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January 2011



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Allan Schwartz, LCSW, Ph.D.

I am 43 and started having panic attacks about a year ago. I have been having panic attacks daily for nearly 2months now and i am having great difficulty swallowing. At first i could swallow food following each mouthful with water  but it has got worse. I would chew my food as small as i could and end up having 2 spit it out because no matter how much i told myself to swallow, i just couldnt. Now i am just taking liquids. Please help. I cant go on like this. I want to feel normal again!!!!

The above is an example of many E. Mails and comments posted to an article about the fear of swallowing.

The original posting and responses can be found at the following URL:


Some people experience a lump in their throat upon swallowing food. Others fear that, if they eat or drink, they will choke to death. What ever the specific fear is, they all fear swallowing and this is called Phagophobia.

It is important to distinguish this psychological fear from those them stem from a real blockage or injury in the throat and trachea. There are many conditions that cause extreme pain upon swallowing and one of the common ones is the strep infection that, if it happens with great frequency, sometimes results in the surgical removal of tonsils. This is why it is never safe to assume that an adult or child who is complaining about being fearful about swallowing is simply having a psychological fear. Quite to the contrary, there are many head, neck and throat illness that create real pain and blockages that obstruct the ability to swallow. A thorough examination is always necessary to rule out anything physical or organic in nature.

Case Study (fictionalized)

During my thirty years if psychotherapy practice, I had several patients with the complaint that they feared swallowing. These individuals had each been to multiple numbers of medical doctors who ordered all types of tests and examinations that yielded nothing but good physical health.

When he came for psychotherapy, this man was filled with anxiety and depression and was losing weight. He was skeptical about the ability of psychotherapy to help him and was even more skeptical about the usefulness of medications. It should be noted that the death of an important relative seemed to have set off his anxiety and depression.

However, Cognitive Behavioral Psychotherapy combined with teaching him meditation and encouraging him to begin a good program of aerobic exercise really helped. He was accustomed to exercise but stopped when his symptoms worsened. Ultimately, he was seen by a psychiatrist who prescribed a low dose of anti depressant medication. That, combined with the psychotherapy, helped him put the swallowing anxiety and all of the symptoms to rest and he was able to resume a normal life.


Phagophobia or the fear of swallowing is usually forms one aspect of people who are overwhelmed with anxiety. In the case of the patient above, there was no incidence earlier in his life that served as catalyst for what became his fear of swallowing. Rather, he always experienced a mild anxiety, a symptom that was familiar throughout his family of origin.

However, there are people who go through something traumatic that can set them on the road to phagophobia. Surgery to remove tonsils with its painful aftermath can be the motivating factor for some people. Others may have a relative who suffered from head and neck cancer and that became the catalyst for their worry and fears about health and swallowing. Certainly, a tendency towards being a hypochondriac (worrying about being sick despite being in good health) along with strong tendencies to worry by obsessing about everything, all add to the likelihood of developing this type of phobia.

There is psychological treatment for this and all phobias and it involved cognitive behavioral therapy, learning meditation and deep relaxation and experiencing a gradual desensitization to these fears.

Source:  http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=35604&cn=1

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