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18 - Delusions of Body Malodour: The Olfactory Reference Syndrome

from Section III - Assessment and Disorders of Olfaction

Published online by Cambridge University Press:  17 August 2009

By
Katharine Phillips ,
Craig Gunderson ,
Uschi Gruber  and
David Castle
Edited by
Warrick J. Brewer ,
David Castle  and
Christos Pantelis
Foreword by
Peter Doherty
Warrick J. Brewer
Affiliation:
Mental Health Research Institute of Victoria, Melbourne
David Castle
Affiliation:
University of Melbourne
Christos Pantelis
Affiliation:
University of Melbourne
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Summary

He said: ‘For the past three months I've been giving off a body odor. It smells like a swamp, dug up mud, a rotten smell; it comes from my guts. I can't go anywhere. I don't want to go with my friends, and I think I've lost them on account of that …. I smell it through my nose. I smell it all over the body. I think it stays 6 feet around me. It smells more in front of me. Sometimes it smells like a swamp. I never experienced something similar….’

Gabriel Garcia Marquez

Introduction

The olfactory reference syndrome (ORS) is an under-recognised type of delusional disorder that has been described for more than a century. It consists of a false belief that one emits an offensive body odour and is often accompanied by prominent delusions of reference and repetitive behaviours aimed at checking or reducing the perceived odour. ORS is associated with significant distress and impaired functioning, especially in the social realm. Many patients seek nonpsychiatric treatment from gastroenterologists, dermatologists, proctologists, dentists and other specialists; however, such treatments appear to be generally ineffective. In contrast, although data are limited, certain psychotropic medications and behavioural interventions are promising.

This chapter discusses ORS's history, clinical features, prevalence, treatment response, possible pathogenesis, nosological status and relationship to other psychiatric disorders, including mood disorders, schizophrenia, social phobia, and obsessive compulsive disorder (OCD).

Keywords

antidepressantsantipsychoticsolfactory reference syndromeORSpsychiatric interventionspsychological treatments
Type
Chapter
Information
Olfaction and the Brain , pp. 334 - 354
Publisher: Cambridge University Press
Print publication year: 2006

