When Are Swallowing Problems Linked To Psychological Implications?

Dysphagia is the medical term for swallowing problems. It has physical causes, but experts reveal through studies it can also exist due to psychological factors. Research has long established a strong connection between physical and mental health conditions, explaining why people feel depressed when ill. Can swallowing problems be psychological, as well? Learn about the various psychological implications of swallowing problems.

Prevalence of Dysphagia

Eating is an essential activity that allows the body to receive nutrition from food. The mouth, throat and esophagus work together for the food to reach the stomach for digestion. While this process is normal for many, some people find it challenging to propel down food or liquid, posing nutritional deficiency.

Dysphagia has a worldwide prevalence rate of 2 to 20%, promoting it as a significant health issue. It affects people at any age but is more common in older adults. Its physical causes stem from the anomaly in the muscles and nerves engaged in swallowing. For example, when throat muscles sustain damage, the esophagus will have trouble squeezing food into the stomach. This condition is called achalasia, which is a type of dysphagia.

Swallowing involves three main muscles — mouth, throat and esophagus. Healthcare providers categorize it based on what part is affected as food journeys through to the stomach.

• Oral dysphagia for mouth problems

• Oropharyngeal dysphagia if it affects the throat

• Esophageal dysphagia when the esophagus is damaged

Psychological Factors Contributing to Dysphagia

The simple act of swallowing is a complex body activity. The nerves surrounding the mouth, throat and esophagus need to work in perfect harmony to perform such activity without any hitch.

You may be aware of dysphagia as a condition with physical causes. But can swallowing problems be psychological? Find out what studies found to be potential mental contributors.

1. Anxiety

One study identified that esophageal hypervigilance and symptom-specific anxiety are substantial predictors of severe esophageal dysphagia. Esophageal hypervigilance happens when you’re highly and negatively focused on the sensations in the esophagus as the food passes through it to the point you think it can cause problems. So, if you have an existing swallowing condition, worrying about it may worsen the symptoms.

2. Stress and Depression

Surprisingly, stress is a substantial psychological factor in swallowing difficulties through a clinical condition called globus sensation. It’s a general term describing the sensation of having a “lump in the throat” or when it feels “full.”

Experts hypothesize that anxiety, stress and depression can lead to globus symptoms. Alternatively, people with chronic globus sensation may also have elevated anxiety, stress and depression levels. This reciprocal relationship was what experts believe caused 96% of patients with globus sensations to experience worsening symptoms during periods of “high emotional intensity.”

3. Fear of Choking

Pseudodysphagia occurs when a person feels they’ll choke to death every time they swallow food, affecting the way they eat. From the word “pseudo” or “false” and dysphagia meaning “swallowing problems,” it’s a symptom without physical characteristics and entirely psychosomatic. However, due to extreme anxiety and distress about choking, your relationship with food may change.

Phagophobia is another phenomenon with fear of swallowing as its main psychological trigger. It’s a rare type of phobia often confused with pseudodysphagia, but it’s different as you’re afraid of the act of swallowing — not choking. With phagophobia, you may experience extreme anxiety and fear just thinking about swallowing after chewing the food. You may also have panic attacks.

4. Trauma and Grief

A report on an older woman found trauma and grief can also induce swallowing problems. Initially, the 62-year-old female patient managed dysphagia for years by eliminating any food that could cause swallowing concerns. But it re-occurred after about seven years and got worse until she choked with her own saliva. It affected her appetite and her health declined due to drastic weight loss.

Later on, researchers found she had a lifetime history of generalized anxiety disorder and had gone through repeated situations causing her extreme grief, starting from the loss of her youngest son and close family members over the last few years.

Experts determined that worsening dysphagia and weight loss problems happened at the same time she experienced frequent complicated grief, leading them to conclude trauma and grief contributed to the development of swallowing problems.

Today, as many as 60% of men and 50% of women go through at least one traumatic event, which raises the incidence of dysphagia. Seeking treatment is vital to prevent worse health scenarios.

Holistic Treatment Approach to Dysphagia

Over half of adults with mental illnesses don’t receive treatment, which is appalling given how studies confirmed the bidirectional link between physical and psychological state. In holistic health, the disease of the physical body is also of the mind and emotion. This seems to be the case with dysphagia, too. Hence, it requires an effective recovery plan that addresses the entire well-being needs of the person. 

Physical Treatment

It starts with an accurate diagnosis to locate the underlying physical cause of the condition. Your health care provider will use high-resolution video imaging medical equipment to look at the structures involved in chewing, drinking and swallowing to detect alarming concerns. This examination in the form of a special X-ray can also rule out any deep-rooted psychological factor that may prompt dysphagia.

Depending on the results, your health care provider may suggest surgery or tube feeding or refer you to a mental health professional if the problem is psychologically related.

Psychological Interventions

Therapy can help you overcome the fear, anxiety or stress associated with eating problems. Some approaches mental health professionals use are:

• Cognitive-behavioral therapy (CBT): You’ll learn to manage stress and fear.

• Trauma-informed therapies: Your therapist will help you process unresolved trauma to improve your eating habits.

• Relaxation techniques: By adopting a stress management skill, you can minimize its impact on swallowing.

• Swallowing therapy: A speech-language pathologist will guide you through exercises and tactics to safely move the food or liquid to the esophagus.

Lifestyle Changes

Your doctor may also suggest lifestyle alterations to improve the way you ingest food. Things like changing the consistency of the foods to make them easy to swallow and trying different textures to see which ones you can take without any problem are among the recommendations.

Swallowing Problems Can Have Psychological Causes

Swallowing problems can have physical and mental implications — but not many know this. Thus, a precise diagnosis is essential to bring up the underlying cause. It’s the key for providers to develop a suitable and effective treatment plan.

For physical diagnosis, a physician may advise surgery and tube feeding.

If psychological factors are involved, therapy and getting the help of a mental health professional and speech-language pathologist can help restore swallowing to normal functions. Dysphagia can lead to malnutrition and provoke other health conditions, so seeking treatment is crucial.