Anxiety and Phantom Smells: What’s Behind It

Smelling something, smoke, chemicals, something burning, that no one else notices and that has no source is a disorienting experience. This is called phantosmia, or a phantom smell, and while anxiety is one recognized factor, it’s important to know that phantom smells have several possible causes, some of which need a medical evaluation to rule out.

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Why Anxiety Can Be a Factor

Anxiety and panic can affect sensory processing, and some people experience heightened or distorted sensory perception, including smell, during periods of high anxiety or a panic attack. This is thought to relate to how anxiety affects attention and the brain’s processing of sensory input, sometimes amplifying or misinterpreting normal background signals as a distinct smell. The brain’s threat-detection system, when highly activated, can also become more sensitive to subtle environmental cues in general, including scent, which may contribute to this experience.

Other Possible Causes Worth Ruling Out First

Because phantom smells can have several origins, a medical evaluation is an important first step, not something to skip in favor of assuming it’s anxiety. Other recognized causes include:

• Sinus or nasal issues, including infections, polyps, or chronic sinus inflammation
• Migraines, where phantom smells can occur as part of an aura, before or during a headache
• Certain neurological conditions, since the smell centers of the brain can occasionally produce phantom sensations independent of any external trigger
• Head injury, which can affect the olfactory nerve or the brain’s smell-processing regions
• Some medications, which can affect smell perception as a side effect
• COVID-19 and other viral illnesses, which have been documented to cause lingering smell distortions, including phantom smells, in some people

An ENT (ear, nose, and throat) doctor or neurologist is typically the right first stop to rule these out, especially if the phantom smell is persistent, one-sided, or comes with other symptoms like headache or visual changes.

When Anxiety Is the Likely Explanation

Once medical causes have been ruled out, a few patterns suggest anxiety is the more likely driver: the phantom smell shows up specifically during anxious or panicked moments, it’s inconsistent rather than a single fixed smell every time, and it resolves as the anxiety episode passes rather than being constant. A smell that’s always the exact same, or that’s constantly present regardless of mood or stress level, points more toward a medical or neurological cause and deserves that evaluation specifically.

What Helps

If anxiety is confirmed as the driver after medical causes are ruled out, treating the anxiety directly, through therapy and, when appropriate, medication, is what addresses the phantom smell, since it’s a downstream effect of the anxious state rather than an independent problem to treat on its own. Grounding techniques that help regulate the nervous system during anxious moments may also reduce how often the sensation occurs.

Getting the Right Evaluation

Because phantom smells can point to several different underlying causes, some medical and some psychiatric, getting a proper evaluation from both a medical provider and, if needed, a psychiatric one is the most reliable way to understand what’s actually happening and get the right treatment, rather than assuming either cause without ruling out the other.