Halitophobia is a persistent preoccupation with the conviction of bad breath although it is not perceptible to others in reality. We report a case of adolescent halitophobia that was successfully treated.
A 19-year-old female, a university student, complained of halitosis from the surface of the tongue. She noticed halitosis in the first grade as a senior high school student, then visited a dental clinic specializing in halitosis and tried many oral care instruments but her condition did not improve. In addition, she stuck to the belief of long tongue papillae and visited an oral surgeon, but no organic abnormalities were found. Gradually, she tended to withdraw, therefore her mother recommended her to visit our department.
She had no medical history except for a congenital defect of the right internal carotid artery. There was no subjective halitosis and she had kept good oral hygiene and the score on the Liebowitz Social Anxiety Scale （LSAS-J） was 56 （fear: 31/avoidance: 25）.
We explained the relationship between halitosis and anthropophobia and suggested pharmacotherapy for relieving interpersonal fear. Her mother was concerned about psychotropic drugs, so we explained the effects on pregnancy and side effects, after which informed consent was obtained. Considering the risk of activation syndrome due to selective serotonin reuptake inhibitors in youth, aripiprazole 0.5mg/day was prescribed at first. For the psychotherapy, the outpatient interview was based on “descriptions of impressions.”
Aripiprazole was increased to 1.0mg/day, and the fear part of LSAS-J decreased to 26 and avoidance decreased to 9 at 25 weeks. Her social activities with her family and friends increased, but she did not acquire confidence in meeting someone for the first time. Then, Fluvoxamine 12.5mg/day was added to aripiprazole 0.5mg/day. Off-campus practical training, which she was anxious to participate in, was accomplished. Moreover, she started a part-time job at a fast-food restaurant. At 43 weeks, the fear part of LSAS-J decreased to 14 and avoidance to 4. At 82 weeks, her complaints of halitosis have disappeared.
In this case, aripiprazole reduced avoidance, but it did not reduce fear and Fluvoxamine had a great effect. She mentioned that she had not worried about halitosis during interpersonal activities and that she had increased social activities, suggesting that supportive psychotherapy had given her confidence on interpersonal occasions with pharmacotherapy. “Descriptions of impressions” were poorer than that of previous reports and the clinical interview was preferred, therefore it is necessary to select psychotherapy appropriate for each patient.
