ORD

Case: 22 years old female is admitted to ICU for suicidal watch. She attempted suicide as she was unable to get rid of her foul-smelling odor despite assurances from friends and family that she had no such issue. The patient was diagnosed with Olfactory reference disorder (ORD). 

Discussion: ORD is a disease where a patient has a persistent preoccupation with emitting a foul body odor about himself. It can be an occupation with bad breath, sweat, flatulence, urine, or the genital area.

In psychiatric literature, it has been described as olfactory delusional syndrome, olfactory paranoid syndrome, delusional halitosis, imaginary halitosis, monosymptomatic hypochondriacal psychosis, and bromidrosiphobia. 

It is not entirely clear that ORD is purely a psychiatric disorder or has underlying neurological pathophysiology. Single-photon emission computed tomography (SPECT) imaging in these patients found decreased perfusion in the left frontotemporal region with multiple additional perfusion defects.

SSRI (Selective Serotonin Reuptake Inhibitor) may be effective.

#psychiatry

References:

1. Begum M, McKenna PJ. Olfactory reference syndrome: a systematic review of the world literature. Psychol Med 2011; 41:453.

2. Stein DJ, Le Roux L, Bouwer C, Van Heerden B. Is olfactory reference syndrome an obsessive-compulsive spectrum disorder?: two cases and a discussion. J Neuropsychiatry Clin Neurosci 1998; 10:96.

3. Konuk N, Atik L, Atasoy N, Ugur MB. Frontotemporal hypoperfusion detected by 99mTc HMPAO SPECT in a patient with olfactory reference syndrome. Gen Hosp Psychiatry 2006; 28:174.

4. Skimming KA, Miller CWT. Transdiagnostic Approach to Olfactory Reference Syndrome: Neurobiological Considerations. Harv Rev Psychiatry. 2019 May/Jun;27(3):193-200. doi: 10.1097/HRP.0000000000000215. PMID: 31082994.