Updated May 19-2010

Olfactory Reference Syndrome

The work group is recommending that this be included in DSM-5, probably in an Appendix for Further Research

A. Preoccupation with the belief that one emits a foul or offensive body odor, which is not perceived by others.

B. The preoccupation causes clinically significant distress (for example, depressed mood, anxiety, shame) or impairment in social, occupational, or other important areas of functioning.

C. The preoccupations are not due to the direct physiological effects of a substance (e.g., a drug of abuse or medication) or a general medical condition.

D. The preoccupations are not restricted to the symptoms of another mental disorder (e.g., the delusions of Schizophrenia or another Psychotic Disorder).

Specify whether ORS beliefs are currently characterized by:

Good or fair insight: Recognizes that olfactory reference syndrome beliefs are definitely or probably not true, or that they may or may not be true

Poor insight: Thinks olfactory reference syndrome beliefs are probably true

Absent insight (i.e., delusional beliefs about body odor): Completely convinced olfactory reference syndrome beliefs are true

The published literature on olfactory reference syndrome (ORS) spans more than a century and provides consistent descriptions of its clinical features and the substantial morbidity it causes. DSM-IV does not explicitly mention ORS, but its clinical features are confusingly mentioned in three different sections of DSM-IV. There appears to be some overlap with delusional disorder, social phobia, body dysmorphic disorder, OCD, and hypochondriasis, but ORS appears to have important differences from all of these disorders. ORS’s current classification is problematic, as this syndrome appears to characterize a distinct and suffering group of people who may be misdiagnosed or unsuccessfully treated because ORS is not clearly identified in DSM. Including ORS in an Appendix would potentially stimulate further systematic research, using specified diagnostic criteria.

The proposed criteria are very similar to previously published criteria by two different groups, which were based on research experience and clinical experience with these patients. The criteria have similarities to those of  several other “near-neighbor” disorders. Available data suggest that a range of insight can characterize ORS. The proposed levels of insight are the same as those proposed for other disorders, and they appear applicable to ORS.

Reference: Feusner JD et al: Olfactory Reference Syndrome: Issues for DSM-V. Depression & Anxiety, 2010; 27: 592-599

An adaptation of the YBOCS/BDD-YBOCS has been developed and used clinically and in research studies (Phillips, unpublished)