Challenges in diagnosis and treatment of olfactory reference syndrome: A case study

In olfactory reference syndrome (ORS), patients exhibit a preoccupation with a perceived foul or offensive odor that they emit, which leads to significant distress and functional impairment. It has been reclassified in the “other specified” category under obsessive-compulsive and related disorder of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, there is limited information about how to diagnose and successfully treat this disorder. This study describes the case of a 20-year-old male who was diagnosed with ORS after excluding other differential and treated using combination strategies that included selective serotonin reuptake inhibitors (SSRI) and cognitive behavioral therapy (CBT). Following 16 weeks of treatment, the patient showed significant improvement in his functioning, which was measured with different scales. The scales were used to measure anxiety and depression revealed the patient was below clinical threshold levels. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), used to measure the severity of obsessive-compulsive disorder (OCD) symptoms, showed mild OCD, with a reduction of 68% from his initial score. In the four-month post-treatment follow-up, the patient maintained his improvement. These findings suggest that further studies regarding the classification of ORS as a specific category are warranted, and should include combination therapy, particularly CBT.