What Is Phagophobia?

Phagophobia, or the fear of swallowing, is a relatively rare type of phobia. It is sometimes confused with pseudodysphagia (the fear of choking). The major difference is that those with phagophobia are afraid of the act of swallowing, while those with pseudodysphagia are afraid that swallowing will lead to choking.

Both fears are sometimes confused with medical conditions such as dysphagia and odynophagia, in which a physiological disorder causes difficult or painful swallowing.

Symptoms of Phagophobia

Phagophobia can cause a number of different symptoms, the most noticeable of which is an extreme reluctance or avoidance of swallowing foods, liquids, or pills.

Other symptoms of phagophobia include:

• Anticipatory anxiety before meals
• Eating in very small mouthfuls and drinking frequently during meals to aid in swallowing
• Extreme anxiety and fear at the thought of swallowing
• Panic attacks
• Rapid heart rate and breathing
• Reluctance or avoidance of eating or drinking in front of others
• Sweating
• Switching to an all-liquid diet as an attempt to alleviate some of the anxiety around swallowing food
• Weight loss

Causes of Phagophobia

The cause of phagophobia isn't known, and it may involve a complex set of factors like prior experiences and other underlying health conditions. Phobias can also be learned by watching others; seeing someone else experience pain or embarrassment while swallowing can cause you to develop a fear of it as well.

Fear of Foods

Phagophobia may surface in people who experience other food-related fears. Food phobias may involve a fear of specific types of food, like perishables or foods that are dangerous when undercooked. Persistent worrying about eating contaminated food may also lead to phagophobia.

Negative Experiences With Eating

Phagophobia is often, though not always, triggered by a negative experience while eating. A prior experience with choking, for example, can lead to phagophobia (and potentially pseudodysphagia). A painful medical procedure involving the throat, like a tracheotomy, may also cause anxiety around swallowing.

Anxiety and Tension

Phagophobia is one of the few phobias that can actually bring about the feared condition (phobophobia, or fear of phobias and fear, is another). Anxiety and tension can cause the throat muscles to constrict, feeling like "a lump in the throat."

Those who fear swallowing may find themselves physically unable to do so once they become too anxious. This, in turn, can worsen the fear, creating a perpetuating cycle that is difficult to break.

Diagnosis of Phagophobia

Phagophobia is recognized as a specific phobia in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Specific phobias involve fear of a specific object or situation—in this case, swallowing—that's out of proportion with the real danger that's present.

To diagnose phagophobia, a healthcare provider will talk to you to determine if your symptoms have lasted at least six months and are extreme enough that they cause disruptions in your life, like in your relationships or career.

They will also rule out other medical conditions that can lead to problems swallowing, like dry mouth, gastroesophageal reflux disease (GERD), body dysmorphia, or globus hystericus (the chronic feeling of having a lump in the throat). They may also look for signs of another mental health condition, such as:

• Eating disorder
• Generalized anxiety disorder (GAD)
• Panic disorder
• Social anxiety disorder (SAD)

Treatment for Phagophobia

Phagophobia can lead to progressively more restricted eating habits and, in serious cases, significant health issues. However, specific phobias do respond to treatment, and several options have shown promise for treating phagophobia.

• Cognitive behavioral therapy (CBT): CBT helps you notice negative thought patterns so you can challenge them and adopt different behaviors. CBT also teaches you ways to overcome distress, like distracting yourself, and may include psychoeducational aspects to help you understand phagophobia.
• Eye movement desensitization and reprocessing (EMDR): EMDR uses sensory stimuli, like repetitive eye movements or hand tapping, to reduce the distress you feel while swallowing.
• Exposure therapy: Exposure therapy involves gradually exposing yourself to your fear with the help and support of your therapist, eventually working your way up to swallowing foods or drinks.
• Hypnotherapy: In hypnotherapy, your therapist helps you enter a trance-like state, which allows to you focus more deeply on the root of your fear.
• Medication: Certain medications may help reduce your anxiety levels during treatment. These may include antidepressants and beta-blockers.

Find a therapist who will work with you to develop a treatment plan that addresses your phagophobia and any related disorders. Developing a relationship with a mental health professional who comes to know you well can be very helpful, as your phagophobia treatment plan will need to be designed to meet your specific needs.

Coping With Phagophobia

While professional help is beneficial for phagophobia, you can also use coping techniques to help you overcome distress on your own. Since the throat muscles often constrict during bouts of anxiety, coping strategies generally focus on remaining calm.

• Find distractions: Some people find that watching TV or listening to music while eating provides a welcome distraction that makes chewing and swallowing a less intense experience.
• Take small bites: Small bites or small sips of liquid may feel easier to swallow than larger portions.
• Chew food thoroughly: Chewing your food well makes it easier to swallow, which may help alleviate some of your anxiety.
• Eat soft foods: Soft foods may irritate your throat less than hard, scratchy foods will. Use trial and error to find the foods you're most comfortable with.
• Drink liquids between bites: Taking a sip of liquid with each bite eases the swallowing process.

Keep in Mind

While phagophobia is rare, it's a serious condition that often requires professional treatment. If you believe you may have this phobia, it's also important to work with a specialist to rule out other medical conditions that are related to problems swallowing.