yemenjmedYemen Journal of MedicinecoVolume 4 Issue 1MultidisciplinaryEnglishJanuary- April 2025NNY20250523ArticleWhen Smell Becomes the Shadow: A Case Report of Olfactory Reference DisorderEnglishY174177SanthoshGoud¹EnglishNAshish RanjanPanda²EnglishYVishal Indla³ EnglishY10.63475/yjm.v4i1.0058Olfactory 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.  EnglishOlfactory Reference Disorder, Olfactory Reference Syndrome, Obsessive-Compulsive and Related Disorder, Cognitive Behavior Therapy.https://www.yemenjmed.com/admin/abstract?id=159References1619World Health Organization. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. World Health Organization; 2024.Roshan MP, Desai A, Dunn JM, Agbeve SD, Mesa-Morales L, LaTray AT, et al. Clearing the Air: Multimodal Treatment of a Case of Olfactory Reference Syndrome. Psych. Res. Case. Rep. 2024 Jun 1; 3(1):100206and;ndash;6.Lochner C, Stein DJ. Prevalence of olfactory reference syndrome in obsessive-compulsive disorder and social anxiety disorder.J. Clin. Psychiatry. 2014 Nov 24; 75(11):15467.Sofko C, Tremont G, Tan JE, Westervelt H, Ahern DC, Menard W, et al. Olfactory and neuropsychological functioning in olfactory reference syndrome. Psychosomatics. 2020 May 1; 61(3):261-7.Thomas E, du Plessis S, Chiliza B, Lochner C, Stein D. Olfactory reference disorder: Diagnosis, epidemiology and management. CNS drugs. 2015 Dec; 29:999-1007.Reuter J, Grocholewski A, Steil R. Prevalence of olfactory reference disorder according to the ICD-11 in a German university student sample. Curr. Psychol. 2024 May; 43(17):15102-12.Thomas E, Voges J, Chiliza B, Stein DJ, Lochner C. Sniffing out olfactory reference syndrome. S. Afr. J. Psychiatr. 2017 Jan 31; 23:1016.Begum M, McKenna PJ. Olfactory reference syndrome: a systematic review of the world literature. Psychol. Med. 2011 Mar; 41(3):453-61.Pryse-Phillips W. An olfactory reference syndrome. Acta. Psychiatr. Scand. 1971;47(4):484-509.Suzuki K, Takei N, Iwata Y, Sekine Y, Toyoda T, Nakamura K, et al. Do olfactory reference syndrome and jiko-shu-kyofu (a subtype of taijin-kyofu) share a common entity? Acta. Psychiatr. Scand. 2004 Feb; 109(2):150-5; discussion 155.Michael S, Boulton M, Andrews G. Two cases of olfactory reference syndrome responding to an atypical antipsychotic and SSRI. Aust. N Z. J. Psychiatry. 2014 Sep; 48(9):878-9.