Fear of Choking: Pseudodysphagia, Explained

Fear of choking is known as pseudodysphagia, often confused with phagophobia which is the intense fear of swallowing.

The two commonly overlap but you can experience one without the other.

The difference is small but distinct. Those with phagophobia fear the process of swallowing, while those with pseudodysphagia are afraid of choking after swallowing.

Choking phobia is a rare condition where sufferers hyperfocus on the sensations they experience when eating and swallowing food in a desperate bid to avoid choking at all costs.

Avoidance becomes a dominant behavior in this cycle. People with choking disorder may restrict their diet and avoid certain food types, blend their food to reduce the risk of choking, and may also avoid taking tablets.

Fear of choking within OCD involves the intense fixation on the bodily sensations when swallowing, with a particular focus on the back of the throat. The vicious cycle sufferers find themselves trapped in remains the same; caught in a loop of obsessions, uncertainty, and compulsions.

Fear of choking within OCD

Diagnostically, the fear of choking (pseudodysphoria) is categorized as a Specific Phobia and lands in the category of specific phobia disorder of anxiety disorders in DSM IV, and has been retained in DSM 5 (The Diagnostic and Statistical Manual of Mental Illnesses).

Phobias often fall under a category called OCD spectrum disorders along with other conditions such as panic disorders and health anxiety, for example. All OCD spectrum disorders feature obsessions and compulsions.

Using the conceptualization of OCD, the fear of choking is the core obsession for someone with pseudodysphoria.

Those intrusive thoughts do not pass quickly, they are relentless and demand time and energy. Mentally, it’s exhausting. You can be left feeling trapped in loop of rumination about what might happen at the next mealtime, or how you’re going to manage at the next family birthday dinner.

The most common compulsion is avoidance behaviors and mental rumination. Most often, this looks like avoidance of certain foods (and drinks) because ultimately, those obsessions play on a fear that goes beyond choking; a fear of dying.

Because of this, it can result in malnourishment and have a negative impact on our physical health. People who suffer from this rare condition not only have to battle with the noise inside their minds but the medical implications as well.

Fortunately, like all phobias and anxiety disorders, it can be treated and you can feel free to enjoy the foods you love again and relieve yourself from the daily terror.

How does fear of choking present itself?

Obsessions:

• Hyperfixation on the sensory feelings in the throat
• Excessive fear of what might happen if they eat something without chewing enough
• Hyperfixation on the texture of foods
• Hyperawareness of sensations in the mouth and throat
• Excessive fears about swallowing liquids, foods, or saliva

Compulsions:

• Avoiding certain foods that ‘might’ cause you to choke, even if you love them
• Avoiding going to the dentist for fear of the utensils they may use in your mouth
• Ruminating about how you felt when you ate your last meal
• Ruminating on how you’re going to cope at the next social gathering where food is a core component of the experience
• Avoiding eating in front of anyone for fear of choking in front of them, or fear of judgment over what they might think of your eating/drinking habits

What does it feel like to live with a fear of choking?

Living with the fear of choking feels like constantly living on the edge of ‘danger’.

Every day we need to eat. Every day we need to ingest something at some point. We need to do this to stay alive, and so it’s tremendously debilitating to fear something that we have to face every single day.

People with a fear of choking can face challenges at every mealtime.

Battling with intrusive thoughts and ruminating on potential consequences, food becomes a source of angst and pain where it was once a source of joy.

The clients who come to work with us explain how they would love to love food again, instead of it being a trigger for their fears. Their fear of choking has them fixated on those bodily sensations in the back of the throat and food/drink (or anything that could cause us to choke) becomes the source of perceived danger.

Beyond this, pseudodysphoria can be incredibly isolating.

Many avoid social occasions where they know food or drink may be involved because they don’t want to have to wrestle with those fears in front of people. 

What if they don’t understand? 

What if I’m peer pressured into eating something I don’t want to eat? 

What if they think my eating habits are strange?

It can become an incredibly lonely disorder, very quickly.

