How to Recognize Psychological Problems with Swallowing and What to Do About Them
Psychogenic Swallowing Difficulties
Swallowing – an everyday activity that most people don't give a second thought to. We automatically move food from our mouth to our throat and down the esophagus without any hesitation. But what if this seemingly simple task becomes a problem? And what if the problem has no physical cause but originates in the mind?
While eating disorders like anorexia or bulimia have been increasingly discussed in recent years, another less-known and often overlooked complication is psychogenic swallowing difficulties, also known as psychogenic dysphagia. This issue may resemble a physical disorder, but its roots lie elsewhere – in the psyche.
How Does Psychogenic Swallowing Disorder Manifest?
People affected by this disorder often describe a sensation of a lump in the throat, an inability to force themselves to swallow, or a fear of choking while swallowing. Sometimes the difficulties arise suddenly and cause panic, while other times they develop gradually. Meanwhile, medical examinations – endoscopy, neurological tests, or X-ray studies of the swallowing process – reveal no clear physical cause.
This can be frustrating for both the patient and their surroundings. The inability to eat or drink without anxiety or a sense of threat disrupts daily life, can lead to malnutrition and dehydration, and further deepens psychological stress. Patients often switch to a liquid diet or avoid eating altogether.
Psychogenic swallowing disorder is still little-known even in professional circles and is often mistakenly confused with other diagnoses – such as neurological diseases or classic eating disorders. However, it is often linked to anxiety disorders, post-traumatic stress disorder, or depression.
Where Does the Fear of Swallowing Come From?
The psyche can significantly affect bodily functions. The brain, perception, and emotions are closely connected to the control of muscle movements – and swallowing is among them. In cases of intense stress, panic, or psychological trauma, the body can "freeze," making normal motor functions challenging or impossible.
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A typical example could be a person who once genuinely choked or had something go down the wrong way, causing them to start choking. This physical experience then associates with danger in the brain, triggering a defensive reaction – anxiety and tension with each subsequent attempt to swallow. The more the individual focuses on the act of swallowing, the less "automatic" it becomes. The body contracts, muscles stiffen, and the cycle of fear and unsuccessful attempts begins.
Another situation might occur with people suffering from generalized anxiety disorder. These individuals often perceive their bodily sensations very intensely, and if they focus on swallowing, they can completely block the process by simply anticipating a complication.
From a psychological perspective, this is a case of somatization – mental pain translates into the body. The body then "speaks" for emotions that the individual does not allow themselves to acknowledge or cannot admit.
A Real-Life Story
Jana (29 years old) was a successful graphic designer, an extroverted young woman who loved cooking and meeting friends over good food. One day, she slightly choked on rice during lunch. It wasn't serious, but the unpleasant sensation of choking frightened her. Since then, she started having trouble swallowing. Initially with rice, then with other solid foods. Eventually, she switched to just soups and smoothies.
She began avoiding group lunches and family dinners. In restaurants, she felt sick just looking at the menu. Despite undergoing all available examinations and being assured that there was nothing physically wrong with her, the problem persisted. It wasn't until psychotherapy helped her realize deeper layers of her stress and anxiety, which she previously didn't acknowledge, that she gradually learned to eat without fear – and, above all, stopped fearing her own body.
How is Psychogenic Swallowing Disorder Treated?
The good news is that psychogenic dysphagia is treatable – but it requires patience and a sensitive approach. Firstly, it's important to rule out all organic causes so the person can be sure their body is healthy. After that, psychological and sometimes even psychiatric help comes into play.
Basic approaches include:
- Psychotherapy, particularly cognitive-behavioral therapy, which helps change thought patterns and fears associated with swallowing.
- Relaxation and breathing exercises, which help alleviate body tension and bring calm to challenging situations.
- Exposure and practice, where the person gradually "relearns" to swallow – starting with liquids and slowly moving to solid foods.
- Nutritional support to ensure the body does not suffer from a lack of energy during treatment.
In some cases, antidepressants or anxiolytics may help, especially if dysphagia is part of a broader anxiety disorder. However, they should always be part of comprehensive care, not the sole solution.
It's Not "Just Psychological"
It's important to emphasize that psychogenic swallowing problems are not "just in the head." The physiological changes that anxiety and stress trigger are real – increased muscle tension, accelerated heartbeat, dry mouth, altered breathing – all contribute to the difficulties. It's not about "faking" or weakness, as some might wrongly think.
"Psychological disorders are no less real than physical ones – we just can't see them on an X-ray," says British neuropsychologist Peter Halligan. This quote captures the key to understanding psychogenic swallowing – the pain and dysfunction are real, even if their origin is invisible.
How Can Surroundings Help?
Family and friends play an important role. Instead of misunderstanding or pressure like "just try to eat," it's better to offer support and calm. It helps when people around don't create additional stress, don't push for performance, and try to be empathetic. Simply knowing that "I'm not alone in this" can be healing for someone dealing with this problem.
At the same time, seeking community support is worthwhile. Online discussion forums, therapeutic groups, or support networks can be sources of sharing and hope. Sometimes even a small gesture, like a recommendation from someone who has gone through a similar situation, can help.
Listening to Both Body and Soul
Psychogenic swallowing difficulties show how closely connected the body and mind are. In times when we face increasing stress and pressure, it's no wonder the body sometimes protests. That's why we should be more attentive to our inner world, the signals of our body, and the needs we often suppress.
Perhaps the problem with swallowing is an important message – a call to slow down, take better care of ourselves, and find balance between performance and inner peace. Ultimately, it's not just about food. It's about how we can "digest" life itself.
