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Olfactory reference syndrome: a systematic review of the world literature

Published online by Cambridge University Press:  09 June 2010

M. Begum  and
P. J. McKenna
M. Begum*
Affiliation:
Behavioural Psychotherapy Service, NHS Forth Valley, Scotland
P. J. McKenna
Affiliation:
Benito Menni CASM, Sant Boi, Barcelona and CIBERSAM, Spain
*
*Address for correspondence: Dr M. Begum, NHS Forth Valley, Behavioural Psychotherapy Service, 2 the Bungalows, Stirling Rd, Larbert FK5 4SD, Scotland. (Email: [email protected])
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Abstract

Background

The nosological status of olfactory reference syndrome (ORS) is a matter of debate and there is uncertainty as to what treatments are effective.

Method

The world literature was searched for reports of cases of ORS. Clinical, nosological and therapeutic information from cases meeting proposed diagnostic criteria for the disorder was summarized and tabulated.

Results

A total of 84 case reports (52 male/32 female) were found. Age of onset was <20 years in almost 60% of cases. Smell-related precipitating events were recorded in 42%. Most patients could not smell the smell or only did so intermittently. Authors of the reports expressed reservations about the delusional nature of the belief in slightly under half of the cases. Over two-thirds were improved or recovered at follow-up, with the disorder responding to antidepressants and psychotherapy more frequently than to neuroleptics.

Conclusions

ORS is a primary psychiatric syndrome that does not fit well into its current classification as a subtype of delusional disorder, both in terms of its nosology and its response to treatment.

Keywords

Delusional disordermonosymptomatic psychosisolfactoryparanoid
Type
Review Article
Information
Psychological Medicine , Volume 41 , Issue 3 , March 2011 , pp. 453 - 461
Copyright
Copyright © Cambridge University Press 2010

