What is pseudodysphagia?
Pseudodysphagia refers to the sensation of having difficulty swallowing, even though there is no underlying physical cause. It is a functional swallowing disorder caused by underlying psychological factors like anxiety, depression, or stress. People with pseudodysphagia often feel like food is stuck in their throat or chest, or that they are choking or unable to swallow properly. However, medical evaluations reveal no anatomical abnormalities or gastroesophageal reasons for their symptoms.
Pseudodysphagia is often triggered by a bad choking incident or traumatic swallowing experience. This leads to developing anxious thoughts around eating and swallowing, and physical tension that causes the swallowing muscles to tighten up. It shares many similarities with globus sensation, which refers to a persistent feeling of a lump in the throat. While globus and pseudodysphagia often coexist, globus is limited to throat sensations while pseudodysphagia extends to perceived swallowing difficulties.
Common symptoms
– Feeling like food is stuck in the throat or chest
– Sensation of choking when swallowing
– Avoidance of foods due to chewing or swallowing difficulties
– Food sticking sensation even with soft foods or liquids
– Tight, tense muscles or clenched jaw when swallowing
– Frequent clearing of the throat
– Globus sensation (persistent lump in the throat)
– Heartburn or reflux-like symptoms
What causes pseudodysphagia?
Pseudodysphagia does not have a clear physiological cause. It is considered a psychosomatic symptom stemming from mental and emotional factors, including:
– Anxiety disorders like generalized anxiety, phobias, PTSD
– Major depression
– High stress levels
– Hypochondria or health anxiety
– History of traumatic choking or near-choking event
– Obsessive thoughts or fears around swallowing
– Somatization of emotional distress into physical symptoms
The anxiety surrounding swallowing causes the throat and esophagus muscles to involuntarily tense up and tighten. This creates a feeling of obstruction despite no true blockages. The anxious thoughts around eating also heighten sensitivity to normal swallowing sensations, causing hypervigilance to every swallow. This vicious cycle perpetuates the feeling of difficulty swallowing.
Risk factors
Factors that increase the risk for developing pseudodysphagia include:
– Mental health conditions like anxiety disorders, depression, hypochondria
– High baseline stress levels
– Traumatic medical events like choking, intubation, or gastric tube placement
– Preexisting eating disorder
– Obsessive compulsive disorder (OCD)
– Upper gastrointestinal issues like acid reflux or hiatal hernia
– Recent illness or infection that temporarily affected swallowing
– History of sexual abuse
Diagnosing pseudodysphagia
Since pseudodysphagia has no structural cause, it is a diagnosis of exclusion after other conditions have been ruled out. Diagnostic tests for pseudodysphagia may include:
Physical exam
An oral and physical exam of the head and neck area checks for issues like masses, nerve damage, strictures or inflammation. No abnormalities would be found to correlate with the swallowing difficulties described.
Endoscopy
A tiny camera on a flexible tube is inserted through the mouth into the esophagus to visually inspect the swallowing passage. This helps rule out tumors, blockages, or gastroesophageal causes of dysphagia like eosinophilic esophagitis.
Barium swallow study
During this radiographic imaging test, the patient swallows a liquid barium mixture while video fluoroscopy tracks the swallowing mechanism. No obstructions or motility abnormalities would be seen.
Manometry
Measuring the muscle pressures in the esophagus further confirms normal peristalsis and contractions.
Psychological evaluation
A mental health assessment tools like questionnaires, interviews and stress scales would reveal underlying anxiety, depression or obsessional thoughts around swallowing.
Once medical causes are ruled out, the diagnosis of pseudodysphagia as a functional swallowing disorder can be made.
Treatment options for pseudodysphagia
Pseudodysphagia is best treated with a multidisciplinary approach combining physical therapy and psychotherapy. Treatment focuses on:
Swallowing therapy
Working with a speech-language pathologist (SLP) trains the muscles involved in chewing and swallowing to function optimally despite underlying anxiety. Swallowing exercises help regain smooth swallowing motions and reduce hypersensitivity. Techniques like thermal stimulation, tongue exercises, throat massage, and appropriate head and neck posturing are utilized.
Relaxation techniques
Learning diaphragmatic breathing, progressive muscle relaxation, guided imagery, and meditation helps relieve muscle tension and anxiety when eating.
Diet modifications
Temporarily eating softer foods that are easier to swallow can provide a sense of safety while working to overcome the pseudodysphagia. However, the long term goal is to be able to eat a regular, healthy diet.
Cognitive behavioral therapy (CBT)
CBT from a psychologist helps reduce anxiety and fear around swallowing. Reframing thoughts, systematic desensitization, and exposure therapy can treat the obsessive thoughts fueling the condition.
