Pseudodysphagia (Fear Of Choking)

Defined as a fear of choking, Pseudodysphagia is a psychological condition which can result in behavioral changes.

What is Pseudodysphagia?

Patients with Pseudodysphagia have an intense fear of choking. Rather than expressing an appropriate amount of fear towards the risk of choking, people have a level of fear which is disproportionate to the actual risk choking poses.

Although Phagophobia is a separate condition and relates to the fear of swallowing, the two conditions are closely intertwined and patients with Pseudodysphagia may also have a fear of swallowing. Generally, patients with Pseudodysphagia fear that attempting to swallow will result in them choking or being unable to breathe.

What are the symptoms of Pseudodysphagia?

Pseudodysphagia can have many far-reaching effects on a patient and the people around them. Although the condition is psychological in nature, it can change a person’s behavior and may, therefore, have an impact on their physical health.

For example, many people with Pseudodysphagia have trouble eating. As they fear choking, eating can become a significant problem for patients and their food intake tends to be highly restricted. As well as suffering from weight loss, patients with Pseudodysphagia may experience symptoms of malnutrition as they are unable to gain appropriate minerals and nutrients from food.

When patients with Pseudodysphagia do attempt to eat, they may drink an excessive amount of liquid with their food. For the patient, the additional liquid reduces the chance of choking and enables them to eat with less anxiety.

Alternatively, patients with a more severe form of Pseudodysphagia may attempt to survive on a liquid-only diet. Meal replacement shakes, baby food, smoothies and pureed foods are often used by patients with Pseudodysphagia as they believe this will reduce the likelihood of choking.

As well as struggling to eat, patients with Pseudodysphagia may have trouble with other aspects of their lives. Often, patients do not attend appointments with dentists, orthodontists or hygienists as they fear choking during or after the appointment. Although this may appear to be a fear of dental work, the fear of choking is actually the precursor which prevents patients from maintaining their oral hygiene.

In addition to this, patients with Pseudodysphagia may exhibit increased anxiety when trying to eat due to the risk of choking. Often, this results in a panic attack which may cause a wide range of symptoms, including:

  • Trouble breathing
  • Feelings of terror
  • Dizziness
  • Nausea
  • Trembling
  • Sweating
  • Shaking
  • Fainting

What causes Pseudodysphagia?

All phobias are deemed to be irrational and, in many cases, the patient may be unaware of what has caused their Pseudodysphagia. Although there are many causes of Pseudodysphagia, some of the most common causes of the condition include:

  • Previous choking incident
  • Witnessing a traumatic event
  • Learned behavior

If a patient has previously struggled to breathe or almost choked while eating, they may fear the incident happening again and they could exhibit avoidance behavior. Similarly, witnessing someone else choking can be such a traumatic memory for the individual that they try to prevent the same thing happening to themselves by avoiding potential choking hazards.

A patient with Pseudodysphagia may begin to avoid particularly chewy foods, for example, before restricting their diet further. As well as having a direct effect on their physical health, this type of fear can have a detrimental effect on a person’s self-esteem.

At first, people with Pseudodysphagia may avoid eating in a restaurant due to the fear of choking while out in public. Following this, patients may refuse invitations to eat at a friend’s home. In many cases, patients with Pseudodysphagia will only eat in their own homes and may feel unable to consume food which has been prepared by anyone else.

As phobias and fears can be learned from other people, it is possible that people could develop Pseudodysphagia as a result of being exposed to other people with the condition. If a child’s caregiver is preoccupied with choking hazards, for example, the child may grow up with an exaggerated or irrational fear of choking, which could lead to Pseudodysphagia.

Before Pseudodysphagia is diagnosed, however, the individual should undergo a psychological examination to rule out the possibility of a physical problem. These may include:

  • Throat conditions
  • Neurological issues
  • Esophageal issues

If there are no physical conditions causing the patient’s symptoms, then Pseudodysphagia may be diagnosed.

Can Pseudodysphagia be treated?

Fortunately, Pseudodysphagia can be successfully treated and there are various options available to patients. These include:

  • Anti-anxiety medication
  • Vitamin and nutritional supplements
  • Psychological therapies and counseling
  • Complementary therapies

In some cases, a long-term anti-anxiety medication may be prescribed. This can help to reduce the patient’s anxiety and enable them to deal with their fears in a more rational manner. Although medication cannot be used to target Pseudodysphagia directly, reducing the patient’s overall level of anxiety can be beneficial in the treatment of fears and phobias.

If the patient is suffering from malnutrition as a result of their condition, they may also be prescribed vitamin supplements. A lack of vitamin B12, for example, can have negative physical effects and will need to be rectified by supplementation if the patient is unable to consume the appropriate foods.

Psychological therapies and counseling are often used to treat Pseudodysphagia and can be extremely effective. If patients are able to identify the root cause of their fear or when the condition first become problematic, they are often able to overcome it. Cognitive behavioral therapy may also be used to help the patient to ‘re-train’ their brain and lessen their fears.

In many instances, patients also use complementary therapies to help overcome their fear of choking. Patients often report treating phobias with hypnotherapy, for example, and this can help patients to reduce or eliminate their fear altogether.

Although patients may find that one form of treatment is effective in curing their Pseudodysphagia, many patients rely on a mix of treatments in order to resolve their condition. If patients are prescribed anti-anxiety medications, for example, they may also attend therapy sessions or use cognitive behavioral therapy to address their symptoms and behaviors.

While Pseudodysphagia can be an extremely distressing and debilitating condition, patients can make a full recovery if the appropriate treatment is made available to them.

Preventing Pseudodysphagia (Fear Of Choking)

As the effects of Pseudodysphagia are not normally apparent until the phobia is deeply rooted in the patient’s subconscious mind, it can be difficult to prevent the condition from occurring.

However, if there is an increased risk of someone developing Pseudodysphagia, steps can be taken to reduce the chance of them suffering from the condition. If a child or young person chokes on a piece of food, for example, their caregivers can help them to overcome the trauma in the immediate aftermath of the incident. In some instances, it may be appropriate to seek professional help at this stage so that the traumatic memory does not continue to cause issues.

Similarly, caregivers can reduce the risk of a child developing Pseudodysphagia by showing an appropriate, and not excessive, amount of concern regarding the risk of choking. If adults do not exhibit an exaggerated fear response, children and young people may be less likely to adopt their fear and their risk of developing Pseudodysphagia is reduced.