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.
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