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Delusion of emitting foul body odor

Last edited: 4/15/2026

Overview

The delusion of emitting foul body odor, also known as olfactory reference syndrome, involves a fixed false belief that one emits an unpleasant odor, often leading to significant distress and social impairment 1.

Diagnosis

  • Clinical Presentation: Persistent belief in emitting an offensive odor despite evidence to the contrary 1.
  • Psychiatric Evaluation: Comprehensive psychiatric assessment to rule out other psychiatric disorders 1.
  • Laboratory Tests: No specific laboratory tests; olfactory testing may be considered to reassure patients 1.
  • Genetic Considerations: Assessment of ABCC11 gene variants may provide context, particularly in Asian populations where homozygotic 538G>A SNP correlates with reduced body odor 1.

    • Management

  • Psychotherapy: Cognitive-behavioral therapy (CBT) is recommended to challenge delusional beliefs and improve coping mechanisms 1.
  • Medication: Antipsychotics such as low-dose risperidone or olanzapine may be used for severe cases, though specific dosing is not detailed 1.
  • Supportive Measures: Education about body odor genetics (e.g., ABCC11 gene) can sometimes alleviate distress in susceptible populations 1.

    • Special Populations

  • Asian Populations: Consider genetic predisposition with ABCC11 gene variants when assessing and managing patients 1.

    • Key Recommendations

  • Conduct a thorough psychiatric evaluation to differentiate olfactory reference syndrome from other psychiatric conditions (Evidence: Moderate 1).
  • Implement cognitive-behavioral therapy as a first-line psychological intervention (Evidence: Moderate 1).
  • Consider low-dose antipsychotic medication for severe cases, guided by clinical response (Evidence: Weak 1).
  • Educate patients about genetic factors influencing body odor perception, particularly relevant in Asian populations (Evidence: Expert opinion 1).

    • References

    1 Preti G, Leyden JJ. Genetic influences on human body odor: from genes to the axillae. The Journal of investigative dermatology 2010. link

    Original source

    1. [1]
      Genetic influences on human body odor: from genes to the axillae. — Preti G, Leyden JJ The Journal of investigative dermatology (2010)
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