Making sense of a delusion of smell: a psychotherapeutic approach

Drug treatment is now recommended as the treatment of choice in monosymptomatic delusional states and attempts are made to distinguish these from their 'neurotic' equivalents who may be given different treatments. Such psychotic/neurotic distinctions are not always possible and are sometimes unhelpful, if relevant dynamic issues are ignored. The most appropriate treatment may better be decided by an assessment of other factors such as personality, motivation and important details of a patient's childhood. A case report is presented of a young woman with a delusional belief that a foul smell emanated from her womb and who was treated successfully with weekly dynamic psychotherapy for 18 months. The process of therapy is outlined in the hope that psychotherapy may be offered more often to such patients.