Olfactory Reference Syndrome Treated With Lurasidone and Cognitive Behavioral Therapy: A Case Report

Olfactory Reference syndrome (ORS) is characterized by patients falsely believing that they exude a foul body odor, which is embarrassing and disturbing to the patient. The increased anxiety due to this belief leads to compulsive behaviors, social anxiety, and functional impairment. ORS poses enormous challenges in its diagnosis and treatment. The disorder can be often treatment-resistant or recurrent. A case formulation followed by a classificatory diagnosis is an effective approach to distinguish it from other diagnoses with an overlapping spectrum of symptoms. Here, we present a case of a 42-year-old Australian woman with recurrence of ORS post major stressful triggers. She reported a trial of a series of expensive cosmetic and hydraulic treatments, however, her symptoms persisted, causing significant deterioration in her mood and social functioning, interpersonal relationships, and self-care. Patient was brought to the psychiatric inpatient unit with the complaint of feeling unsafe in her own house. She was started on Lurasidone, along with 12 weeks of intense cognitive behavioral sessions. The use of psychotherapy is underreported even though it significantly reduces ongoing distress. The patient remains asymptomatic along with improved social functioning on subsequent follow-ups.