A Case Report of Olfactory Reference Disorder with Childhood Trauma: Aetiological and neurobiological insights

TL;DR

A 22-year-old man with a history of childhood trauma developed olfactory reference disorder, which improved with medication, suggesting trauma's role in the condition.

Contribution

This case provides aetiological and neurobiological insights into olfactory reference disorder linked to childhood trauma.

Findings

The patient's olfactory reference disorder was associated with childhood sexual abuse and responded to sertraline and aripiprazole.

The case supports a diathesis-stress model where trauma may manifest as olfactory reference disorder through experiential avoidance.

Abstract

We report a 22-year-old male, who presented in 2020 to a clinic in Kahramanmaraş, Turkey, with a 5-year history of a fixed preoccupation with the belief of emitting a ‘plastic smell’ from his anal region. This case illustrates a clinically significant link with a history of childhood sexual abuse. The patient was diagnosed with olfactory reference disorder (ORD) with poor insight and comorbid depressive disorder, based on ICD-11 and DSM-5-TR criteria. Extensive medical workups ruled out organic causes. He responded well to a combination therapy of sertraline and aripiprazole, showing significant symptom reduction. This case supports a diathesis-stress model where ORD can manifest as a somatic metaphor for trauma, mediated by experiential avoidance. It highlights the importance of trauma assessment and a neurobiologically informed psychopharmacological approach in managing ORD.

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