Pharmacological Treatment of Olfactory Reference Disorder: A Systematic Review and Historical Analysis of Treatment Patterns.

Abstract

Objective: olfactory Reference Disorder (ORD) is characterized by a persistent preoccupation with the belief of emitting a bad or unpleasant body odor or breath, which is either imperceptible or only minimally perceptible to others. To systematically review studies investigating the pharmacological treatment of Olfactory Reference Disorder (ORD) and explore clinical characteristics, treatment response, and historical changes in pharmacological prescribing patterns.

Method: systematic review conducted in accordance with PRISMA guidelines. Sociodemographic, clinical, phenomenological, and therapeutic variables were extracted.

Results: fifty-two studies (47 case reports, 5 case series, and no controlled clinical trials), totaling 87 patients, were included. Treatment included serotonin reuptake inhibitors in 59.8%, antipsychotics in 52.9%, and both in 22% of cases. The overall treatment response rate was 86.2%, although interpretation is limited by uncontrolled study designs and probable publication bias. A historical analysis revealed that antipsychotics were more frequently prescribed in earlier reports, whereas SRIs became widely used only after the 1990s, reflecting a shift in the conceptualization of ORD toward the obsessive-compulsive spectrum. Also, no statistically significant differences were observed between responders and non-responders regarding sex, illness duration, psychiatric comorbidities, treatment modality, or pharmacological class used. Evidence of publication bias was identified.

Conclusions: ORD appears to be a potentially treatable condition, although the available evidence is limited by uncontrolled study designs, heterogeneous outcome measures, and probable publication bias. The shift toward serotonergic treatments parallels the evolving understanding of ORD within the obsessive-compulsive spectrum. Prospective studies using standardized outcome measures are needed..