Choking Fear

What is Choking Fear?

Choking phobia is an apparently rare condition characterised by an excessive fear of choking to death on food, drink, medicines or tablets. It is more usually associated with food or pills rather than with fluids and sufferers typically have difficulty with eating. They tend to eat items that they regard as safer foods such as soup, purees, yoghurt, etc, but even these are avoided as much as possible so that sufferers usually lose weight. Food is chewed excessively before it is swallowed to further reduce the perceived risk of choking.

However, doctors now recognise that the sensation of globus can have a physical cause such as the throat having been previously scratched by a hard piece of food. Whatever the cause, people with globus report discomfort upon swallowing and are not afraid of choking. Difficulty in swallowing connected with a definite physical disorder (commonly of the oesophagus) is called dysphagia. Hence, choking phobia can be easily distinguished from this condition which has an identifiable organic cause.

Treatment of Choking fear

Since choking phobia is relatively rare, no comparative studies have been carried out on treatment methods but successful outcomes have been reported using behavioural and cognitive behavioural therapies and drugs. Behavioural therapy is based on graduated exposure which, in choking phobia, consists of encouraging the person to eat a series of foods beginning with I safe,' soft items and then progressing to harder, more feared ones. This takes place with the aid of the therapist who also works with the patient to reduce chewing to normal levels.

Negative cognitions concerning eating and the risk of choking can be successfully reduced by these means in some people. In others, however, behavioural experiments may be helpful in challenging these such as ones designed to demonstrate the effectiveness of coughing and practising swallowing exercises. Some choking phobics have been helped by modem drug treatments and it is thought that selective serotonin re-uptake inhibitors (SSRIs) may prove useful. However, it is generally agreed that behavioural and cognitive behavioural therapies offer the best treatment for all specific phobias, including choking phobia.

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