AbstractIn this paper a treatment-resistant olfactory perversion (osmophi-lia) was eventually treated successfully with antiandrogen medication and psychotherapy. A single case method was utilized and an ego psychological and self psychological theoretical framework employed. It is concluded that two processes must be addressed in the treatment of perversions: the “structure” of the perversion, which is biopsychologically driven by the individual's particular neurobiology, and the “content” of the perversion, which is psy-chodynamically driven. The treatment of perverse symptom formation must be multimodal and eclectic.