Phagophobia or swallowing anxiety is the fear of swallowing. This is usually accompanied by a fear of choking (choking phobia) and should not be confused with globus hystericus or anorexia nervosa. In addition to the fear of choking on food, there may also be a fear of swallowing saliva.
Phagophobia is classified as a specific phobia (ICD: F40.2) and is distinguished from agoraphobia, panic disorder, and generalized anxiety disorder. The disorder is also mentioned in the DSM-5.
About fear of swallowing (phagophobia)
The disease is considered very rare, there are hardly any data and no standardized therapy. In the literature, there are mostly single case descriptions or case series with a small number of cases. A somewhat larger case series includes a study in which 41 patients were collected over a period of 27 years. This found a 2:1 predominance of women and a high association with anxiety and panic disorders and compulsions. Stressful life events were also common. In our own experience, we have some doubts about these numbers, as patients have come to us with these complaints very often in recent years.
About the normal swallowing
Swallowed and alone: What to do?
Trigger and onset of the complaints
We have been able to treat numerous patients in recent years. The trigger for the symptomatology consisted in each case of an experience with swallowing, which was experienced as dangerous or even life-threatening. Depending on which food had caused the threat in the trigger situation, solid food or drinks were subsequently experienced as threatening.
In some patients, the symptomatology was triggered after they had seen a family member choking or they had only seen a video of someone almost choking.
Finally, there were also patients who at some point became aware that swallowing does not have to work naturally.
Assuming someone choked on bread, for example, then bread is naturally feared the most. Within a short time, other solid foods are added. Usually the fear generalizes quickly and then includes all foods with a solid consistency.
Somewhat less common is the fear of choking on liquid foods (water, juices, milk, coffee, etc.). Here, too, a threatening experience with drinks was at the beginning.
Avoidance
In virtually all cases, the original triggering food is avoided. If there is fear of solid food, the food is liquefied, i.e. solid food is drunk. Somewhat less common is the fear of swallowing liquid food (water, juices, milk, coffee, etc.). Again, it starts with a threatening experience with drinks. Avoiding drinks is usually more difficult and can be solved, for example, by thickening (gelatin). Water is then "eaten." Both methods usually lead to weight loss, are associated with great anxiety and can be life-threatening.
Dangerous consciousness
Risk factors
Personality
Most often, these are individuals who exhibit a combination of high sensitivity, irritability, and performance anxiety. Increased anxiety, depressiveness and other vegetative disorders are found more often in the history.
Breathing
We observed major respiratory abnormalities in virtually all the patients we treated. There was a more or less pronounced chronic hyperventilation, which explains a significant part of the accompanying symptoms (panic, tension, dizziness, lightheadedness, palpitations, fatigue, exhaustion, pressure on the chest, tightness in the neck, etc.). The corresponding measured values (especially CO2) were very striking.
Consequences of near suffocation
Therapy
In recent years, we have developed a systematic training program that has proven to be very successful. It usually takes place as intensive therapy over 2 weeks and contains the following elements:
- Information and education about the symptoms
- Body-based relaxation methods with massages and warmth
- Physiotherapeutic exercises to relax the muscles
- Breathing training with various methods
- Systematic swallowing training in case of ascending difficulties
- If necessary, accompanying psychotherapy
Research
On phagophobia research
Phagophobia or fear of swallowing is the fear of swallowing. This is usually accompanied by fear of choking (phagophobia of choking) and should not be confused with globus hystericus or anorexia nervosa. In addition to fear of swallowing food, fear of swallowing saliva may also occur. We have been able to gain new knowledge about fear of swallowing that will lead to better treatment outcomes. Since there is little research in this area, we ask you to fill out an online questionnaire ( if you suffer from swallowing anxiety. You will then find the results on youtube or on our pages (www.weiss.de/schluckangst or you can email us: schluckangst@weiss.de if you would like to be informed.