Olfactory reference syndrome triggered by stressful life events and responsive to pharmacotherapy: A case series

Background: Olfactory Reference Syndrome (ORS) is a debilitating and underrecognized psychiatric condition characterized by a persistent, fixed false belief that one emits a foul body odor. This belief persists despite a lack of objective evidence and leads to significant distress, social withdrawal, and functional impairment. A scarcity of empirical research complicates the diagnosis and management of ORS.Cases Presentation: We present a case series of four patients diagnosed with ORS. At baseline, assessment with the Yale–Brown Obsessive-Compulsive Scale (YBOCS) and the Brown Assessment of Beliefs Scale (BABS) revealed severe delusional beliefs and marked psychosocial dysfunction. Following an eight-week course of pharmacological treatment with selective serotonin reuptake inhibitors (SSRIs) and/or antipsychotic medications, all patients demonstrated notable clinical improvement. This was evidenced by significant reductions in YBOCS and BABS scores and corresponding enhancements in social functioning.Discussion: This series underscores the importance of recognizing ORS in clinical psychiatric practice. The positive treatment response observed suggests that a combination of SSRIs and antipsychotics can be an effective therapeutic strategy. These findings highlight the critical need for further controlled studies to establish evidence-based treatment guidelines for this often-underdiagnosed and debilitating condition.