Olfactory reference syndrome: Diagnostic criteria and differential diagnosis

Olfactory reference syndrome (ORS) has been defined as a psychiatric condition that is characterized by persistent preoccupations about body odour accompanied by persistent shame and embarrassment. Patients' degree of insight varies and, although the symptoms may not be recognized as unreasonable or excessive, there is often significant accompanying shame and distress as well as avoidance behaviour and social isolation. ORS has not (yet) been included in the Diagnostic and Statistical Manual of Mental Disorders and, given that its primary symptoms may be found in various other disorders, differential diagnosis can be problematic. Using an illustrative case of ORS, this article reviews those disorders that can arguably be differentiated from ORS (including body dysmorphic disorder, hypochondriasis, social anxiety disorder, avoidant personality disorder, obsessive-compulsive disorder, major depression with social withdrawal and delusional disorder (somatic type)).