Olfactory Reference Syndrome (ORS) and Irritable Bowel Syndrome (IBS)-like Symptoms: Is There A Hidden Relationship Between the Psychiatric and Physical Symptoms? An Internet-based Study (Preprint)
Authors: Kawanishi Hitomi , Sekiguchi Atsushi , Sugawara Norio , Funaba Misako , Tomita Yoshitoshi , Ohara Chisato , Sugawara Ayako , Kanazawa Motoyori , Fukudo Shin , Ando Tetsuya 
Published: August 2020

BACKGROUND

Olfactory Reference Syndrome (ORS) is characterized by a preoccupation focus on the belief that one emits a foul body odor. ORS preoccupied with stool/flatus odor is often comorbid in Irritable bowel syndrome (IBS). The association between gastrointestinal symptoms and ORS has not been extensively studied, and the pathological mechanisms are poorly understood. There is an underlying reason why the study has not been done because ORS patients with IBS often feel ashamed and embarrassed about their problems. It might lead to barriers to health care utilization. Therefore, we used an internet survey for maintaining anonymity.

OBJECTIVE

This study aimed to examine the association between ORS and IBS-like symptoms to elucidate the hidden pathological mechanisms and to understand comprehensive features of individuals with the two symptoms.

METHODS

An internet survey was administrated between January 23, 2019 through February 28, 2019, to individuals who had both ORS and IBS-like symptoms on Japanese websites. ORS was assessed using the self-report Yale-Brown Obsessive Compulsive Scale adopted to preoccupation with stool/flatus odor (Y-BOCS focused on ORS). IBS-like symptom was assessed with the IBS severity index (IBSSI-J). The types of sensory modalities, (a) vision (b) audition (c) olfaction (d) taste (e) touch and (f) interoception, triggering ORS symptoms as antecedent stimuli were examined. Beck Depression Inventory-II (BDI-II), Liebowitz Social Anxiety Scale (LSAS) and Oxford Schizotypal Personality Scale (STA) were measured.

RESULTS

A total of 203 usable responses was obtained. The mean score of 19.8 (SD = 7.6) on the Y-BOCS focused on ORS, indicating moderate severity of ORS in OCD. The mean IBSSI-J score was 243 (SD = 101.3), indicating moderate severity of IBS. Correlation between Y-BOCS focused on ORS and IBSSI-J was r = 0.37 (P <.001). The strongest correlation was seen between Y-BOCS focused on ORS and BDI-II (r = 0.62, P <.001). Of the sensory modalities, interoception such as abdominal pain or anal discomfort was the most common (82.2%) followed by audition (77.3%) and olfaction (76.8%). Mean scores of 25.4 for the BDI-II, 72.8 (SD = 28.0) for the LSAS, and 16.5 (SD = 6.8) for the STA. Concerning suicide risk assessed by BDI-II, item 9 showed 68.5% had experienced suicidal ideation within the two weeks prior. In particular, 14.8% (scored2) and 10.8% (scored3) indicating a high risk of suicide.

CONCLUSIONS

From the analysis of the relationship between ORS and IBS- like symptoms, ORS concerning stool/flatus odor may be influenced by IBS–like symptoms. The scores of the mental symptoms (depression/social anxiety) indicated moderate severity, and the suicide risk was high. It should be considered that a subset of IBS patients has comorbid ORS, which may lead to negative mental effects.