Matsumoto Kazuki, Nonaka Mari, Arai Kaoru, Nakamura Masayuki
Division of Clinical Psychology Kagoshima University Hospital Kagoshima Japan.
Department of Psychiatry Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan.
PCN Rep. 2024 Mar 8;3(1):e179. doi: 10.1002/pcn5.179. eCollection 2024 Mar.
Olfactory reference disorder (ORD) is a mental illness in which individuals overestimate their sense of smell and worry about the negative impact of odors. Little is known about its successful treatment. A new cognitive behavioral model was developed based on cognitive behavioral therapy (CBT) for obsessive-compulsive disorder. Using this model, this study reports a successful treatment process of a 53-year-old female with ORD.
The patient's initial diagnosis was schizophrenia, and improvements were observed, such as the disappearance of persecutory delusions, through medication therapy. During this treatment process, it became clear that the patient's preoccupation with her own offensive body odor was not a hallucination or delusion caused by schizophrenia but rather a symptom of ORD. Within a limited 4-week hospitalization period, high-intensity CBT was provided by a clinical psychologist and a psychiatrist. Multiple CBT techniques were employed, including case formulation to identify her beliefs, reviewing safety-seeking behaviors, attention shift training, behavioral experiments, public opinion polls, mindfulness meditation, and exposure and response prevention.
Following a seven-sessions intensive intervention over 3 weeks, her symptoms of ORD, anxiety, and depression reduced. High-frequency CBT practices could be beneficial in treatment of patients with severe ORD, addressing severe ORD cases, facilitating rapid improvement in both ORD symptoms and functioning.
嗅觉参照障碍（ORD）是一种精神疾病，患者高估自己的嗅觉并担心气味产生的负面影响。关于其成功治疗的了解甚少。基于强迫症的认知行为疗法（CBT）开发了一种新的认知行为模型。利用该模型，本研究报告了一名53岁ORD女性患者的成功治疗过程。
患者最初被诊断为精神分裂症，通过药物治疗观察到病情有所改善，如被害妄想消失。在治疗过程中，逐渐明确患者对自身难闻体臭的过度关注并非精神分裂症所致的幻觉或妄想，而是ORD的症状。在为期4周的有限住院期间，由临床心理学家和精神科医生提供高强度CBT。采用了多种CBT技术，包括病例构思以识别她的信念、回顾寻求安全行为、注意力转移训练、行为实验、民意调查、正念冥想以及暴露与反应阻止。
经过3周共7次的强化干预后，她的ORD、焦虑和抑郁症状减轻。高频CBT实践可能有益于治疗重度ORD患者，解决重度ORD病例，促进ORD症状和功能的快速改善。
