The Work Of The Psychologist When Helping Patients With Phagophobia

The work of the Psychologist when helping patients with Phagophobia

Phagophobia, also called choking phobia or choking phobia, is an intense fear and anxiety of choking, accompanied by the systematic avoidance of eating certain foods, whether solid, drinks or pills, in the absence of an underlying organic pathology. This irrational fear of choking causes a lot of distress for people with phagophobia.

The difficulty in swallowing may be greater or lesser depending on the patient and is accompanied by spasms in the glottis, which are symptoms of anxiety. Patients with phagophobia can develop an eating disorder from their fear. For this reason, it is essential that the treatment of these patients is carried out by a group of health professionals; that is, an interdisciplinary approach. In this article we will see What is the job of the psychologist during treatment to help patients with phagophobia?.

What is phagophobia?

As we noted, phagophobia is rooted in the irrational fear that certain foods will get stuck in the throat when trying to swallow. It is common for people to experience that they cannot eat certain foods, or not be able to eat them at all, when they are having a peak of anxiety. Although phagophobia as such is not a diagnostic category, it has been studied in relation to the parameters of manuals such as the DSM-IV and DSM-5, and most authors agree that It is not an eating disorder per se but rather an anxiety disorder. For this reason, it is usually accompanied by other bodily symptoms typical of anxiety, such as sweating, dizziness or tachycardia.

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This fear causes the person to focus their attention on the muscles of the throat, around the glottis; also the back, shoulders, facial muscles and jaw. It may even happen that people with phagophobia become hoarse due to excess tension in the laryngeal area, specifically in the vocal cords.

The causes of swallowing difficulties

There are several possible causes for phagophobia. Some of the most common are having witnessed or heard of choking in another person or having suffered a traumatic experience related to eating, generally associated with a specific food. People with this fear usually take the measure of avoiding certain foods that they consider may be more difficult to swallow such as the most solid or granular, or those foods that, for some reason, are being interpreted by a distorted belief linked to them or to food in general.

Fear in phagophobia

The fear that triggers phagophobia is, after all, fear. This apparent tautology actually serves to emphasize the fact that fear is, at first, adaptive, necessary, and universal; shared by all human beings. It is fear that has helped us survive as a species throughout our history, to defend ourselves from predators, to stay close to our fellow humans and also to keep away those foods that experience has shown us could be toxic or harmful. Thanks to this, we have the ability to choose which foods to eat and which not to eat; and we can even inferring which foods might be edible without tasting them, based on their color, shape, smell, or texture. The fact that we can carry out behaviors that are consistent with our reasoning is a great evolutionary advantage.

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The problem is that the ways in which we interpret reality could interfere with the way we behave, leading us to adopt maladaptive behaviors such as generating hypertension in the glottic area when we want to eat.

Psychological treatment for phagophobia: what it consists of and stages

The psychologist, logically, is one of those in charge of addressing the psychological dimension of the problem, but must always consider that the patient may have comorbidities for which consultation with another professional is required. Furthermore, phagophobia may not necessarily cause an eating disorder but may cause a significant fluctuation in the person’s weight. In any case, it is also important to work together with a nutritionist.

Cognitive behavioral therapy is one of the most effective psychological treatments for phagophobia. First of all, psychologists who work from this approach promote psychoeducation. This would involve providing information about the disorder that the patient suffers, to him or her and to his or her family, so that they are fully aware of what is happening to them and how some interventions will work during treatment. In other words, the aim is for the person to learn what psychological aspects are involved in swallowing difficulties.

In the second instance, the psychologist helps the person to recognize the physical sensations and internal experiences that are associated with the act of swallowing and the functioning of the glottis, which is explained in a simple but precise way.

Also, to identify the thoughts that appear in relation to swallowing. Based on this, the patient is helped to question those thoughts that may be biased—that is, those that do not correspond or are out of adjustment with reality—and that could influence the fact that he cannot swallow. Some beliefs refer to food, but others may refer to the person themselves, and may, for example, overestimate the risks of consuming a certain food or be catastrophic about it. Ultimately, these beliefs can be a deep source of suffering. The cognitive restructuring process involves questioning and modifying these biased thoughts, replacing them with more adaptive ones.

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Finally, the patient is trained to be able to expose himself to the physical sensations of anxiety gradually, to leave the act of swallowing at the service of his body and not deliberately try to control it. In this process, a hierarchy of the feared situations is carried out – that is, foods are categorized according to the difficulties they cause a particular patient to swallow – and then progress is made towards exposing these situations progressively, starting with the simplest ones.

The treatment service for phagophobia in Azor and associates

In this way, working with a psychologist is key to treating fear of swallowing. Thanks to psychological help it is possible to improve safely and supervised by a team of professionals.

From Azor & associates A treatment unit for phagophobia has been proposed based on cognitive-behavioral strategies and coordination with a team of medical experts on the subject. It is a new service that can be requested in person or online and has different contracting options.