Successful Treatment of Olfactory Reference Syndrome With Cognitive Behavioral Therapy: A Case Study

Olfactory reference syndrome (ORS) is characterized by a preoccupation with the belief that one's body emits a foul odor. Cognitive behavioral therapy (CBT) was used to treat a woman in her 50s who presented in our outpatient anxiety disorders specialty clinic with ORS, accompanied by embarrassment, shame, distress, avoidance behavior, and social isolation. Monitoring and systematic reduction of safety behaviors, combined with exposure to anxiety-provoking situations, resulted in elimination of the perceived body odor over the course of ten treatment sessions. Scores on the Overvalued Ideas Scale indicated improvements in the client's insight over the course of treatment, and there was an 82.6% reduction in her preoccupation and compulsive behaviors as measured by the Body Dysmorphic Disorder Yale-Brown Obsessive Compulsive Scale. Indices of depression, anxiety, and stress as measured by the 21-item version of the Depression Anxiety Stress Scales were also reduced from the extremely severe to normal range. These findings suggest further investigation of CBT in the treatment of ORS is warranted.