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References

*Beary, MD, Cobb, JP (1981). Solitary psychosis – three cases of monosymptomatic delusion of alimentary stench treated with behavioural psychotherapy. British Journal of Psychiatry 138, 64–66.CrossRefGoogle ScholarPubMed
*Bishop, ER Jr. (1980). An olfactory reference syndrome – monosymptomatic hypochondriasis. Journal of Clinical Psychiatry 41, 57–59.Google ScholarPubMed
*Bizamcer, AN, Dubin, WR, Hayburn, B (2008). Olfactory reference syndrome. Psychosomatics 49, 77–81.CrossRefGoogle ScholarPubMed
*Bourgeois, M (1973). L'autodysosmophobie et le syndrome ou delire olfactif de relation (a propos de 7 observations). Annales Médico-psychologiques 2, 353–376.Google Scholar
*Brosig, B, Kupfer, J, Niemeyer, V, Milch, W, Gieler, U (2001). Delusional bromidosis in psychotherapy – a case study. Dermatology and Psychosomatics 2, 82–85.CrossRefGoogle Scholar
*Brotman, AW, Jenike, MA (1984). Monosymptomatic hypochondriasis treated with tricyclic antidepressants. American Journal of Psychiatry 141, 1608–1609.Google ScholarPubMed
Castle, DJ, Rossell, S, Kyrios, M (2006). Body dysmorphic disorder. Psychiatric Clinics of North America 29, 521–538.CrossRefGoogle ScholarPubMed
*Clarvit, SR, Schneier, FR, Liebowitz, MR (1996). The offensive subtype of Taijin-kyofu-sho in New York City: the phenomenology and treatment of a social anxiety disorder. Jouirnal of Clinical Psychiatry 57, 523–527.CrossRefGoogle ScholarPubMed
*Dominguez, RA, Puig, A (1997). Olfactory reference syndrome responds to clomipramine but not fluoxetine: a case report. Jounral of Clinical Psychiatry 58, 497–498.CrossRefGoogle Scholar
*Fazal, MA, Shah, AM (1985). Monosymptomatic delusions of smell: are these new symptoms in East Africa? Nordic Journal of Psychiatry 39, 389–393.Google Scholar
*Fishbain, DA, Goldberg, M (1991). Fluoxetine for obsessive fear of loss of control of malodorous flatulence. Psychosomatics 32, 105–107.CrossRefGoogle ScholarPubMed
Freeman, D, Garety, PA, Bebbington, PE, Smith, B, Rollinson, R, Fowler, D, Kuipers, E, Ray, K, Dunn, G (2005). Psychological investigation of the structure of paranoia in a non-clinical population. British Journal of Psychiatry 186, 427–435.CrossRefGoogle Scholar
Green, CE, Freeman, D, Kuipers, E, Bebbington, P, Fowler, D, Dunn, G, Garety, PA (2008). Measuring ideas of persecution and social reference: the Green et al. Paranoid Thought Scales (GPTS). Psychologcal Medicine 38, 101–111.CrossRefGoogle Scholar
*Habeck, D (1965). Contribution to smell hallucinosis with delusion of reference. Archiv fur Psychiatrie und Nervenkrankheiten 207, 196–205.CrossRefGoogle ScholarPubMed
Jaspers, K (1959). General Psychopathology (trans. J. Hoenig & M. W. Hamilton, 1963). Manchester University Press: Manchester.Google Scholar
*Johanson, E (1964). Mild paranoia. Acta Psychiatrica Scandinavica, Supplement 177, 1–100.Google Scholar
*Johnson, BE (1996). The olfactory reference syndrome and halitosis. In Bad Breath. A Mulitidisciplinary Approach (ed. Van Steenberghe, D. and Rosenberg, M.), pp. 231–240. Leuven University Press: Leuven.Google Scholar
*Kizu, A, Miyagishi, T (1993). Behaviour therapy for two cases complaining of emitting body odour. Japanese Journal of Behaviour Therapy 19, 38–45.Google Scholar
*Kobayashi, N, Kurauchi, S, Sawamura, T, Shigemura, J, Sano, SY, Nomura, S (2003). The effect of paroxetine on Taijinkyofusho: a report of three cases. Psychiatry 66, 262–267.CrossRefGoogle ScholarPubMed
*Kopecek, M, Horacek, J, Motlova, L, Preiss, M, Belohlavek, O (2004). The 18FDG PET imaging of an olfactory paranoid syndrome (case report). Psychiatrie (Praha) 7, 214–217.Google Scholar
*Lochner, C, Stein, DJ (2003). Olfactory reference syndrome: diagnostic criteria and differential diagnosis. Journal of Postgraduate Medicine 49, 328–331.Google ScholarPubMed
*McArdle, M (1974). Treatment of a phobia. Nursing Times 70, 637–639.Google ScholarPubMed
*McGoldrick, T, Begum, M, Brown, KW (2008). EMDR and olfactory reference syndrome. Journal of EMDR Practice and Research 2, 63–68.CrossRefGoogle Scholar
McKenna, PJ (1984). Disorders with overvalued ideas. British Journal of Psychiatry 145, 579–585.CrossRefGoogle ScholarPubMed
*Malasi, TH, el-Hilu, SM, Mirza, IA, el-Islam, MF (1990). Olfactory delusional syndrome with various aetiologies. British Journal of Psychiatry 156, 256–260.CrossRefGoogle ScholarPubMed
*Masuda, Y, Takemura, T, Shimizu, T, Hishikawa, Y (1998). A case with smell-egorrhea symptom improved by administration of risperidone. Japanese Journal of Psychosomatic Medicine 38, 267–271.Google Scholar
*Milan, MA, Kolko, DJ (1982). Paradoxical intention in the treatment of obsessional flatulence ruminations. Journal of Behavior Therapy and Experimental Psychiatry 13, 167–172.CrossRefGoogle ScholarPubMed
*Miyamoto, T (1965). Psychiatric problems in patients with self-odors. Dental Outlook (Japan) 25, 461–471.Google Scholar
*Monti, M, Sambvani, N, Sacrini, F (1998). Obsessive-compulsive disorders in dermatology. Journal of the European Academy of Dermatology and Venereology 11, 103–108.Google ScholarPubMed
