Innovative treatment of a rare exggerated obsessive-compulsive reaction to smell
- Author:
Malik Badri
- Publication Type:Case Reports
- From:ASEAN Journal of Psychiatry
2013;14(1):1-4
- CountryMalaysia
- Language:English
-
Abstract:
This case report highlights about a patient with OCD (Obsessive-Compulsive Disorder) patient who presented with exaggerated compulsions related to bad smell. Methods: We report a case of a cleaner who encountered bad odors
and responded with compulsive showering and wearing fresh clothes. His disorder is differentially diagnosed with similarities and differences between his disorder and
that of olfactory reference syndrome, bromidrophobia and obsessive disgust to smell. Results: The treatment of choice for OCD is exposure and prevention therapy
(EPT). We started the treatment with cognitive restructuring combined with our
innovative spiritually oriented mindfulness and acceptance therapy. And to avoid the shortcoming of EPT of excessive anxiety to full-blown exposure and prevention,
we have introduced novel adaptations that rendered our therapy to be more of the classical reciprocal inhibition and the gradual systematic desensitization techniques
of Wolpe than the straight forward EPT. The reciprocal inhibition was presented by asking the patient to smell a rotten fish in a plastic bag and whenever his anxiety
became unbearable the bag was closed and he inhaled the opposite fragrance of sprayed perfume while relaxing and breathing abdominally. Similar to systematic
desensitization therapy, we repeated the whole process but gradually increased the time of smelling the rotten fish before enjoying its opposite fragrance. His
improvement was dramatic, observed from the first session. After 4 sessions, he resumed his job and had no relapse, but he carried a bottle of his preferred perfume
to counteract the bad smell. Conclusion: OCD reaction to smell may respond well with only cognitive-behaviour therapy.
