Olfactory Reference Syndrome (Halitophobia) With Oral Cenesthopathy Treated With Low-Dose Aripiprazole: A Case Report

INTRODUCTION: Olfactory reference syndrome (ORS) (halitophobia) is the excessive fear of having bad breath without clinical findings supporting the patient's complaints. In this case report, a low dose of aripiprazole (ARP) successfully improved oral cenesthopathy and then improved ORS. CASE PRESENTATION: A 44-year-old female patient complained of a sensation of astringent film sticking on her tongue. She was also very anxious about her bad breath at work. We prescribed 0.5 mg of ARP for her symptoms because she worried about potential drowsiness. One week later, the patient reported that the oral sensation had resolved 2 to 3 days after the mediation was administered. No obvious adverse effects were observed except temporary arousal during sleep. Three months after the initial visit, her symptoms worsened, partly because of her job change, so we increased the dose of ARP from 0.5 mg to 1 mg. Later, the patient reported that she was better able to manage the anxiety about her breath. At the 2-year follow-up, her symptoms have continued to improve without medication. CONCLUSIONS: Although the most effective approach to ORS is not established, the current study indicates that a low dose of ARP to treat oral cenesthopathy might improve ORS.