Prevalence of olfactory reference syndrome in obsessive-compulsive disorder and social anxiety disorder.

To the Editor: Olfactory reference syndrome (ORS) is a condition characterized by concerns about perceived body odor, which may lead to repetitive behaviors to diminish the odor, as well as to avoidance of social interactions.1,2 A range of other terms describing olfactory reference symptomatology has appeared in the literature; for example, based on the observation that it involves a single belief that is often delusional in intensity, ORS has been referred to as a type of monosymptomatic hypochondriacal psychosis (eg, see references 3–5). ORS is now referred to in DSM-5 as a type of “other specified obsessive-compulsive and related disorder.” In this section, DSM-5 lists the Japanese construct of jikoshu-kyofu, which appears similar to ORS. It notes that jikoshukyofu is considered a variant of taijin kyofusho,6 a diagnosis that has features in common with social anxiety disorder (SAD). Although it has been argued that ORS is sufficiently prevalent to include in DSM-5,7 there is a relative lack of prevalence studies that employ structured diagnostic interviews. Suggested prevalence rates range from 0.5% to 2.1% (eg, see references 8 and 9). Given the increased prevalence of some obsessive-compulsive–related disorders in obsessive-compulsive disorder (OCD), it might be expected that ORS is also seen in OCD patients. Given that ORS may have features, such as heightened social concerns, in common with SAD, it might also be hypothesized that ORS is comorbid with SAD. To our knowledge, this is the first study to examine the prevalence of ORS in OCD and SAD.