Olfactory Reference Syndrome Responds to Clomipramine But Not Fluoxetine

Dominguez, Roberto A.; Puig, Alina

doi:10.4088/jcp.v58n1106e

Cited by 27 publications

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“…Several case reports and series describe response to antipsychotic monotherapy, particularly pimozide [18, 34], but multiple case reports and series describe improvement with serotonin reuptake inhibitor (SRI) monotherapy [35–38]. Some individuals did not respond to an antipsychotic but did respond to an SRI [35].…”

Section: Resultsmentioning

confidence: 99%

Olfactory reference syndrome: issues for DSM-V

2010

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The published literature on olfactory reference syndrome (ORS) spans more than a century and provides consistent descriptions of its clinical features. The core symptom is preoccupation with the belief that one emits a foul or offensive body odor, which is not perceived by others. This syndrome is associated with substantial distress and disability. DSM-IV and ICD-10 do not explicitly mention ORS but note convictions about emitting a foul body odor in their description of delusional disorder, somatic type. However, the fact that such symptoms can be non-delusional poses a diagnostic conundrum. Indeed, DSM-IV also mentions fears about the offensiveness of one’s body odor in the social phobia text (as a symptom of taijin kyofusho). There also appears to be phenomenological overlap with body dysmorphic disorder, obsessive-compulsive disorder, and hypochondriasis. This paper provides a focused review of the literature to address issues for DSM-V, including whether ORS should continue to be mentioned as an example of another disorder or should be included as a separate diagnosis. We present a number of options and preliminary recommendations for consideration for DSM-V. Because research is still very limited, it is unclear how ORS should best be classified. Nonetheless, classifying ORS as a type of delusional disorder appears problematic. Given this syndrome’s consistent clinical description across cultures for more than a century, substantial morbidity, and a small but growing research literature, we make the preliminary recommendation that ORS be included in DSM-V’s Appendix of Criteria Sets Provided for Further Study, and we suggest diagnostic criteria.

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Section: Resultsmentioning

confidence: 99%

Olfactory reference syndrome: issues for DSM-V

2010

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“…However, several authors have questioned this categorization (Dominguez & Puig, 1997 ;Stein et al 1998 ;Suzuki et al 2004 ;Phillips et al 2006 ;McGoldrick et al 2008), arguing that the core belief in ORS is not always held with delusional intensity and that the patients can show a spectrum of insight. This nosological uncertainty spills over into the literature on treatment.…”

Section: Introductionmentioning

confidence: 99%

Olfactory reference syndrome: a systematic review of the world literature

Begum

McKenna

2010

Psychol. Med.

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“…2 There is no established standard treatment for ORS. Some case studies have reported (partial) response with clomipramine, 1,3,4 while others have reported nonresponse. [5][6][7] The interpretation of previous case reports on behavioral therapy and eye movement desensitization and reprocessing (EMDR) is impeded by the paucity of objective outcome assessments.…”

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confidence: 99%

Cognitive Behavioral Therapy for Olfactory Reference Syndrome

Zantvoord

Vulink

Denys

2016

J. Clin. Psychiatry

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was carried out with 8 fellow group members who were all suffering from body dysmorphic disorder (BDD). Treatment consisted of twice-weekly sessions with a total duration of 16 weeks. CBT was based on a previously published manual, 13 which was adapted to facilitate group-based treatment. The first session entailed psychoeducation and establishment of treatment goals. In the second session, an exposure hierarchy was composed. During and between sessions, gradual and repetitive in vivo exposure with task concentration and response prevention were performed. The treatment manual was adapted specifically for Ms A to include tailored exposure exercises to evoke fear-inducing stimuli related to her emitting an offensive body odor. Examples included approaching someone on the street for small talk and, subsequently, standing close and talking to someone in a confined space and then doing so without using deodorant or showering beforehand. Cognitive restructuring was introduced to identify and adjust dysfunctional beliefs. In the final sessions, relapse prevention strategies were discussed. Apart from body-oriented therapy elements, such as progressive muscle relaxation (Jacobson technique) and breathing exercises, no concurrent treatments were performed.Following treatment, Ms A's ORS symptoms fully remitted. For residual GAD symptoms, paroxetine 20 mg/d was initiated after CBT termination. Two months thereafter, GAD symptoms remitted (Table 1). In the following months, ORS and GAD symptoms remained in remission. Ms A resumed her studies and group fitness classes. The present case is the first report of successful treatment of ORS combining cognitive and behavioral techniques. ORS and comorbid symptoms were assessed using objective rating scales, elaborating on previous reports on behavioral therapy and EMDR in ORS.5,7-9 After CBT group treatment, ORS symptoms fully remitted and improvement was maintained for 6 months. Paroxetine treatment initiated after CBT could have contributed to maintenance of remission. Our findings are promising, because a standard treatment for ORS has not been established. 2,6 The classification of ORS as an obsessive-compulsive spectrum disorder is a point of ongoing debate.2 The group CBT in which our patient enrolled was designed for treatment of BDD. Nevertheless, ORS remitted, which gives some support for the classification of ORS as an obsessive-compulsive spectrum disorder. However, our observations should be interpreted with caution, as the effects noted could be based on nonspecific therapeutic factors and were limited to a single case. Therefore, further research, particularly a randomized controlled trial of the efficacy of CBT in ORS, is warranted.

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Olfactory Reference Syndrome Responds to Clomipramine But Not Fluoxetine

Cited by 27 publications

References 0 publications

Olfactory reference syndrome: issues for DSM-V

Olfactory reference syndrome: issues for DSM-V

Olfactory reference syndrome: a systematic review of the world literature

Cognitive Behavioral Therapy for Olfactory Reference Syndrome

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