Background: Delusional disorders related to the skin, such as subjective bromidrosis, are clinically associated with a chronic course and doubtful prognosis. Case studies showing in detail the process of psychotherapy and its results are few. Case Report: A 32-year-old African graduate student suffered from the delusive idea that other people might be embarrassed by his ‘malodor’ (bromidrosis). He retired from social contact, stopped studying, and became increasingly depressed. He developed the conviction that he was afflicted with a life-threatening physical illness which had not yet been diagnosed. Psychotherapy: Transferred to our psychodermatological hospital unit, he entered a short-term course of psychodynamic treatment, which focussed on his projective defenses, directed against severe aggressive strivings resulting from a painful divorce. The patient gained insight and his complaints improved. Follow-up: After discharge, the patient’s mental state improved clinically and psychometrically (SCL-90-R, ACS), compared with the initial scores. A follow-up 3 years later confirmed a gradual but decisive change in psychic functioning and a better social adjustment. Conclusion: The psychodynamic function of his symptomatology is discussed in summary. It can be concluded that insight-oriented, psychodynamic treatment may alleviate severe psychodermatological conditions.

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