Olfactory reference syndrome

[Sommer]

In olfactory reference syndrome, people are preoccupied with the belief that they give off an unpleasant, foul-smelling, or offensive body odor when in fact they do not.
People with olfactory reference disorder believe that they have an offensive body odor even though they do not. This belief causes them significant distress and usually makes them less able to function—for example, by preventing them from going out in public. Olfactory reference syndrome is similar to obsessive-compulsive disorders.
Usually, people with olfactory reference syndrome repeatedly do certain things, such as showering excessively, brushing their teeth, or smelling themselves, in response to this preoccupation. These people often use perfume or deodorant to try to cover up the odor that they think they have. They may also think that others are sitting far away, covering their noses, or taking special notice of them in a negative way because of the perceived odor.
Treatment with a selective serotonin reuptake inhibitor or clomipramine (types of antidepressant) may help. An antidepressant may be used alone or with one of these drugs.
Cognitive-behavioral therapy similar to that used for body dysmorphic disorder may be helpful.

[Hina Muqadas]

Olfactory reference syndrome is an example of other specified obsessive-compulsive and related disorder, as listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) .
Patients with olfactory reference syndrome are preoccupied with a distressing or impairing belief that they emit a foul or offensive body odor, which is not perceived by others. The preoccupation is usually accompanied by repetitive behaviors (eg, smelling themselves, excessive showering) and efforts to camouflage the perceived odor (eg, with perfume or deodorant). Insight is usually poor or absent.
Referential thinking is common; for example, patients may inaccurately believe that their body odor is the reason people are sitting far away or covering their nose. Olfactory reference syndrome usually substantially impairs functioning, and patients typically avoid social situations.
Because insight is usually poor or absent, many patients seek treatment (eg, tonsillectomy for perceived halitosis) from physicians other than psychiatrists, which does not appear to be helpful.
Treatment studies of olfactory reference syndrome have not been done, but clinical experience and published case series suggest that SSRIs or clomipramine , alone or used with an antipsychotic, and cognitive-behavioral therapy similar to therapy for body dysmorphic disorder may be helpful.