Background: Olfactory Reference Syndrome (ORS), also known as Olfactory Reference Disorder, is a distressing psychiatric condition marked by the persistent, often delusional belief that one emits a foul body odor, despite no detectable smell by others. ORS typically begins in adolescence or early adulthood and affects both sexes, with some studies indicating a slight male predominance. It is frequently comorbid with other psychiatric disorders, including major depressive disorder (69%), social anxiety disorder (48%), and obsessive-compulsive disorder (27%). Suicidal ideation and behavior are also common, emphasizing the condition’s clinical severity A hallmark of ORS is its profound impact on social functioning. Individuals often misinterpret neutral social cues—such as someone touching their nose or stepping back—as confirmation of their feared odor, leading to shame, paranoia, and significant social withdrawal. This can result in avoidance of public spaces and, as in the present case, disengagement from school and other social settings. Case report: “Bart” is a 17-year-old male with a three-year history of progressively worsening social functioning, marked by a persistent preoccupation with emitting a foul body odor, despite no objective evidence—consistent with Olfactory Reference Syndrome (ORS). His symptoms began at age 14 and were accompanied by auditory hallucinations, paranoid ideation, and heightened sensitivity to social cues, leading to significant emotional distress, shame, and eventual withdrawal from school. Over time, he developed intense social avoidance, rigid thinking patterns, and behaviors consistent with the obsessive-compulsive spectrum, such as compulsive grooming and concerns about others' modesty. Despite ongoing cognitive challenges, including impaired concentration and memory, Bart remains cognitively intact and continues to pursue independent learning, reflecting a degree of resilience and ongoing engagement with his personal development. Conclusion: This case highlights the complex clinical presentation and significant functional impairment associated with Olfactory Reference Syndrome in adolescence. Early recognition and a comprehensive, multidisciplinary approach are essential to address the condition’s psychiatric comorbidities, reduce social isolation, and support adaptive functioning and educational engagement.
