Cause of Functional Dysphagia: Anxiety, Depression, and More

Anxiety dysphagia is one of many physical and medical causes of dysphagia. Dysphagia is the medical term for difficulty when swallowing. Swallowing is a complex process. It involves coordination from about 50 different nerves and muscles in the mouth, throat, and esophagus.

Functional dysphagia is a condition described as having dysphagia symptoms when there seems to be no structural or medical reason for it. People with psychological issues or mental illness are prone to dysphagia, though the reasons aren't completely understood.

This article discusses mental health disorders associated with dysphagia, causes of functional dysphagia, and treatments.

What Is Functional Dysphagia?

When a person has dysphagia symptoms that are not explained by structural abnormalities, motility disorders, or gastroesophageal reflux disease (GERD), it is called functional dysphagia. This can be psychosomatic, meaning it's related to a mental disorder, though not always.

Symptoms of functional dysphagia can differ from person to person but may include:

• Difficulty swallowing
• Globus (the sensation of a lump in the throat)
• Having the feeling that food is stuck in your throat or chest
• Chest pain
• Heartburn
  

Dysphagia can be serious if you choke and food gets into your airways and blocks them, known as aspiration.

There is a high incidence of dysphagia among people with mental health conditions, which may be due to a side effect of medication, a phobia, or abnormal eating behaviors.

Anxiety and Dysphagia

Anxiety and panic attacks can cause the throat muscles to tighten and constrict. Some people report anxiety makes them feel as if they are being choked. This can make swallowing difficult.

Dysphagia associated with anxiety may also be a result of somatic symptom disorder (SSD)—an intense focus on physical symptoms, enough to disrupt daily activities.

People are diagnosed with SSD if they have at least two of the following characteristics:

• High level of health-related anxiety
• Ongoing and exaggerated concerns about the severity of a health concern
• Excessive attention to health concerns

If the symptoms last for more than six months, it's considered chronic.

Among people with SSD who have dysphagia, functional dysphagia is the most common. It's also called medically unexplained oropharyngeal dysphagia, or MUNOD. People with MUNOD feel like food is stuck in their throats. If they feel the food is stuck in the esophagus, which may be accompanied by choking, it's called esophageal dysphagia.

Experts have also noted a strong link between anxiety and the severity of dysphagia symptoms. Anxiety can cause "esophageal hypervigilance," an intense, exaggerated focus on swallowing. It occurs more often in people who have been treated for a medical condition involving the esophagus.

Depression and Dysphagia

Dysphagia is associated with depression and appears to be more common as the severity of depression increases. A review of 30 studies found that people with mild depression were three times more likely to have dysphagia, and people with moderate depression were 13 times more likely to have dysphagia compared to people not experiencing anxiety or depression.

Other Mental Health Disorders Linked to Dysphagia

In addition to anxiety and depression, other mental health disorders associated with functional dysphagia include:

• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Panic disorder
• Social phobias
• Generalized anxiety disorder (GAD)

Sometimes, though rare, dysphagia is a form of a phobia. These phobias include:

• Phagophobia: Fear of swallowing, due to a psychogenic (psychological rather than physical) reason where a person avoids swallowing food, liquid, or pills. It is sometimes also associated with a fear of choking. 
• Pseudodysphagia: Fear of choking. People with pseudodysphagia often have difficulty eating solid foods. In some cases, they resort to eating only pureed foods, baby food, or protein shakes. 

Symptoms associated with phagophobia include:

• Avoidance of certain foods
• Hypermastication (over chewing)
• Feeling of food sticking in the throat or esophagus
• Weight loss
• Anxiety and social withdrawal

Symptoms associated with pseudodysphagia include:

• Feelings of panic about swallowing
• Difficulty swallowing
• Avoiding eating solid food
• Weight loss
• Anxiety and depression

Other individuals with mental illnesses may have episodes of dysphagia because they have trouble sitting still when eating, which increases the chance of food getting stuck. Or, they are hyperactive and eat their food too quickly.

Dysphagia and Psychiatric Medication

Dysphagia may also occur as a side effect of medication. Medications associated with mental illness that can induce dysphagia include:

• Antipsychotics: These can weaken the esophagus (windpipe), increasing the risk of food getting stuck. The medications can also cause xerostomia, better known as dry mouth, which can make it harder to swallow.
• Anticholergenic drugs: These medications, which may be given along with antipsychotics, affect the nervous system and increase the risk of developing dysphagia.
• Tardive dyskinesia: Some medications for mental illness can cause this involuntary movement disorder as a side effect. Tardive dyskinesia can affect the swallowing reflex in either the throat or esophagus.
  

Treatment

Treatment for dysphagia depends on the cause. If it is due to a psychiatric cause, treatment can include:

• Medication change: Providers may lower the dose or try a different medication for people with mental disorders in which dysphagia may be a side effect
• Psychotherapy or behavioral therapy: This includes cognitive behavioral therapy (CBT), hypnosis, or relaxation therapy
• Chewing and swallowing therapy: This therapy is sometimes as an adjunct to psychotherapy.

Tips for Managing Swallowing Difficulties

Strategies to help manage swallowing difficulties include:

• Keeping mealtimes relaxed
• Taking smaller bites
• Chewing thoroughly
• Eating more slowly 
• Choosing soft, moist foods, such as scrambled eggs, yogurt, cottage cheese, soups, stews, cooked vegetables, and canned fruits
• Using a thickener in drinks if liquids are difficult to swallow
• Sitting up straight while eating
• Not talking and swallowing at the same time
  

Summary

Dysphagia describes difficulty swallowing. If severe, dysphagia can make it difficult to eat, lead to a higher risk of choking, and disrupt normal routines.

Dysphagia can have many different causes. Some cases of dysphagia are due to structural abnormalities or disease, and some are considered functional, where there is no apparent physical cause. Psychiatric reasons for dysphagia include anxiety disorders, depression, phobias, somatic symptom disorder, and more.

Treatment includes therapy or changes in medication and/or dosages, which may help alleviate symptoms so that they do not interfere with daily life.