When Smell Becomes the Shadow: A Case Report of Olfactory Reference Disorder

Olfactory Reference Disorder (ORD) is defined by a continuous fixation on the belief that one is exuding an unpleasant or offensive body odor or breath, which is either imperceptible or only marginally detectable by others. This report describes a 26-year-old male who sought assistance due to his conviction of emitting a foul odor from his mouth and nose, prompting him to visit multiple dentists and otolaryngologists. His condition led to social withdrawal, resulting in feelings of despair and powerlessness. The Mental Status Examination (MSE) revealed a depressed mood, suicidal thoughts, and an obsession with the perceived smell. Both MRI and EEG findings were normal. The patient was diagnosed with ORD and depression based on the Yale-Brown Obsessive-Compulsive Scale – Olfactory Reference Syndrome (YBOCS-ORS) and the Hamilton Depression Rating Scale (HAM-D). He was prescribed fluoxetine at a dosage of 40 mg, along with a low dose of olanzapine. Furthermore, Cognitive Behavioral Therapy (CBT) was initiated to support his recovery. Ultimately, the patient secured employment. Although he continued to have lingering thoughts of an unpleasant odor at a low intensity, he managed to function adequately and engage in social interactions more effectively.