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What causes Phagophobia?

Phagophobia, also known as fear of swallowing or fear of choking, is an anxiety disorder characterized by an extreme fear of swallowing food or liquids. This excessive fear can lead to avoidance of eating and drinking in public situations. Phagophobia is considered a specific phobia, which means that the fear response is triggered by a specific stimulus – in this case, swallowing. While the exact causes of phagophobia are unknown, it likely involves both environmental and genetic factors.

Symptoms of Phagophobia

Individuals with phagophobia experience intense anxiety when swallowing or when thinking about swallowing food or liquids. Common symptoms include:

  • Extreme anxiety when swallowing
  • Avoidance of eating/drinking in public situations
  • Difficulty swallowing (dysphagia)
  • Tightness in the throat
  • Nausea or vomiting when trying to swallow
  • Shortness of breath
  • Racing heart rate
  • Sweating or tremors when faced with swallowing

In severe cases, the individual may significantly restrict their diet and liquid intake due to the intense fear, leading to malnutrition and dehydration. Weight loss is common. The anxiety can be so debilitating that the individual avoids swallowing their own saliva.

Causes and Risk Factors

While the exact cause of phagophobia is unknown, it is likely due to a combination of genetic and environmental factors.

Genetic Factors

Phagophobia appears to run in families, suggesting there may be genetic risk factors. First-degree relatives of people with phagophobia are more likely to develop the condition themselves. Research also shows that people with phagophobia are more likely to have a family history of other anxiety disorders. Certain genes involved in regulation of anxiety may increase risk.

Environmental Triggers

External events or situations often serve as triggers for the development of phagophobia. Common triggers include:

  • Traumatic experience with choking or vomiting – Having a scary episode of choking on food or vomiting after eating can lead to the development of phagophobia through classical conditioning.
  • Witnessing another person choke – Seeing someone else struggle with choking or swallowing difficulties can trigger the phobia.
  • Teasing/bullying – Being teased or bullied about eating habits or weight can contribute to disordered eating patterns.
  • Underlying medical conditions – Gastrointestinal disorders like GERD or neurological conditions like stroke that affect swallowing may predispose people to choking episodes and swallowing difficulties.
  • Major life stress – Highly stressful events or significant life changes may act as a catalyst for the emergence of the phobia in predisposed individuals.

Information Processing Biases

People with phagophobia also appear to have certain cognitive and information processing biases that maintain or exacerbate the fear response, including:

  • Selective attention – Hypervigilance and selective focus on any cues of choking or difficulty swallowing.
  • Confirmation bias – Tendency to look for and remember information that confirms their fear.
  • Overestimation of threat – Tendency to overestimate the danger and consequences of choking/swallowing.

Brain Structure and Function

Brain imaging studies show some differences in key structures and networks involved in fear processing and regulation in people with phagophobia and other anxiety disorders:

  • Increased amygdala activation – The amygdala is involved in detecting threats and triggering fear responses. People with phagophobia show increased activity in the amygdala when exposed to images of people eating/choking.
  • Altered prefrontal cortex function – Areas like the ventromedial prefrontal cortex that are involved in fear regulation and safety learning show different patterns of activation.
  • Insula hyperactivity – The insula, involved in monitoring internal body states, is overactive during exposure to swallowing/choking stimuli.

These brain differences likely contribute to the exaggerated fear of swallowing seen in phagophobia.

Psychological Factors

Certain psychological and personality traits have been associated with phagophobia, which may contribute to its development and maintenance:

Trauma and Adverse Childhood Experiences

Individuals who experienced traumatic events, abuse, or neglect in childhood appear to be at increased risk for developing phagophobia later in life. Early traumatic experiences can alter fear regulation pathways in the brain.

Anxiety Sensitivity

People who are more sensitive to anxiety symptoms and their physical sensations tend to be more prone to developing anxiety disorders like phagophobia after distressing events.

Food-Related Experiences

Those with a history of picky eating, gagging or vomiting in response to certain food textures, or forced/unpleasant feeding situations as a child may be more vulnerable to developing maladaptive swallowing fears.


Perfectionistic personality traits, including fear of failure and mistake avoidance, may predispose people to phobias like phagophobia. The fear of imperfect swallowing/choking can become overwhelming.

Obsessive-Compulsive Traits

Individuals with obsessive-compulsive tendencies may be more prone to getting “stuck” on fears about swallowing and engage in compulsive avoidance rituals.

Social and Environmental Factors

Certain social and cultural factors can also contribute to phagophobia in vulnerable individuals:

Media Portrayal of Choking

Seeing choking depicted as frightening or life-threatening in movies and stories can reinforce swallowing fears, especially in children.

Peer Influences

Having friends or peers with eating anxieties or related phobias may shape fears through social observation and reinforcement of avoidance behaviors.

Cultural Attitudes About Eating

Cultures that attach moral judgment or stigma to eating patterns, weight or body image may foster disordered eating habits.

Overprotective Parents

Parental reinforcement of choking fears or overprotective feeding practices can perpetuate maladaptive beliefs in children.

Other Factors That Can Contribute to Phagophobia

– History of abuse or trauma surrounding feeding situations
– Being forced to eat excessively as a child
– Exposure to others’ fears about choking (e.g. a parent)
– Teasing or bullying about eating habits or weight
– Underlying medical conditions like acid reflux or stroke affecting swallowing
– Recent stressful life events


In summary, phagophobia or fear of swallowing appears to stem from a complex interplay of biological and environmental factors. Genetic vulnerabilities, brain differences in fear regulation, information processing biases, traumatic life events, and certain psychological traits all seem to contribute to its development and maintenance in susceptible individuals. While more research is still needed, better understanding the causes of this debilitating anxiety disorder will help improve treatment approaches aimed at helping sufferers overcome their extreme swallowing fear and regain normal eating abilities. With compassionate professional help and evidence-based strategies like exposure therapy, the outlook for overcoming phagophobia is good.