Olfactory Reference Syndrome with Suicidal Attempt Treatedwith Pimozide and Fluvoxamine

The core symptomatology of the Olfactory Reference Syndrome (ORS) is characterized by a preoccupation with the belief thatone emits an offensive odor, albeit not perceived by others. The present case is that of a 75-year-old African American woman,with an unclear past psychiatric history, who was brought into our Emergency Room after a suicide attempt. The patient reporteda three-year history of a “rotten” smell from her vagina. She adamantly believes that she smells despite being told otherwiseby people. The patient reported a trial of several feminine products to get rid of this smell and multiple visits to specialistsbut her symptoms persisted. Her symptoms involved a significant depressed mood and deterioration in her social functioning,interpersonal relationships, and self-care. She was constantly in the shower and had stopped leaving her apartment due to worriesthat people might smell her vagina. The culmination of her distress was the suicidal attempt, for which she was brought to thehospital. She was admitted to the inpatient psychiatric unit and started on Pimozide and Fluvoxamine. The patient made remarkableprogress within a few days on admission and in the course of her hospitalization. Follow-up in our outpatient clinic shows that thepatient remains completely asymptomatic with significant progress in her social functioning.