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)

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 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.