What is phagophobia and who is at risk for developing it?
Phagophobia is a psychogenic condition in which a person has a fear of swallowing. It is often accompanied with pseudodysphasia which is a psychogenic condition in which a person has a fear of choking.
A person is diagnosed with a psychogenic disorder when there is no identifying medical condition underlying the difficulty in swallowing. However, the person who develops the fear cannot psychologically perform the behavior as they once were able. There is an intense fixation on the sensations that occur with swallowing. This hyper awareness interferes with the fluid act of swallowing, further perpetuating the discomforts of swallowing and the fear itself.
This phobia can develop at any age. However, it is more likely to develop as people age due to medical conditions that are indirectly related to changes in the swallowing mechanisms. Also, people who are prone to anxiety or depression are more prone to developing this fear.
What causes phagophobia and pseudo dysphasia?
Phagophobia / pseudo dysphasia can come on suddenly after a scary incident with food getting stuck in the throat or an incident of near choking. It can also develop gradually from a feeling of a lump in the throat due to chronic anxiety.
Often people who struggle with acid reflux (GERD) can feel a discomfort in their throat. It might feel like a lump or a narrowing of the airways. These sensations can trigger a fear of swallowing or a fear of choking despite any real tangible obstruction.
Some people report the fear of choking developing concurrently with a mucus build up in the throat or a post nasal drip after a virus or allergies. They might have an irrational fear of choking on their own saliva or mucus in addition to regular food.
It is also possible that there is no known physical cause. The fear of swallowing can be set off by a recurring thought or image about choking. The fixation on that thought or image combined with an activated nervous system can trigger this phobia and its accompanying anxiety symptoms.
Some people who struggle with the fear of swallowing have a concurrent disorder known as
avoidant/restrictive food intake disorder (ARFID). ARFID is a specific type of eating disorder in which the person restricts their food consumption so significantly that they lose weight rapidly, develop digestive tract problems or become malnourished. If severe enough, the person may require a feeding tube. ARFID is not due to anorexia or a desire to lose weight. It is often sensory or related to the fear of choking.
What are the psychological effects of having this fear?
People’s quality of life may suffer significantly with the fear of swallowing. They may feel stuck in a perpetual fight or flight reaction. If they eat solid food, they fear they may choke and die and if they don’t eat, they fear malnourishment and death.
People with this phobia may struggle to swallow pills which are necessary for medical treatment. They might delay taking their pill or avoid medical intervention altogether. They might try to crush the pill but this isn’t always an option. They might feel embarrassed to ask the doctor or pharmacist to convert the pill to liquid or chewable form if it’s even possible.
People with phagophobia often change their diet to soft foods and liquids and may see rapid weight loss occur. If they do attempt to eat solid food, they usually cut the food into very small pieces or nibble their food and chew it excessively before swallowing. It may take a very long time to complete a meal due to excessive chewing and needing breaks from eating. People may also drink a lot of fluids to assist them in swallowing.
People may fear their own mental health. Despite reassurance from doctors that nothing anatomical or medical is obstructing their esophagus or airways, they continue to have a difficult time moving food through the proper channels like they used to.
Family and friends may not understand the issue, and therefore, may not be able to give the support the person needs.
People who struggle with this psychosomatic disorder are often battling with anxiety, depression, panic attacks and rapid weight loss.
How is phagophobia treated?
Cognitive Behavioral Therapy (CBT) is extremely effective in treating phobias. A specific type of cognitive behavioral therapy known as Exposure Therapy and Response Prevention (ERP) helps the person face their fear by gradually exposing them to different food types. A skilled therapist will create a hierarchy to help the person acclimate to swallowing starting with manageable foods and working up to full solid foods.
The client might be asked to start with safe foods like clear broth or jello and then graduate to yogurt or smoothies. Soon enough, they can try mashed potatoes with peas mixed in. Once they feel comfortable, they will be introduced to more challenging food types like nibbles of solid food. As they build confidence in their ability to swallow, the person will likely be taking larger bites and trying more challenging textures like chips and meat.
A skilled therapist will understand how to help the client connect the mind and body to facilitate the complex movement of food through its various channels. Using visualization, the client will relearn how to coordinate the movement of mouth, tongue, jaw, saliva, throat, esophagus and accompanying airways to move food and liquids from the mouth to the stomach.
Additional CBT techniques include abdominal breathing, muscle relaxation, mindfulness techniques, and cognitive reframing. With the combination of an empathetic therapist and the proper CBT treatment, the client will be equipped with the necessary tools to swallow without anxiety.
Conclusion
If you struggle with fear of swallowing (Phagophobia), reach out to Dr. Suzanne Feinstein at Advanced Behavioral Health. Dr. Feinstein is a Columbia University-trained Clinical Psychologist who specializes in evidence-based treatments such as DBT, assertion training, CBT, Acceptance and Commitment Therapy (ACT), mindfulness training, visualization, and emotional regulation tools.