Coping With Pseudodysphagia (the Fear of Choking)

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Updated on September 20, 2023

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Man clapping choking woman on the back — Science Photo Library/Getty Images

Pseudodysphagia, or the fear of choking, isn't a common phobia, but it can be serious. When people have this phobia, they are often so afraid of choking that it affects how they eat. This can lead to an unbalanced diet, unintended weight loss, and malnutrition.

One word of caution—there are medical conditions that can make swallowing difficult. People who have these conditions are also afraid of choking, but that's because they are actually at an increased risk of choking due to their condition.

In other words, don't try to diagnose yourself! Talk to your doctor so you can rule out physiological causes, which might include certain neurological issues and conditions of the esophagus.

Those conditions require different treatments. If your fear is due to pseudodysphagia, your care team will then be better prepared to recommend psychological treatments that can help.

At a Glance

The fear of choking can make eating and drinking very difficult. Some people may chew their food excessively, while others may only consume liquids. This can contribute to malnutrition and dental problems. Treatment is often necessary, and many involve the use of psychotherapy or medications to help manage symptoms.

What Is the Fear of Choking (Pseudodysphagia)?

Pseudo means 'false' while dysphagia refers to 'problems swallowing.' While people with this condition have no physical problem preventing swallowing, they experience extreme distress and anxiety about choking on food or liquid.

Pseudodysphagia is sometimes confused with phagophobia, or the fear of swallowing. Although both conditions involve the act of swallowing, the difference is in the precise nature of the fear. Those with phagophobia fear swallowing, while those with pseudodysphagia worry that swallowing might lead to choking.

Pseudodysphagia may also co-occur with a condition known as avoidant/restrictive food intake disorder (ARFID). This eating disorder leads to severe food aversions and food restrictions. Some research has found that people with ARFID are often afraid of choking.

Symptoms of the Fear of Choking

Common symptoms of pseudodysphagia include:

Difficulty swallowing
Feelings of panic when swallowing
Avoiding certain foods
Only consuming liquids
Excessively examining food before eating it
Hyperfixating on sensations in the throat
Intrusive thoughts about choking
Avoiding the dentist due to fears of choking on dental equipment

People with the condition experience anticipatory anxiety about meal times. Other behaviors may include eating very small bites, chewing excessively, drinking water frequently to aid in swallowing, and avoiding eating in social settings. Some case reports suggest that symptoms can worsen when a person is under stress.

What Causes the Fear of Choking?

Like other phobias, pseudodysphagia may have a number of different causes. Genetics, environmental factors, and individual characteristics can all play a role in the development of this type of fear.

In some instances, the fear of choking may stem from a difficult or traumatic experience. Choking or witnessing another person choking can trigger the onset of this phobia. It might start right away, but sometimes it might not emerge until much later.

The condition can affect anyone of any age, but some populations may be at a higher risk. Older adults are more likely to experience difficulty swallowing, which may lead to fears of choking. Past research has indicated that women have a somewhat higher risk of developing the condition.

Some research also suggests that people with other mental health conditions such as depression or anxiety may be more likely to develop pseudodysphagia.

Impact of the Fear of Choking

Like other specific phobias, the fear of choking can be extremely disruptive to a person's life. Eating is a central part of a person's life and health, so struggling to eat with this fear can be a serious ongoing source of distress. It may lead to:

Social withdrawal: People with this condition often avoid going out to eat or sharing meals with others. They may withdraw from any social activity that might involve eating or drinking.
Distress: The fear of choking can also contribute to constant anxiety and stress. It may interfere with sleep and make it hard for people to concentrate at work or school.
Weight loss: It is not uncommon for this fear to cause highly restrictive eating, which may contribute to weight loss or malnutrition.

How Pseudodysphagia Affects Eating

People with pseudodysphagia often have difficulty eating solid foods. Anxiety and tension cause throat muscles to constrict, which (somewhat ironically) further increases the chance of choking.

Many people find that excessive chewing and swallowing each bite with a large sip of liquid can help to ease their symptoms. Those with a more severe fear, however, may need to resort to shakes, baby food, and purees, or even subsist on a liquid diet.

In the era of food processors and high powered blenders, it's not impossible to maintain optimal health on a liquid diet, but over time, those who are less knowledgeable about the various facets of nutrition may experience malnutrition. For this and many other reasons, it's very important to treat pseudodysphagia as soon as possible.

Fear of Choking and the Dentist

Many people who do not otherwise suffer from pseudodysphagia are afraid of choking during or after a dental procedure. Those who have a more generalized fear of choking may find it difficult or impossible to visit the dentist at all. These fears often contribute to a more generalized fear of dentists.