Munro, A (1980 a). Monosymptomatic hypochondriacal psychosis. British Journal of Hospital Medicine 24, 34, 36–38.Google ScholarPubMed
*Munro, A (1980 b). Monosymptomatic hypochondriacal psychosis (MHP): new aspects of an old syndrome. Journal of Psychiatric Treatment and Evaluation 2, 79–86.Google Scholar
*Munro, A (1981). Delusional hypochondriasis: a description of monosymptomatic hypochondriacal psychosis (MHD). University of Liverpool: Liverpool.Google Scholar
Munro, A (1988). Monosymptomatic hypochondriacal psychosis. British Journal of Psychiatry (Suppl.), 37–40.CrossRefGoogle ScholarPubMed
Munro, A (1999). Delusional Disorder: Paranoia and Related Illnesses. Cambridge University Press: Cambridge.CrossRefGoogle Scholar
*Nakazawa, A (1962). Of the illness mentality of people who complain of body smells: a consideration from the anthropological point of view. Psychiatrica et Neurologica Japonica 65, 451–469.Google Scholar
*Nelki, J (1988). Making sense of a delusion of smell: a psychotherapeutic approach. British Journal of Medical Psychology 61, 267–275.CrossRefGoogle Scholar
*Oxtoby, A, Field, EA (1994). Delusional symptoms in dental patients: a report of four cases. British Dental Journal 176, 140–143.CrossRefGoogle ScholarPubMed
Phillips, K, Gunderson, C, Gruber, U, Castle, D (2006). Delusions of body malodour: the olfactory reference syndrome. In Olfaction and the Brain (ed. Brewer, W., Castle, D. and Pantelis, C.),pp. 334–353. Cambridge University Press: Cambridge.Google Scholar
Phillips, KA (2004). Psychosis in body dysmorphic disorder. Journal of Psychiatric Research 38, 63–72.CrossRefGoogle ScholarPubMed
Phillips, KA, Castle, DJ (2007). Recognizing and treating olfactory reference syndrome. Current Psychiatry 6, 49–65.Google Scholar
*Popella, E, Greger, J (1965). Smell delusions and smell hallucinations. a clinical contribution to the psychopathology of the sense of smell. Psychiatria et Neurologia (Basel) 149, 171–181.CrossRefGoogle Scholar
Potts, CS (1891). Two cases of hallucination of smell. University of Pennsylvania Medical Magazine, 226.Google Scholar
*Pryse-Phillips, W (1968). Olfactory Hallucinations: A Clinical Study. University of London: London.Google Scholar
Pryse-Phillips, W (1971). An olfactory reference syndrome. Acta Psychiatrica Scandinavica 47, 484–509.CrossRefGoogle Scholar
*Sano, A, Kakimoto, Y (1990). A case in which clomipramine proved effective in relieving body odor phobia and obsessive compulsive symptoms. Seishinigaku (Clinical Psychiatry) 32, 1011–1012.Google Scholar
Séglas, MJ (1892). De l'obsession hallucinatoire et de l'hallucination obsédante. Annales Médico-psychologiques 50, 119–130.Google Scholar
*Singh, GP (2006). Is olfactory reference syndrome an OCD. Indian Journal of Psychiatry 48, 201–202.CrossRefGoogle ScholarPubMed
*Stein, DJ, Le Roux, L, Bouwer, C, Van Heerden, B (1998). Is olfactory reference syndrome an obsessive-compulsive spectrum disorder?: two cases and a discussion. Journal of Neuropsychiatry and Clinical Neurosciences 10, 96–99.CrossRefGoogle ScholarPubMed
*Strnad, M, Widdernannová, L (1965). Contribution to the psychiatric problem of the pathological conviction about the incontinence of intestinal gases. Psychiatrie (Praha) 61, 113–118.Google Scholar
Sutton, RL (1919). Bromidrosiphobia. Journal of the American Medical Association 72, 1267–1268.CrossRefGoogle Scholar
*Suwaki, H (1971). Sexual problem and guiltfeeling of olfactory paranoid patient. Japanese Journal of Clinical Psychiatry 13, 879–883.Google Scholar
*Suzuki, K, Takei, N, Iwata, Y, Sekine, Y, Toyoda, T, Nakamura, K, Minabe, Y, Kawai, M, Iyo, M, Mori, N (2004). Do olfactory reference syndrome and jiko-shu-kyofu (a subtype of taijin-kyofu) share a common entity? Acta Psychiatrica Scandinavica 109, 150–155.CrossRefGoogle Scholar
*Toyofuku, A, Umemoto, G, Naitou, Y, Kikuta, T, Miyako, H (2000). A case of a halitosis patient who needed behaviour restriction therapy. Japanese Journal of Psychosomatic Dentistry 15, 197–202.Google Scholar
*Tsunoda, H, Miyaoka, H, Takagi, K, Tsunoda, K, Takamori, K, Nagai, T, Nakagawa, T, Fujino, M, Katayama, Y (2003). ‘Adolescent paranoia’ complaining of emitting foul breath: report of a case. Japanese Journal of Psychosomatic Dentistry 18, 85–88.Google Scholar
Veale, D (2002). Over-valued ideas: a conceptual analysis. Behaviour Research and Therapy 40, 383–400.CrossRefGoogle ScholarPubMed
*Videbech, T (1966). Chronic olfactory paranoid syndromes. A contribution to the psychopathology of the sense of smell. Acta Psychiatrica Scandinavica 42, 183–213.CrossRefGoogle Scholar
Walter, K (1965). Über das ‘phobische beziehungssyndrom’. Nervenarzt 36, 7–11.Google Scholar
Wing, JK, Cooper, JE, Sartorius, N (1974). The Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar
*Yamada, M, Kashiwamura, K, Nakamura, Y, Ota, T (1977). Fear of emitting bad odours. Bulletin of the Yagamuchi Medical School 24, 141–161.Google Scholar
*Yamashita, I (1993). Taijin-kyofu or Delusional Social Phobia. Hokkaido University Press: Sapporo.Google Scholar
*Yamazaki, T, Morita, S, Ogiuchi, H (2005). A case of halitophobia with two planned attempts at suicide. Japanese Journal of Psychosomatic Dentistry 20, 17–19.Google Scholar