it hard to focus on tasks or engage in normal daily activities. That’s why specialized treatment for OCD is so critical.
Get your life back from OCD
How is phantosmia diagnosed?
First, a medical provider will need to evaluate you, examining your nose and ears, and asking about when you notice cigarette smoke when there is none, as well as your other symptoms. They’ll rule out or confirm illnesses or other medical conditions—like sinus infections or head trauma—that might be causing the phantosmia.
If no physical cause is detected, your doctor may recommend you see a therapist who can determine whether your olfactory hallucinations are the result of OCD or another mental health condition.
Are there any natural remedies for phantosmia?
For cases where the phantosmia is caused by a blockage to the nasal passages, nasal cleanses or medications that clear your sinuses may help. That includes nasal irrigation, saline solution, or over-the-counter nasal sprays that contain oxymetazoline and are meant to reduce congestion.
People that experience olfactory hallucinations from neurological conditions or mental health disorders should seek professional treatment, as home remedies can’t resolve the underlying cause.
Professional treatment for phantosmia
Professional treatment is needed for phantosmia when the smell hallucinations are repetitive, uncomfortable, and impact daily living. Treatment is also needed when the cause of the phantosmia is related to a more serious neurological disorder or mental health condition like OCD.
That said, professional treatment for phantosmia varies depending on the underlying cause. For instance, antimigraine medication can help if migraines are the culprit. While antipsychotic medications may be used to treat schizophrenia.
When phantosmia is a symptom of OCD, exposure and response prevention (ERP) is the gold standard of treatment. Unlike traditional talk therapy, which can backfire and make OCD worse, ERP—which was developed specifically to treat OCD—is clinically proven to be effective in the majority of people.
ERP works by gradually exposing you to what triggers your fears, and teaching you new ways to respond that don’t involve compulsions.
What does that look like in practice? If you have a fear of fire or being burned, one “exposure” you do you might be to watch a short video animation of a house catching fire. Over time, as you learn to sit with uncomfortable feelings without engaging in compulsions, the intrusive thoughts and sensations—like that smell of cigarette smoke that you perceive—start to lose their power over you.
Bottom line: If you suspect you are smelling odors that are not there, talk with your healthcare provider. No matter what the cause, help is available—and can significantly improve your quality of life.