Olfactory reference syndrome: demographic and clinical features of imagined body odor

ObjectiveOlfactory reference syndrome (ORS) — preoccupation with a false belief that one emits a foul or offensive body odor — has been described around the world for more than a century. However, only a few small studies have systematically assessed ORS's clinical features.MethodTwenty patients with ORS were systematically assessed using semistructured measures.ResultsSubjects' mean age was 33.4±14.1; 60% were female. Preoccupation most often focused on the mouth (75%), armpits (60%) and genitals (35%). Bad breath (75%) and sweat (65%) were the most common odor descriptions. Currently, 85% of subjects had delusional ORS beliefs, 77% had referential thinking and 85% reported actually smelling the odor. Ninety-five percent of subjects reported performing one or more ORS-related repetitive behaviors (e.g., excessive showering). Forty percent had been housebound for at least 1 week because of ORS symptoms, 68% had a history of suicidal ideation, 32% had attempted suicide and 53% had been psychiatrically hospitalized. Forty-four percent of subjects had sought nonpsychiatric medical, surgical or dental treatment for the perceived odor, and one third had received such treatment, which was ineffective in all cases.ConclusionORS appears to be characterized by high morbidity and seeking of nonpsychiatric treatment.