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SAMJ: South African Medical Journal

On-line version ISSN 2078-5135
Print version ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.99 n.9 Pretoria Sep. 2009




Olfactory reference syndrome in DSM-V



S J FlegarI; B VythilingumI; D J SteinI; C LochnerII

IDepartment of Psychiatry Groote Schuur Hospital and University of Cape Town
IIDepartment of Psychiatry Stellenbosch University Tygerberg, W Cape



To the Editor: We read with interest Dr A Lawrence's recent SAMJ case report of a young man who presented with persistent preoccupation with personal body odour in the absence of any physical abnormalities.1

Dr Lawrence does not explicitly consider a diagnosis of olfactory reference syndrome (ORS). This condition, characterised by a preoccupation with the idea that one's body odour is foul or offensive to others, may be part of the differential diagnosis in patients with psychotic disorders (who may have olfactory hallucinations), in patients with obsessive-compulsive disorder (who may have concerns about contamination, and wash or clean repeatedly) and in patients with a social phobia spectrum disorder (who may have severe social anxiety because of fears of causing offence).

One of the reasons why ORS was not included in the differential diagnoses is that it is not formally included in the Diagnostic and Statistical Manual , 4th edition (DSM-IV). The condition is briefly mentioned in the text on delusion disorder, somatic subtype and social phobia (given that some patients with taijin kyofusho (a condition related to social phobia) may suffer from concerns that their body odour is offensive).

Although we cannot be sure that a diagnosis of ORS might have been accurate or clinically useful for Dr Lawrence's patient, we would argue that this kind of discussion provides a good basis for explicitly including ORS in DSM-V. It is a well-described condition,2 for which diagnostic criteria have been proposed,3 and for which various interventions have been noted in the literature.2,4-6 Including the condition in DSM-V would help to improve reliability of diagnosis and raise awareness among clinicians, and probably lead to further research on this entity.


1. Lawrence A. The quest for a groundless surgical procedure. S Afr Med J 2009; 99: 231.         [ Links ]

2. Pryse-Phillips W. An olfactory reference syndrome. Acta Psychiatr Scand 1971; 47: 484-509.         [ Links ]

3. Lochner C, Stein DJ. Olfactory reference syndrome: diagnostic criteria and differential diagnosis. J Postgrad Med 2003; 49: 328-331.         [ Links ]

4. Videbech T. Chronic olfactory paranoid syndromes. Acta Psychiatr Scand 1967; 42: 182-213.         [ Links ]

5. Stein D, 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: 96-99.         [ Links ]

6. Yeh YW, Chen CK, Huang SY, et al. Successful treatment with amisulpride for the progression of olfactory reference syndrome to schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33: 579-580.        [ Links ]

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