Clearing the air: Multimodal treatment of a case of olfactory reference syndrome

Olfactory reference syndrome (ORS) is a relatively unknown psychiatric condition characterized by recurrent and unremitting preoccupations with producing an unpleasant bodily odor. As a result, patients with ORS experience significant distress and social impairment. Although reports of ORS have been published globally since the 1800s, its prevalence remains unknown, potentially due to patients’ feelings of embarrassment and shame. The classification of ORS in the Diagnostic and Statistical Manual of Mental Disorders (DSM) has also been controversial. While some classify ORS as a subtype of delusional disorder, others correlate the condition to social anxiety disorder (SAD). Due to the absence of explicit diagnostic criteria for ORS, treatment options have varied, ranging from selective serotonin reuptake inhibitors (SSRIs) to antipsychotic medications. Herein, we present a case of a 60-year-old patient with a relevant past medical history of ORS, major depressive disorder, and generalized anxiety disorder. We successfully treated their ORS symptoms by adding as-needed lorazepam to their medication regimen before social interactions.