Olfactory Reference Disorder: Diagnosis, Epidemiology and Management

Although not included as a disorder in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), olfactory reference disorder (ORD) is being considered for inclusion as a discrete disorder in the ICD-11 (International Classification of Diseases, 11th edition). ORD is likely underdiagnosed and undertreated. The purpose of this paper is to provide information to clinicians and researchers on the epidemiology, clinical presentation and treatment options for this condition. A narrative overview of the literature as retrieved from a computerized database search is provided. ORD is a condition that is characterized by the erroneous belief that one emits a foul or unpleasant body odour, resulting in significant distress and impairment. It is often accompanied by referential thinking and repetitive behaviours aimed at camouflaging the perceived odour. Level of insight varies, with some patients having concerns that are delusional. Patients usually do not spontaneously report their symptoms and so screening in suspected cases is crucial. The literature regarding ORD treatment remains limited.