Pseudodysphagia

Individuals with pseudodysphagia have difficulty swallowing, and may experience panic before or during the act of swallowing. This can therefore lead to the avoidance of swallowing solid foods and liquids, taking any forms of tablets or pills without the presence of physiological or anatomical abnormalities. Avoidance of restaurants or social settings is common, since sometimes food can only be taken in small bites or with liquid. Furthermore, the resulting avoidance of food and drinks caused by the phobic stimulus may ultimately lead to weight loss, anxiety, depressions and social withdrawal. The strain is generally bounded to solids, however the essence of the difficulty can vary where most patients are able to consume semi solids or soft foods, whereas some are able to only consume when the food is properly lubricated or only solid foods in small pieces. Furthermore, some patients experience the inability to swallow pills or are afraid to drink liquids.

It has been suggested that pseudodysphagia occurs most frequently secondary to a traumatic experience of being choked by food. The act of swallowing becomes mentally linked with choking or with reduced capacity of the opening of the throat. Pseudodysphagia has a tendency to evolve progressively, as the patient becomes more and more preoccupied with the idea that swallowing will lead to choking, until this anxiety becomes a constant sensation whenever food is being consumed. Such events cause negative internal feedback to obtain exponential momentum, as the initial presence of fear gradually mounts into an inevitable and immense obsession. This anxiety will in time become strong enough to cause psychosomatic choking symptoms.

Since pseudodysphagia tends to coincide with a mixture of other mental disorders such as generalised anxiety disorder, therapists endorse an extensive and multi-pronged treatment scheme. Such programs address the psychological issues related to pseudodysphagia first, which make the choking phobia easier to oppose later on with retraining schemes and talk therapy which centre on helping the patient learn to relax whilst eating. Proposed treatments include hypnotherapy, cognitive behavioural therapy and Eye Movement desensitisation and reprocessing. Aversion relief therapy is a commonly used treatment which has been proven to be effective in the field of choking phobias. In this case, the patient is given a small shock to their fingers until they swallow.[2] In order to get relief, the patient will have no other option but to swallow the food since the shock only stops once the action of swallowing occurs. Another possible treatment for pseudodysphagia includes tongue depressors placed on the back of the throat in order for the patient to defeat the anxiety associated with swallowing. (Whitehead and Schuster 1958) Lastly, relaxation sessions can take place before meals. Such treatments include positive visualisation, deep breathing, and guided meditation. Although pharmacotherapy such as low doses of selective serotonin reuptake inhibitors have been used for treatment, it is more common for behavioural approaches to be used.

Additionally, before pseudodysphagia can be diagnosed, it is of the utmost importance to remove any other potential natural conditions which may be actually causing choking symptoms. In this case, dysphagia may be a real health problem that could be causing constriction of the oesophagus during swallowing, meaning that people with this condition are legitimately not imagining the symptoms that they outline. Furthermore, Omophydroid Muscle Syndrome - a rare muscle condition which causes chronic soreness and pain swallowing, may be the cause of falsely diagnosed pseudodysphagia. It is also not uncommon for pseudodysphagia to be misdiagnosed with conversion disorder (Globus Pharyngeus) and eating disorders.