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

- We present a case of successful use of Cognitive Behavioural Therapy (CBT) in the treatment of Olfactory Reference Disorder (ORD).
- Techniques such as Theory A/B, behavioural experiments, surveys and video feedback were useful to change the beliefs maintaining ORD.
- Empirically supported CBT approaches to treating BDD and OCD translate well to treatment of ORD.
- CBT significantly reduces core symptoms of ORD in addition to depressive and anxious symptoms.
- Change in symptoms is best measured using an ORD focused measure.

Olfactory Reference Disorder (ORD) is preoccupation with the belief that one is emitting a foul odour. It can be a distressing and substantially impairing problem. However, very little is known about its successful treatment. This study describes the treatment of a 38-year-old female with longstanding ORD using Cognitive Behavioural Therapy (CBT). Case conceptualisation focused on identifying unhelpful beliefs and maintaining factors including safety-seeking behaviours, self-focus and avoidance. These were then targeted using a variety of techniques including discussion and behavioural experiments to facilitate belief and behaviour change. Following a 12-week treatment, measures of anxiety and depression reduced to below clinical thresholds. In addition, there were reductions on a specific measure of symptoms of ORD. Issues regarding the use of CBT to treat this particular disorder are considered.