Phagophobia (from Greekphagein, "to eat", and phobos, "fear") is a psychogenicdysphagia, defined as a fear of the act of swallowing.[1] It is a relatively rare specific phobia that presents as various swallowing complaints without any apparent physical reason detectable by physical inspection and laboratory analyses.
Phagophobia is classified as a specific phobia and, according to the DSM-5 classification, usually falls under the category of "Specific Phobia: Other" or "Choking Phobia".[2] It is distinct from physical dysphagia, where a mechanical or neurological problem impedes swallowing. While formerly referred to interchangeably as choking phobia,[3] researchers have suggested distinguishing phagophobia (fear of the mechanics of swallowing/propulsion of the bolus) from pseudodysphagia (the fear of choking), though the two conditions often overlap clinically.[1]
The condition can lead to significant health consequences, including weight loss and malnutrition, and is often confused with eating disorders such as anorexia nervosa, despite having a fundamentally different psychological motivation.
Signs and symptoms
The primary symptom of phagophobia is an intense, irrational fear of swallowing. This fear often triggers a physiological anxiety response (panic) when the sufferer attempts to eat or drink. Individuals with phagophobia may exhibit the following behaviors and symptoms:
**Dietary restriction:** Avoiding solid foods in favor of a liquid or soft diet (e.g., smoothies, nutritional shakes, baby food).[4]
**Texture avoidance:** Refusal to eat foods with mixed textures or foods perceived as "difficult" to swallow (e.g., meat, dry bread).
**Compensatory rituals:** Excessive chewing, sipping large amounts of liquid with every bite to "wash down" food, or taking extremely small bites.
**Physical symptoms:** Tachycardia, sweating, sensation of a lump in the throat (globus pharyngis), and muscle tension in the neck and throat during meals.
**Psychological impact:** Anticipatory anxiety before mealtimes, avoidance of eating in public or social situations, and frustration regarding the inability to eat normally.
In severe cases, the avoidance behavior can result in significant weight loss, dehydration, and nutritional deficiencies.
Causes
Phagophobia is often precipitated by a traumatic event, though it can also develop without a clear trigger. Common etiologies include:
**Direct conditioning:** A personal experience with choking, gagging, or difficult swallowing (e.g., a pill getting stuck).
**Vicarious learning:** Witnessing another person choke or struggle to swallow.
**Informational transmission:** Hearing frightening stories about choking or medical procedures involving the throat.
**Generalized anxiety:** Individuals with high baseline anxiety or panic disorders may manifest their symptoms somatically in the throat area.
Diagnosis
Diagnosis of phagophobia is a process of exclusion. Because the symptoms mimic physiological disorders, medical professionals must first rule out organic causes of dysphagia. This typically involves a multidisciplinary approach:
**Psychological Evaluation:** Once physical causes are ruled out, a mental health professional assesses the patient for specific phobia.
Differential diagnosis
It is crucial to distinguish phagophobia from other conditions:
**Anorexia nervosa:** Unlike patients with anorexia, individuals with phagophobia usually desire to eat and do not have a distorted body image or a fear of gaining weight. They lose weight as a consequence of the phobia, not as a goal.
**Globus pharyngis:** A persistent sensation of a lump in the throat. While often psychogenic, globus does not necessarily involve a phobia of the act of swallowing itself.
**Avoidant/restrictive food intake disorder (ARFID):** While phagophobia can be a driver of ARFID, ARFID is a broader category that includes sensory aversion (taste/smell) or lack of interest in food, not just the fear of the swallowing mechanism.
Treatment
Phagophobia is generally treatable with psychological interventions. The prognosis is often good, especially with early intervention.
**Cognitive behavioral therapy (CBT):** The most common treatment, involving the identification and restructuring of negative thoughts regarding swallowing.
**Exposure therapy:** A gradual desensitization process. Patients may start by swallowing saliva, then progress to liquids, soft foods, and eventually solids. This is often done in a "hierarchy of fears" approach.
**Psychoeducation:** Explaining the mechanics of swallowing to reassure the patient that the body protects the airway automatically.
**Pharmacotherapy:** In some cases, anti-anxiety medications (such as SSRIs) may be prescribed to lower general anxiety levels, facilitating therapy.
**Swallowing therapy:** Speech-language pathologists may work with patients to relearn normal swallowing patterns and reduce muscle tension.
12Shapiro J, Franko DL, Gagne A. Phagophobia: a form of psychogenic dysphagia. A new entity. Ann Otol Rhinol Laryngol 1997; 106: 286-290.
↑American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington, VA: American Psychiatric Publishing.
↑McNally RJ. Choking phobia: a review of the literature. Compr Psychiatry 1994; 35: 83-89.
Baijens, LW; Koetsenruijter, K; Pilz, W (2013). "Diagnosis and treatment of phagophobia: a review". Dysphagia. 28 (2): 260–270. doi:10.1007/s00455-013-9457-3. PMID23604975.
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