Successful Treatment of Halitophobia with Cognitive Behavioural Therapy: A Case Study


Halitophobia is a condition characterized by an excessive preoccupation with the belief of having halitosis. Cognitive Behavioural Therapy (CBT) was successfully used to treat a man in his 20 s who presented with important anxiety, avoidance and safety behaviours, isolation, and depressed mood. Progressive in-vivo exposure to fearful situations with the systematic prevention of avoidance and safety behaviours resulted in a significant improvement in the patient’s anxiety and depression levels. This case suggests that CBT techniques, usually performed in anxiety disorders and in obsessive–compulsive disorder, can be adapted to halitophobia.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. American Psychiatric Association, A. D., A. P. S. M. T. F. (2013). Diagnostic and statistical manual of mental disorders. (5th ed.). Washington, DC: APA

    Google Scholar 

  2. Begum, M., & McKenna, P. J. (2011). Olfactory reference syndrome: A systematic review of the world literature. Psychological Medicine, 41, 453–461.

    Article  CAS  PubMed  Google Scholar 

  3. Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A. & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depression and Anxiety,

    Article  PubMed  PubMed Central  Google Scholar 

  4. Choy, Y., Fyer, A. J., & Lipsitz, J. D. (2007). Treatment of specific phobia in adults. Clinical Psychology Review, 27, 266–286.

    Article  PubMed  Google Scholar 

  5. Ferreira, J. A., Dallaqua, R. P., Fontenelle, L. F., & Torres, A. R. (2014a). Olfactory reference syndrome: A still open nosological and treatment debate. General Hospital Psychiatry, 36, 760 e761–763.

    Article  PubMed  Google Scholar 

  6. Greenberg, J. L., Mothi, S. S., & Wilhelm, S. (2016). Cognitive-behavioral therapy for adolescent body dysmorphic disorder: A pilot study. Behavior Therapy, 47, 213–224.

    Article  PubMed  Google Scholar 

  7. Hamilton, M. (1960). A rating scale for depression. J Neurol Neurosurg Psychiatry, 23, 56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Kazdin, A. E. (1981). Drawing valid inferences from case studies. Journal of Consulting and Clinical Psychology, 49, 183–192.

    Article  CAS  PubMed  Google Scholar 

  9. Maack, D. J., Deacon, B. J., & Zhao, M. (2013). Exposure therapy for emetophobia: A case study with three-year follow-up. Journal of Anxiety Disorders, 27, 527–534.

    Article  PubMed  Google Scholar 

  10. Maier, W., Buller, R., Philipp, M., & Heuser, I. (1988). The Hamilton Anxiety Scale: Reliability, validity and sensitivity to change in anxiety and depressive disorders. Journal of Affective Disorders, 14, 61–68.

    Article  CAS  PubMed  Google Scholar 

  11. Martin-Pichora, A. L., & Antony, M. M. (2011). Successful treatment of olfactory reference syndrome with cognitive behavioral therapy: A case study. Cognitive and Behavioral Practice, 18, 545–554.

    Article  Google Scholar 

  12. McLean, C. P., Van Meter, P. E., Carpenter, J. K., Simpson, H. B., Foa, E. B. (2015). Exposure and response prevention helps adults with obsessive-compulsive disorder who do not respond to pharmacological augmentation strategies. The Journal of Clinical Psychiatry, 76, 1555–2101.

    Article  Google Scholar 

  13. Moody, T. D., Morfini, F., Cheng, G., Sheen, C., Tadayonnejad, R., Reggente, N., et al. (2017). Mechanisms of cognitive-behavioral therapy for obsessive-compulsive disorder involve robust and extensive increases in brain network connectivity. Translational psychiatry, 7, e1230.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Ong, C. W., Clyde, J. W., Bluett, E. J., Levin, M. E., & Twohig, M. P. (2016). Dropout rates in exposure with response prevention for obsessive-compulsive disorder: What do the data really say? Journal of Anxiety Disorders, 40, 1873–7897.

    Article  Google Scholar 

  15. Patton, L. L., Siegel, M. A., Benoliel, R., & De Laat, A. (2007). Management of burning mouth syndrome: systematic review and management recommendations. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology, 103, S39.e31.

    Article  Google Scholar 

  16. Phillips, K. A., & Menard, W. (2011). Olfactory reference syndrome: Demographic and clinical features of imagined body odor. General Hospital Psychiatry, 33, 398–406.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Prazeres, A. M., Nascimento, A. L., & Fontenelle, L. F. (2013). Cognitive-behavioral therapy for body dysmorphic disorder: A review of its efficacy. Neuropsychiatric Disease and Treatment, 9, 307–316.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Rowa, K., Antony, M. M., & Swinson, R. P. (2007). Exposure and response prevention. In M. M. Antony, C. Purdon & L. J. Summerfeldt (Eds.), Psychological treatment of obsessive–compulsive disorder: Fundamentals and beyond (pp. 79–109). Washington, DC: American Psychological Association.

    Google Scholar 

  19. Thoma, N., Pilecki, B., & McKay, D. (2015). Contemporary cognitive behavior therapy: A review of theory, history, and evidence. Psychodynamic Psychiatry, 43, 423–461.

    Article  PubMed  Google Scholar 

  20. Toyofuku, A. (2016). Psychosomatic problems in dentistry. Biopsychosocial Medicine, 10, 14.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Toyofuku, A., Miyagi, U. G., Tone, T., Kikuta, K., Miyako, T. H (2001). The efficacy of fluvoxamine for “halitophobia”. Jpn J Psychosom, 16, 81–85.

    Google Scholar 

  22. Wide Boman, U., Carlsson, V., Westin, M., & Hakeberg, M. (2013). Psychological treatment of dental anxiety among adults: A systematic review. European Journal of Oral Sciences, 121, 225–234.

    Article  PubMed  Google Scholar 

  23. Yaegaki, K., & Coil, J. M. (2000). Examination, classification, and treatment of halitosis; Clinical perspectives. Journal of Canadian Dental Association, 66, 257–261.

    CAS  Google Scholar 

Download references


The authors would like to thank Mrs. Asma Hammami for correcting the language of the paper.


This study was not funded by any source.

Author information



Corresponding author

Correspondence to Jihed Mrizak.

Ethics declarations

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the hospital and national research committee and with the 1964 Helsinki Declaration and its later amendments.

Informed Consent

Informed consent was obtained from the individual participating in the current study. Written consent for the release of the information was also obtained from the patient.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mrizak, J., Ouali, U., Arous, A. et al. Successful Treatment of Halitophobia with Cognitive Behavioural Therapy: A Case Study. J Contemp Psychother 49, 119–125 (2019).

Download citation


  • Halitophobia
  • Cognitive behaviour therapy
  • Case report
  • Treatment outcome
  • Anxiety