Cognitive Behavioral Therapy for Olfactory Reference Syndrome

Abstract

was carried out with 8 fellow group members who were all suffering from body dysmorphic disorder (BDD). Treatment consisted of twice-weekly sessions with a total duration of 16 weeks. CBT was based on a previously published manual, 13 which was adapted to facilitate group-based treatment. The first session entailed psychoeducation and establishment of treatment goals. In the second session, an exposure hierarchy was composed. During and between sessions, gradual and repetitive in vivo exposure with task concentration and response prevention were performed. The treatment manual was adapted specifically for Ms A to include tailored exposure exercises to evoke fear-inducing stimuli related to her emitting an offensive body odor. Examples included approaching someone on the street for small talk and, subsequently, standing close and talking to someone in a confined space and then doing so without using deodorant or showering beforehand. Cognitive restructuring was introduced to identify and adjust dysfunctional beliefs. In the final sessions, relapse prevention strategies were discussed. Apart from body-oriented therapy elements, such as progressive muscle relaxation (Jacobson technique) and breathing exercises, no concurrent treatments were performed.Following treatment, Ms A's ORS symptoms fully remitted. For residual GAD symptoms, paroxetine 20 mg/d was initiated after CBT termination. Two months thereafter, GAD symptoms remitted (Table 1). In the following months, ORS and GAD symptoms remained in remission. Ms A resumed her studies and group fitness classes. The present case is the first report of successful treatment of ORS combining cognitive and behavioral techniques. ORS and comorbid symptoms were assessed using objective rating scales, elaborating on previous reports on behavioral therapy and EMDR in ORS.5,7-9 After CBT group treatment, ORS symptoms fully remitted and improvement was maintained for 6 months. Paroxetine treatment initiated after CBT could have contributed to maintenance of remission. Our findings are promising, because a standard treatment for ORS has not been established. 2,6 The classification of ORS as an obsessive-compulsive spectrum disorder is a point of ongoing debate.2 The group CBT in which our patient enrolled was designed for treatment of BDD. Nevertheless, ORS remitted, which gives some support for the classification of ORS as an obsessive-compulsive spectrum disorder. However, our observations should be interpreted with caution, as the effects noted could be based on nonspecific therapeutic factors and were limited to a single case. Therefore, further research, particularly a randomized controlled trial of the efficacy of CBT in ORS, is warranted.

Olfactory Reference Syndrome Treated With Lurasidone and Cognitive Behavioral Therapy: A Case Report

“…CBT has proven to be helpful not only for anxiety, depression, OCD and BDD, but it has shown to substantially benefit ORS patients with full remission after only 2 months. 14 Similarly, in our case patient showed exceptional improvement and full remission after 3 months of offering treatment.…”

“…A meticulous search of the literature, however, proves CBT to be effective both alone and in combination with pharmacotherapy. 12,[14][15][16]18,19 In our case, the patient experienced foul body odor, anxiety, and paranoia after a stressful triggering event. We believe that our patient might have lost insight early on in her illness.…”

“…A meticulous search of the literature, however, proves CBT to be effective both alone and in combination with pharmacotherapy. 12,14 -16,18,19…”

Cognitive behaviour therapy for olfactory reference disorder (ORD): A case study

“…The research evidence on mechanisms and treatment of ORD is scant. Interventions using pharmacotherapy have been reported using SSRIs or SSRI with antipsychotic augmentation (Dominguez & Puig, 1997;Michael, Boulton, & Andrews, 2014;Stein, Le Roux, Bouwer, & Van Heerden, 1998) but only three case reports using psychological therapy have been reported, two with successful use of an exposure and response prevention rationale (Martin-Pichora & Antony, 2011, Zantvoord, Vulink, & Denys, 2016) and a case series utilising EMDR (McGoldrick, Begum, & Brown, 2008). Disorder specific treatment guidelines…”

Cognitive behavioral therapy for a Japanese woman with olfactory reference disorder (ORD) comorbid with schizophrenia: A case study

“…Another potential for ORD treatment is cognitive behavioral therapy (CBT). Some previous case reports have suggested that utilizing CBT adjusted for obsessive–compulsive disorder (OCD) models could potentially reduce ORD symptoms 4,9,10 . The CBT model has been successful in treating female patients in the UK, the USA, and Australia 4,10,11 .…”