Idiopathic environmental intolerance (Multiple chemical sensitivity): A psychiatric case report with psychodynamic formulation

Patients labelled with “Multiple Chemical Sensitivity” (MCS) frequently present with multi-system complaints, high avoidance, and substantial psychiatric burden. Etiology remains disputed. Psychiatric care must validate suffering while remaining agnostic about toxic causality. A 67-year-old woman with lifelong somatic vulnerability, chronic tobacco use, and extensive occupational exposure to pesticides and solvents reported odor-linked autonomic surges, fatigue, pain, and cognitive fog. External physicians documented GSTM1 null genotype; abnormal red-ox/mitochondrial markers (elevated lactate–pyruvate ratio, high SOD, low GPx), disturbed vitamin-D metabolism (low 25-OH with high 1,25-di-OH), and MRI/MRS (2013) interpreted by neuroradiology as diffuse toxic leukoencephalopathy “compatible with chronic solvent exposure.” Autonomic testing reproduced paroxysmal tachycardia. Psychiatric evaluation identified depressive and anxiety symptoms, illness-focused ruminations, high environmental vigilance, and moderate structural vulnerabilities in affect regulation and mentalization. Psychodynamic counseling (OPD-guided focus on self-esteem regulation, affect tolerance, and relational patterns), paced functional restoration, and liaison with medical care. No etiologic assertions were made. Improved affect regulation and role function with a reduced avoidance radius; persistent sensitivity to strong odors. Psychodynamic treatment can reduce distress and disability in IEI/MCS-labelled presentations while remaining causally neutral. Transparent attribution of external medical findings and CARE-standard reporting enable constructive interdisciplinary dialogue.