“Multiple chemical sensitivities” has become an increasingly common clinical presentation to physicians, though it is infrequently seen by psychotherapists. This case report describes a 61-year-old woman who presents with a long history of chemical sensitivities, that led to a somatization disorder with debilitating agoraphobia, depression, and marital problems. Features of a variety of anxiety disorders are present, as are metacognitions that required an unusual case conceptualization. A cognitive therapy case conceptualization and treatment are described, which address the highly idiosyncratic clinical presentation of this patient.