Therapy of something non-existent

• The condition of halitophobia is particularly complex. Apart from the fact that patients will experience any diagnostic disproof of their oral malodour as a personal affront and a sign of not being taken seriously. They will rather doubt the doctor’s capabilities or the suitability of the instrument and seek advice of someone else they believe an authority. 

• Therapy of halitophobia can only be attempted by an experienced psychotherapist or psychologist. As the condition is part of the patient’s subjective reality, the therapist has to follow the patient into this subjective reality. As soon as the patient feels being taken seriously in his reality, he might be able to follow the therapist out into objective reality.  The initial difficulty is to convince the patients suffering from halitophobia to seek psychiatric advice. Yaegaki and Coil (1999) suggest a catalogue of rules intended to assist in dealing with halitophobia patients.

The following recommendations are formulated:

• Not to join into discussions regarding the existence or non-existence of the patient’s bad breath. Attempts to persuade the patients of their oral malodour being not there will drive the patients away as they will feel they are not being taken seriously.
• To clarify if the patients are overly conscious of and tend to deduce unpleasant odor from other people’s reactions. 
• To repeatedly explain that particular gestures, such as covering one’s nose are not indicative of malodour perceived.
• To assist in optimizing the patients’ oral hygiene. This is the only way to keep in contact with the patient.
• To repeatedly remind the patients that it is impossible to conclude the quality of their breath from other people’s gestures or reactions.