Olfactory reference syndrome: A nosological conundrum?

Background: Individuals with olfactory reference syndrome (ORS) erroneously believe that they have unpleasant body odour or halitosis, often leading to compulsive washing or toothbrushing, self-consciousness, and social withdrawal [3], symptoms shared with obsessive-compulsive disorder (OCD) and social anxiety disorder (SAD) [1,2,4], respectively. ORS is classified as an ORCD, but the literature on comorbidity of ORS with OCD and SAD is sparse. We therefore examined ORS's prevalence in people with OCD and/or SAD. Methods: In a South African clinical sample (n = 371; male = 164 [44.2 %], female = 207 [55.8 %], mean age: 32.3 [SD: 11.5 years]), ages ranging between 14 and 64 years), rates of ORS in people with primary OCD without SAD (OCD-SAD; n = 211) were compared using a chi square test with those with primary SAD without OCD (SAD-OCD; n = 118), and those with both OCD and SAD (OCD + SAD; n = 42). The study was formally approved by the research ethics committee of Stellenbosch University (reference number: 99/013). All participants provided written informed consent prior to participation in the study. Results: In the combined dataset, ORS rates were low (n = 6/371; 1.6 %). There were significantly higher rates of comorbid ORS in the SAD-OCD group (n = 5/118; 4.2 %) compared to the OCD-SAD patients (n = 0/211; p = .005) and OCD + SAD (n = 1/42; 2.4 %; p = .022), with no significant difference between OCD-SAD and OCD + SAD (p = .677). Conclusion: Our findings suggest a stronger link between ORS and SAD than between ORS and OCD, which may have nosological implications. Further research on the psychobiology and management of ORS may be useful in determining whether it is more closely related to SAD or to OCD. Funding: This work has not been funded specifically. The authors are supported by the South African Medical Research Council.