Phagophobia · What Is It, Signs and Symptoms, Treatment, and More

Individuals with phagophobia often avoid eating solid foods and swallowing fluids or pills due to an extreme and persistent fear of choking. They may experience anticipatory anxiety or worry when thinking about swallowing and develop symptoms such as heart palpitations, shaking, and sweating whenever they attempt to swallow or bring food close to their mouth. Over time, individuals may develop avoidance behaviors, such as eating small mouthfuls of food, swallowing one mouthful in several attempts, and drinking lots of water to facilitate swallowing. They may also avoid social situations that may involve eating or drinking, including dinner parties, family meetings, or social events, which can lead to loneliness and isolation.  

People with phagophobia may also change their diet habits to accommodate the fear of swallowing, including eating only liquids, purées, or soft foods. In severe cases, phagophobia can lead to the avoidance of eating or drinking altogether, resulting in significant weight loss and malnutrition. Like with other anxiety disorders, the symptoms of phagophobia are often worsened by stress and triggered by feelings of anger, sadness, or isolation.   

Diagnosis of phagophobia often involves collaboration between mental health professionals and other healthcare providers, such as gastroenterologists or speech-language pathologists. It is important to differentiate phagophobia from other conditions that may cause similar symptoms, such as dysphagia (i.e., difficulty swallowing) due to another medical condition or other anxiety disorders. Although phagophobia itself is not listed as a specific diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), specific phobias, including those related to swallowing or choking, are categorized under the broader category of anxiety disorders.  

The DSM-5 diagnostic criteria for specific phobias include: 

(a) Marked fear or anxiety about a specific object or situation (e.g., extreme fear of swallowing)  

(b) The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation 

(c) The fear or anxiety causes significant distress that results in impairments of activities of daily living and other important areas of functioning 

(d) The disturbance has lasted 6 months or more 

(e) Another medical condition does not better explain the disturbance 

Treatment of phagophobia is aimed at addressing the fear of swallowing and helping individuals develop coping strategies to manage their symptoms. Psychotherapy, particularly cognitive behavioral therapy (CBT), can be beneficial for individuals with phagophobia, as it can help them unlearn harmful thought patterns and behaviors associated with the fear of swallowing. Another type of treatment used in specific phobias is exposure therapy, which involves gradually exposing the individual to feared situations and teaching them coping strategies to overcome the anxiety. Similar to CBT, exposure therapy requires multiple sessions where individuals learn to cope and manage their fear responses.  

In certain cases, antidepressants like selective serotonin reuptake inhibitors (e.g., sertraline, paroxetine, fluoxetine) or anti-anxiety medications like benzodiazepines (e.g., diazepam, lorazepam) may be prescribed to help relieve anxiety symptoms that are often associated with phagophobia. Additionally, working with a nutritionist can help develop a meal plan that accommodates the individual’s fear of swallowing while ensuring adequate nutrition and hydration. Most individuals with phagophobia can recover healthy eating habits with adequate psychological and nutritional support. In severe cases, though, artificial feeding may be needed to prevent extreme weight loss and malnutrition through the course of treatment. Artificial feeding may include placing a nasogastric tube (i.e., NG tube) through the nose and into the stomach to deliver nutrition.