Medications
Antidepressants like SSRIs (selective serotonin reuptake inhibitors) may be prescribed to address underlying anxiety or depression. Anti-anxiety meds like benzodiazepines can provide temporary relief of muscle tension prior to meals.
Self-help strategies
– Practice mindful eating by slowing down and paying attention to textures and flavors
– Use mindfulness, meditation, and deep breathing techniques to reduce stress and anxiety
– Avoid eating when overly rushed or stressed
– Distract yourself with music or light conversation during meals
– Maintain proper posture while eating and swallowing
– Limit caffeine, alcohol, spicy, acidic, or gas-forming foods if they aggravate symptoms
– Join a support group to share experiences and tips for coping
With a tailored treatment plan focused on the root psychological triggers, the symptoms of pseudodysphagia can be successfully overcome. However, a chronic case may require several months of progressive therapy along with regular practice of learned techniques.
What is the prognosis for pseudodysphagia?
The prognosis for pseudodysphagia is generally positive, with most people able to achieve normal swallowing function again through targeted treatment. However, it requires patience and consistent effort over a period of weeks to months.
Some key predictors of better prognosis include:
– Mild to moderate symptom severity
– Shorter duration of symptoms
– Lower levels of anxiety and fear
– Absence of major depression or OCD
– Good response to psychotherapy and exercises
– Social support and self-motivation
Patient commitment to the treatment regimen and following through consistently on techniques learned is vital. Even after overt symptoms subside, periodic maintenance therapy is needed to prevent recurrence. Relapses are common if anxiety is not well-controlled.
With severe anxiety or depression, symptoms may wax and wane over time and become persistent. Inpatient intensive therapy programs may be warranted in difficult cases. Seeking help early on when symptoms first manifest leads to the best outcomes.
Tips for living with and managing pseudodysphagia
Here are some helpful tips for effectively managing your pseudodysphagia:
Keep a symptom diary
Track symptoms like timing, triggers, foods, severity. This helps identify patterns and progress.
Find your trigger points
Note situations that worsen anxiety around eating like rush, stress, social settings. Avoid these or utilize coping strategies.
Have an eating routine
Eat at regular meal times in calm environments. Creating structure reduces uncertainty.
Chew thoroughly
Over-chewing food into a smooth bolus eases swallowing. Counting chews can help.
Eat slowly
Taking small bites and pacing yourself prevents feeling rushed.
Stay hydrated
Sipping fluids regularly keeps mucus membranes moist and swallowing smooth.
Optimize posture
Sit up straight when eating and keep your chin tucked slightly down.
Practice stress reduction
Try yoga, meditation, deep breathing, or listening to music to calm your mind.
Lean on your support system
Share your experiences with loved ones. Don’t isolate yourself.
Avoid negative self-talk
Be patient with yourself and replace self-criticism with positive affirmations.
Distract your mind
Listen to audiobooks or podcasts while eating to disengage from unhelpful thoughts.
Try easy-to-swallow foods
Well-cooked eggs, soups, yogurts, mashed potatoes. Avoid mixed textures.
Get moving
Light exercise can boost mood and relieve muscle tension.
Sticking to a treatment plan alongside implementing lifestyle changes empowers you to manage symptoms successfully long-term.
When to see a doctor
See your doctor if swallowing difficulties persist beyond a couple weeks, especially if you experience:
– Weight loss from avoiding foods
– Coughing or choking with meals
– Difficulty managing secretions
– Food sticking that requires drinking to clear
– Pain or difficulty swallowing pills
– Heartburn, reflux or regurgitation
While pseudodysphagia itself is not medically dangerous, it is still important to rule out underlying physical causes. Otolaryngologists can assess any structural abnormalities, while mental health providers address the root psychological factors perpetuating this condition.
With proper professional treatment and self-care, you can overcome your anxiety and retrain your swallowing mechanism to function smoothly again. Don’t lose hope. Consistent effort focused on both physical and mental wellbeing will ultimately help you regain normal, pleasurable eating.
Conclusion
Pseudodysphagia is a functional swallowing disorder in which underlying anxiety creates a perceived impairment in swallowing ability. While extremely uncomfortable, it does not indicate any true anatomical problem or damage. Appropriately diagnosing pseudodysphagia involves excluding any gastroesophageal or neuromuscular causes through medical tests.
Once identified as a psychosomatic condition, the most effective treatment combines physical rehabilitation exercises along with psychotherapy and stress reduction techniques. This dual approach addresses both the physical manifestation of throat and esophageal tension as well as the mental and emotional triggers like anxiety, depression and trauma.
With commitment and patience, the symptoms of pseudodysphagia can be successfully overcome through targetted treatment. Supportive self-care strategies, lifestyle modifications and adherence to maintenance techniques also promote effective long-term management. Seeking help from trained professionals ensures you can regain normal swallowing function and resume comfortable, pleasurable eating.