Olfactory reference syndrome: Issues for DSM-V

Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, California, USA.
Depression and Anxiety (Impact Factor: 4.41). 06/2010; 27(6):592-9. DOI: 10.1002/da.20688
Source: PubMed


The published literature on olfactory reference syndrome (ORS) spans more than a century and provides consistent descriptions of its clinical features. The core symptom is preoccupation with the belief that one emits a foul or offensive body odor, which is not perceived by others. This syndrome is associated with substantial distress and disability. DSM-IV and ICD-10 do not explicitly mention ORS, but note convictions about emitting a foul body odor in their description of delusional disorder, somatic type. However, the fact that such symptoms can be nondelusional poses a diagnostic conundrum. Indeed, DSM-IV also mentions fears about the offensiveness of one's body odor in the social phobia text (as a symptom of taijin kyofusho). There also seems to be phenomenological overlap with body dysmorphic disorder, obsessive-compulsive disorder, and hypochondriasis. This article provides a focused review of the literature to address issues for DSM-V, including whether ORS should continue to be mentioned as an example of another disorder or should be included as a separate diagnosis. We present a number of options and preliminary recommendations for consideration for DSM-V. Because research is still very limited, it is unclear how ORS should best be classified. Nonetheless, classifying ORS as a type of delusional disorder seems problematic. Given this syndrome's consistent clinical description across cultures for more than a century, substantial morbidity and a small but growing research literature, we make the preliminary recommendation that ORS be included in DSM-Vs Appendix of Criteria Sets Provided for Further Study, and we suggest diagnostic criteria.

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    • "Moreover, the clinical presentation of ORS (i.e., obsessions about personal odor and compulsive odor-related behaviors) and its preferential response to selective serotonin reuptake inhibitors (SRIs) overlap significantly with obsessivecompulsive spectrum disorders and suggest a more accurate classification as part of the obsessive-compulsive and related disorders[5]. Indeed, the DSM-5 Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Workgroup highlighted the importance of studying ORS and suggested adding ORS to the Appendix of Criteria Sets Provided for Further Study[18]. Olfactory reference syndrome currently appears in DSM 5 under " Other Specified Obsessive Compulsive Disorders " as Jikoshu-kyofu, a variant of taijin kyofusho characterized by fear of having an offensive body odor[19]. In order to better understand the classification and treatment of ORS, it is critical to first investigate its clinical and epidemiological features. "
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    ABSTRACT: Objective: Preoccupation with perceived bodily odor has been described in neuropsychiatric disorders for more than a century; however, empirical research on olfactory reference syndrome (ORS) is scarce. This study investigated the phenomenology of ORS in a broadly ascertained, diverse sample. Method: Data were obtained from 253 subjects in an internet-based survey that operated from January - March 2010. Measures included the Yale-Brown Obsessive Compulsive Scale Modified for ORS (ORS-YBOCS), Work and Social Adjustment Scale (WSAS), Depression Anxiety Stress Scales (DASS), and symptom specific questionnaires developed for this study. Results: Individuals reported, on average, moderately severe ORS symptoms. The average age of onset of ORS symptoms was 21.1 years, with 54% reporting a chronic, unremitting course. Individuals endorsed a lifetime average of two malodorous preoccupations, most commonly stool, garbage, and ammonia. Odors were most often reported to emanate from the armpits, feet, and breasts. Nearly all participants engaged in time-consuming rituals to try to hide or fix their perceived malodor (e.g., checking and camouflaging). Eighteen percent reported poor or delusional insight and 64.0% reported ideas or delusions of reference. More severe ORS symptoms were moderately associated with female gender, poorer insight, and higher levels of impairment (in work, social leisure, ability to maintain close relationships, and consecutive days housebound). Conclusion: This is the largest study on ORS to date. Results underscore the clinical significance and psychosocial impact of this understudied disorder, and highlight the need for subsequent research to examine clinical features and inform treatment.
    No preview · Article · Nov 2015 · Journal of Psychosomatic Research
    • "Somatic preoccupations, poor insight, repetitive checking of body functions and the search for medical treatments are common features. However, in hypochondriasis, the central fear/belief is of having a serious illness [9,15], while ideas of reference and social avoidance are rarely observed [3] "
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    ABSTRACT: Objective : Report a case of olfactory reference syndrome (ORS) with several co-occurring disorders and to discuss ORS differential diagnoses, diagnostic criteria and classification. Method : Case report. Results : A 37 year-old married woman presented overvalued ideas of having bad breath since adolescence. She met current diagnostic criteria for Social Anxiety Disorder, Specific Phobia, Obsessive-Compulsive Disorder, Generalized Anxiety Disorder, Body Dysmorphic Disorder and Major Depressive Disorder. ORS similarities and differences with some related disorders are discussed. Conclusion : Further studies regarding symptoms, biomarkers and outcomes are needed to fully disentangle ORS from existing depressive, anxiety and obsessive-compulsive spectrum disorders.
    No preview · Article · Nov 2014 · General Hospital Psychiatry
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    • "Because research is still very limited, it is unclear how ORS should best be classified. Classifying ORS as a type of delusional disorder seems problematic and it has now been added to the appendix of the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V, in order to trigger more research [6]. Treating halitophobic patients in the dental practice is extremely challenging. "
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    ABSTRACT: Clinical investigations on patients suffering from halitosis clearly reveal that in the vast majority of cases the source for an offensive breath odor can be found within the oral cavity (90%). Based on these studies, the main sources for intra-oral halitosis where tongue coating, gingivitis/periodontitis or a combination of the two. Thus, it is perfectly logical that general dental practitioners (GDPs) should be able to manage intra-oral halitosis under the conditions found in a normal dental practice. However, GDPs who are interested in diagnosing and treating halitosis are challenged to incorporate scientifically based strategies for use in their clinics. Therefore, the present paper summarizes the results of a consensus workshop of international authorities held with the aim to reach a consensus on general guidelines on how to assess and diagnose patients' breath odor concerns and general guidelines on regimens for the treatment of halitosis.
    Full-text · Article · Feb 2014 · Journal of Breath Research
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