Common dental choking fears include choking on saliva, choking on dental instruments, and choking on gauze. Some people are afraid that they will be unable to breathe or swallow while their mouths are numb. Many people find that their fears worsen when the chair is tipped all the way back.

If you are concerned about choking at the dentist's office, discuss your concerns with the dentist in advance. Dentists are used to dealing with people with all sorts of fears, and most have action plans ready to go.

In addition, set up a system for communicating your needs to the dentist during your procedure, such as raising your left hand to request suction. While dental procedures are never fun, honesty and open communication make the experience a bit easier for everyone.

Treatment for the Fear of Choking

If simply avoiding some foods is all that is needed to keep your pseudodysphagia at bay, then there's probably no need for therapy. It is important to talk to a mental health professional if your phobia is causing distress or significantly interfering with your day-to-day life, relationships, and profession.

Like other phobias, there are effective treatments that can improve functioning and relieve symptoms of pseudodysphagia. Some potential treatments your doctor or therapist may recommend include:

Cognitive-behavioral therapy (CBT): This type of therapy is often used to treat different types of phobias. It helps people identify the negative thought patterns that contribute to their fear and then replace those thoughts with more helpful, positive ones.
Exposure therapy: This form of CBT involves gradually exposing you to what you fear. Over time, the anxiety response begins to fade. It may begin with just imagining what you fear before slowly working your way up to facing it in the real world.
Medication: Antidepressants and anti-anxiety medications may be prescribed to help you cope with feelings of anxiety. These medications are often most effective when they are used alongside other strategies such as therapy and self-help techniques.

Coping With the Fear of Choking

If you are experiencing symptoms of pseudodysphagia, it is important to seek help from a qualified mental health professional. The condition can pose serious health risks and lead to disordered eating and malnutrition, so getting professional intervention is essential.

Talk to a doctor to rule out any physical factors that might contribute to difficulty swallowing.

In addition to therapy and medication, there are strategies you can use on your own to help manage your symptoms:

Create an exposure or fear hierarchy: Make a list of foods that trigger your fear of choking. Rank these foods based on how challenging you would find them to eat, starting with the easier and continuing up to the most difficult. Talk to your therapist about your list and use this to guide graded exposure sessions.
Use relaxation techniques: Exploring different ways to relieve stress and anxiety can also be helpful. Mindfulness practices, deep breathing, and progressive muscle relaxation are a few that you might try.

Final Thoughts

Fear of choking can be scary. It can make eating and drinking challenging, which can take a toll on both physical and emotional health. The first step is to get the correct diagnosis—which means ruling out any physiological causes that might make swallowing difficult.

Once you understand what's causing your symptoms, you can work with your doctor and therapist to find the right treatment for you. Like other phobias, gradual exposure to the source of your fear—in this case, swallowing—is an important way to progressively reduce feelings of fear. Targeting the negative thoughts that cause you to feel more anxious and utilizing tactics to calm your mind and body are also essential.

With the right approach, you can eventually overcome your fears and eat and drink without constant anxiety and stress.

7 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Philpott H, Garg M, Tomic D, Balasubramanian S, Sweis R. Dysphagia: thinking outside the box. World J Gastroenterol. 2017;23(38):6942–6951. doi:10.3748/wjg.v23.i38.6942
Nicely TA, Lane-Loney S, Masciulli E, Hollenbeak CS, Ornstein RM. Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. J Eat Disord. 2014;2(1):21. doi:10.1186/s40337-014-0021-3
Suraweera C, Hanwella R, de Silva V. Phagophobia: A case report. BMC Res Notes. 2014;7:574. doi:10.1186/1756-0500-7-574
McNally RJ. Choking phobia: a review of the literature. Compr Psychiatry. 1994;35(1):83-89. doi:10.1016/0010-440x(94)90174-0
Sahoo S, Hazari N, Padhy SK. Choking phobia: an uncommon phobic disorder, treated with behavior therapy: a case report and review of the literature. Shanghai Arch Psychiatry. 2016;28(6):349–352. doi:10.11919/j.issn.1002-0829.216055
Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent. 2016;8:35–50. doi:10.2147/CCIDE.S63626
Kaczkurkin AN, Foa EB. Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues Clin Neurosci. 2015;17(3):337-346. doi:10.31887/DCNS.2015.17.3/akaczkurkin

Additional Reading

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). Arlington, VA: American Psychiatric Publishing, Inc.

By Lisa Fritscher
Lisa Fritscher is a freelance writer and editor with a deep interest in phobias and other mental health topics.

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