This mental health condition may be rare but it feels incredibly limiting and makes challenges out of behaviors we naturally do every single day.

If you resonate with this then the good news is that there are proven treatments that can help you get back to normality and stop this fear of choking from dictating how you choose to live your life.

Can OCD cause swallowing problems?

A common question clients have is whether or not OCD can cause swallowing problems.

OCD does not cause swallowing problems. 

However, there is a subtype of OCD called Somatic OCD (or sensorimotor OCD) where sufferers fixate on swallowing and the frequency of swallowing.

Those with somatic OCD suffer from an intense fixation with their bodily functions. They may fixate on their breathing, blinking, or swallowing. For example, someone may wonder whether or not they are breathing too loudly or blinking too quickly.

In the case of pseudodysphoria, the focus is on the feelings and sensations within the mouth and back of the throat when swallowing. 

But the fear is, ‘What if I choke on this and I can’t breathe?’

Whereas, for someone with Somatic OCD the fixation is “What if I never stop fixating on my swallowing?”

Someone who suffers with a fear of choking may find themselves caught in a catch-22…

When we are anxious about the uncertainty of whether or not we may choke on our next meal, tension arises in our throats. And because we’re hyperfocused on that area of our body – looking for any sign that something isn’t right and eating this food might be risky – we find it.

When you notice tightness in your throat, it does feel like something could get caught in there.

But because sufferers are now so aware of their bodily functions, any ‘sign’ becomes intensified.

When clients come to work with us, we work together to change the way we think and respond to those bodily functions in order to be free of this cycle and help regain a sense of control so that the client decides where they place their attention rather than the fear directing their attention.

What causes fear of choking?

It has been proposed that this mental health condition is most commonly triggered by traumatic experiences surrounding food and choking.

However, many clients come to us with a phobia of choking who have not had a traumatic experience like this.

The sufferer themselves may have choked on food at some point in their life, or may have witnessed someone else choking, or even seen it on a movie, for example.

Food (or ingestion of any kind) then becomes a trigger for anxiety.

The brain learns that anything that goes into our mouth is perceived as a potential source of danger. While our threat response is doing exactly what it should do – trying to protect us – disturbing thoughts about choking followed by paralyzing anxiety then incentivizes compulsive behaviors.

Although providing temporary relief, this then perpetuates the cycle of fear.

Treatment for Fear of Choking (Pseudodysphoria)

The leading treatment modality for fear of choking (and other somatic OCD subtypes) is exposure and response prevention.

ERP therapy

ERP therapy is a type of Cognitive Behavioral Therapy (CBT). It requires that you do these two things:

1. Return back to eating a wide variety of foods in multiple settings.
2. Choose a response other than avoidance or compulsive behavior.

This is an oversimplified overview of how the ERP process works, but ultimately, you will work together with your therapist to create a treatment plan involving exposures that are challenging but also achievable.

Together, you may look at the foods you avoid, for example, and begin to slowly reintroduce them into your diet.

The ERP process is gradual, so you will not be thrust into a situation that feels too big to handle. It’s not about throwing you into the deep end, it’s about taking small steps toward allowing yourself to be guided by your values rather than your fears.

We want to get you to a place where you can say, “What would I choose to do if I didn’t have this fear?” And do it!

It can feel scary to begin this process and many face resistance (which is entirely understandable – that’s fear talking!). However, when our clients begin working with us they rarely regret starting the recovery process.

There will be times of discomfort, but you face that discomfort with a cheerleader in your corner, knowing that it’s leaning into that discomfort that will allow you to live a life without limits once again.

Finding a qualified therapist

If this resonates with you, and you suspect you may be exhibiting symptoms of pseudodysphoria, then please reach out to our friendly team of highly qualified mental health professionals.

Based in the state of California, we are an elite team of trained clinicians who advocate for a compassionate and non-judgemental approach to mental illness recovery.

We’re here to meet you where you’re at, and guide you through an effective and tailored treatment plan that has incredible success rates.

If you’d like to see if we’re a good fit to support you, please submit an initial intake form here.