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References

Alvarez, (1958) Practical Leads to Puzzling Diagnoses. Philadelphia: JB Lippincott Company.
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders, Third Edition (revised). Washington, DC: APA.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: APA.
Beary, M. D. & Cobb, J. P. (1981) Solitary psychosis: three cases of monosymptomatic delusion of alimentary stench treated with behavioural psychotherapy. Br J Psychiatry, 138, 64–6.CrossRefGoogle Scholar
Bishop, E. R. (1980) An olfactory reference syndrome–monosymptomatic hypochondriasis. J Clin Psychiatry, 41, 57–9.Google Scholar
Bishop, E. R. (1983) Monosymptomatic hypochondriacal syndromes in dermatology. J Am Acad Dermat, 9, 152–8.Google Scholar
Bourgeois, M. & Paty, J. (1972) L'autodysosmophobie et la psychopathologie de l'olfaction. Bourdeaux Méd, 17, 2269–86.Google Scholar
Brotman, A. W. & Jenike, M. A. (1984) Monosymptomatic hypochondriasis treated with tricyclic antidepressants. Am J Psychiatry, 141, 1608–9.Google Scholar
Castle, D. J. & Phillips, K. A. (2006) The OCD spectrum of disorders: a defensible construct? Aust N Z J Psychiatry, 40, 114–20.
Chang, S. C. (1997) Social anxiety (phobia) and East Asian culture. Depression Anxiety, 5, 115–20.Google Scholar
Davidson, M. & Mukherjee, S. (1982) Progression of olfactory reference syndrome to mania: a case report. Am J Psychiatry, 139, 1623–4.Google Scholar
Dominguez, R. A. & Puig, A. (1997) Olfactory reference syndrome responds to clomipramine but not fluoxetine: a case report. J Clin Psychiatry, 58, 497–8.CrossRefGoogle Scholar
Forte, F. S. (1952) Olfactory hallucinations as a proctologic manifestation of early schizophrenia. Am J Surgery, 84, 620–2.CrossRefGoogle Scholar
Gomez-Perez, J. D., Marks, I. M. & Gutierrez-Fisac, J. L. (1994) Dysmorphophobia: clinical features and outcome with behavior therapy. Eur Psychiatry, 9, 229–35.Google Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al. (1989) The Yale-Brown Obsessive Compulsive Scale. I: Development, use, and reliability. Arch Gen Psychiatry, 46, 1006–11.CrossRefGoogle Scholar
Harriman, P. L. (1934) A case of olfactory hallucination in a hypochondriacal prisoner. J Ab Soc Psychol, 29, 457–8.CrossRefGoogle Scholar
Hawkins, C. (1987) Real and imaginary halitosis. BMJ, 294, 200–1.CrossRefGoogle Scholar
Iwakura, M., Yasuno, Y., Shimura, M., et al. (1994) Clinical characteristics of halitosis: differences in two patient groups with primary and secondary complaints of halitosis. J Dental Res, 73, 1568–74.Google Scholar
Iwu, C. O. & Akpata, O. (1990) Delusional halitosis. Review of the literature and analysis of 32 cases. Br Dental J, 168, 294–6.CrossRefGoogle Scholar
Johanson, E. (1964) Mild paranoia. Acta Psychiatrica Scand, 40, 13–14.CrossRefGoogle Scholar
Kasahara, Y. & Kenji, S. (1971) Ereuthophobia and allied conditions: a contribution toward the psychopathological and crosscultural study of a borderline state. In The World Biennial of Psychiatry in Psychotherapy (ed Arieti, S.). New York: Basic Books.
Kizu, A. & Miyoshi, N. (1994) A case with fear of emitting body odour resulted in successful treatment with clomipramine, 69, 1477–80.Google Scholar
Kong, S. G. & Tan, K. H. (1984) Monosymptomatic hypochondriacal psychosis: a report of 3 cases. Sing Medl J, 25, 432–5.Google Scholar
Kraepelin, E. (1976) Manic-depressive Insanity and Paranoia. New York: Arno Press.
Lochner, C. & Stein, D. J. (2003) Olfactory reference syndrome: diagnostic criteria and differential diagnosis. J Postgrad Med, 49, 328–31.Google Scholar
Malasi, T. H., El-Hilu, S. R., Mirza, I. A., et al. (1990) Olfactory delusional syndrome with various aetiologies. Br J Psychiatry, 156, 256–60.Google Scholar
Marks, I. M. (1987). Fears, Phobias, and Rituals.Oxford: Oxford University Press.
Marks, I. & Mishan, J. (1988) Dysmorphophobic avoidance with disturbed bodily perception: a pilot study of exposure therapy. Br J Psychiatry, 152, 674–8.Google Scholar
Milan, M. A. & Kolko, D. J. (1982) Paradoxical intention in the treatment of obsessional flatulence ruminations. J Beh Ther Exp Psychiatry, 13, 167–72.Google Scholar
Munro, A. (1982) Delusional Hypochondriasis. Toronto: Clarke Institute of Psychiatry Monograph No. 5.
Munro, A. (1988) Monosymptomatic hypochondriacal psychosis. Br J Psychiatry, 153, 37–40.Google Scholar
Munro, A. & Pollock, B. (1981) Monosymptomatic psychoses which progress to schizophrenia. J Clin Psychiatry, 42, 474–6.Google Scholar
Nelki, J. (1988) Making sense of a delusion of smell: a psychotherapeutic approach. Br J Psychology, 61, 267–75.CrossRefGoogle Scholar
Osman, A. A. (1991) Monosymptomatic hypochondriacal psychosis in developing countries. Br J Psychiatry, 159, 428–31.CrossRefGoogle Scholar
Phillips, K. A. (2002) Pharmacologic treatment of body dysmorphic disorder: review of the evidence and a recommended treatment approach. CNS Spectrums, 7, 453–60.CrossRefGoogle Scholar
Phillips, K. A. (2005) A placebo-controlled study of pimozide augmentation of fluoxetine in body dysmorphic disorder. Am J Psychiatry, 162, 377–79.Google Scholar
Phillips, K. A., Hollander, E., Rasmussen, S. A., et al. (1997) A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-Brown Obsessive Compulsive Scale. Psychopharmacol Bull, 33, 17–22.Google Scholar
Phillips, K. A., Price, L. H., Greenberg, B. D., et al. (2003) Should DSM's diagnostic groupings be changed? In Advancing DSM: Dilemmas in Psychiatric Diagnosis. (eds Phillips, K. A., First, M. B. & Pincus, H.). Washington, DC: American Psychiatric Publishing Inc.
Potts, C. S. (1891) Two cases of hallucination of smell. Univ Penn Med Mag, 226.Google Scholar
Pryse-Phillips, W. (1971) An olfactory reference syndrome. Acta Psychiatr Scand, 47, 484–509.Google Scholar
Riding, J. & Munro, A. (1975) Pimozide in the treatment of monosymptomatic hypochondriacal psychosis. Acta Psychiatr Scand, 52, 23–30.CrossRefGoogle Scholar
Ross, C. A., Siddiqui, A. R. & Matas, M. (1987) DSM-III: Problems in diagnosis of paranoia and obsessive-compulsive disorder. Can J Psychiatry, 32, 146–8.CrossRefGoogle Scholar
Stein, D. J., Roux, L., Bouwer, C., et al. (1998) Is olfactory reference syndrome an obsessive-compulsive spectrum disorder?: two cases and a discussion. J Neuropsychiatry Clin Neurosci, 10, 96–9.Google Scholar
Sutton, R. L. (1919) Bromidrosiphobia. J Am Med Assoc, 72, 1267–8.CrossRefGoogle Scholar
Suzuki, K., Takei, N., Iwata, Y., et al. (2004) Do olfactory reference syndrome and Jiko-shu-kyofu (a subtype of Taijin-kyofu) share a common entity?Acta Psychiatr Scand, 109, 150–5.Google Scholar
Tilley, H. (1895) Three cases of parosmia: causes and treatment. Lancet, ii, 907–8.Google Scholar
Toone, B. K. (1978) Psychomotor seizures, arterio-venous malformation and the olfactory reference syndrome. Acta Psychiatr Scand, 58, 61–6.CrossRefGoogle Scholar
Ulzen, T. P. M. (1993) Pimozide-responsive monosymptomatic hypochondriacal psychosis in an adolescent. Can J Psychiatry, 38, 153–4.CrossRefGoogle Scholar
Videbech, T. (1966) Chronic olfactory paranoid syndromes. Acta Psychiat Scand, 42, 183–213.Google Scholar
World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders. Geneva.
Yamada, M., Shigemoto, T., Kashiwamura, K., et al. (1977) Fear of emitting bad odors. Bull Yamaguchi Med School, 24, 141–61.Google Scholar
Yamada, M., Kobashi, K., Shigemoto, T., et al. (1978) On dysmorphophobia. Bull Yamaguchi Med School, 25, 47–54.Google Scholar

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