Phagophobia is the avoidance of swallowing foods, liquids, or pills, usually based on a fear of choking. Since the first reported case study in behavior therapy, cases reported in the cognitive-behavioral literature reveal that ostensibly different approaches have yielded similarly positive outcomes. A limited number of fundamental behavioral mechanisms appear to underlie the various manifestations of swallowing phobias. These may account for effectiveness of different cognitive-behavioral treatment protocols. This article describes a new case of phagophobia in an adult male client, revealing some of the variables that need to be considered in assessment and treatment. As the case described contained elements of body dysmorphic disorder, fear of choking, social anxiety, and fear of fear, it demonstrates subtleties of treatment design and the importance of adhering to sound behavioral principles and the value of a sophisticated functional analysis.
Ball, S.G., & Otto, M.W. ( 1994). Cognitive-behavioral treatment of choking phobia: 3 case studies. Psychotherapy and Psychosomatics, 62, 207-211.
2.
Bartolome, G., & Neumann, S. ( 1993). Swallowing therapy in patients with neurological disorders causing cricopharyngeal dysfunction. Dysphagia, 8, 146-149.
3.
Bryant, F.B., & Veroff, J. ( 2007). Savoring: A new model of positive experience. Mahwah, NJ: Lawrence Erlbaum.
4.
Chambless, D.L., Caputo, G.C., Bright, P., & Gallagher, R. ( 1984). Assessment of fear of fear in agoraphobics: The Body Sensation Questionnaire and the Agoraphobic Cognitions Questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090-1097.
5.
Chatoor, I., Conley, C., & Dickson, L. ( 1988). Food refusal after an incident of choking: A posttraumatic eating disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 27, 105-110.
6.
Chorpita, B.F., Vitali, A.E., & Barlow, D.H. ( 1997). Behavioral treatment of choking phobia in an adolescent: An experimental analysis. Journal of Behavior Therapy and Experimental Psychiatry, 28, 307-315.
7.
Çiyiltepe, M., & Türkbay, T. (2006). Phagophobia: A case report . Turkish Journal of Pediatrics, 48, 80-84.
8.
Clark, D.M. ( 1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461-470.
9.
Clark, D.M., & Wells, A. ( 1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz , D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York, NY: Guilford.
10.
Culbert, T.P., Kajander, R.L., Kohen, D.P., & Reaney, J.B. ( 1996). Hypnobehavioral approaches for school-age children with dysphagia and food aversion: A case series. Journal of Developmental & Behavioral Pediatrics, 17, 335-341.
11.
Curtis, V.A., & Biran, A. ( 2001). Dirt, disgust, and disease: Is hygiene in our genes?Perspectives in Biology and Medicine, 44, 17-31.
12.
Dahlquist, L.M., & Blount, R.L. ( 1984). Teaching a six-year-old girl to swallow pills. Journal of Behavior Therapy and Experimental Psychiatry, 15, 171-173.
13.
Di Scipio, W.J., & Kaslon, K. ( 1982). Conditioned dysphagia in cleft palate children after pharyngeal flap surgery. Psychosomatic Medicine, 44, 247-257.
14.
Donzelli, J., Brady, S., Wesling, M., & Theisen, M. ( 2005). Effects of the removal of the tracheotomy tube on swallowing during the fiberoptic endoscopic exam of the swallow (FEES). Dysphagia, 20, 283-289.
15.
Evans, I.M. ( 1972). A conditioning model of a common neurotic pattern: Fear of fear. Psychotherapy: Theory, Research & Practice, 9, 238-241.
16.
Evans, I.M. ( 1980). Relaxation training. In R. Herink (Ed.), The psychotherapy handbook (pp. 361-368). New York: Meridian.
17.
Eysenck, H.J. ( 1968). A theory of the incubation of anxiety/fear responses . Behaviour Research and Therapy, 6, 309-321.
18.
Finkenbine, R., & Miele, V.J. ( 2004). Globus hystericus: A brief review. General Hospital Psychiatry, 26, 78-82.
19.
Hayes, S.C., Strosahl, K., & Wilson, K.G. ( 1999). Acceptance and commitment therapy: An experiential approach to behaviour change. New York, NY: Guilford.
20.
Hayes, S.C., Wilson, K.G., Gifford, E.V., Follette, V.M., & Strosahl, K. ( 1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152-1168.
21.
Kaplan, P.R., & Evans, I.M. ( 1978). A case of functional dysphagia treated on the model of fear of fear. Journal of Behavior Therapy and Experimental Psychiatry, 9, 71-72.
22.
Kim, C.H., Hsu, J.J., Williams, D.E., Weaver, A.L., & Zinsmeister, A.R. (1996). A prospective psychological evaluation of patients with dysphagia of various etiologies. Dysphagia, 11, 34-40.
Liebowitz, M.R. ( 1987). Globus hystericus and panic attacks. American Journal of Psychiatry, 144, 390-391.
25.
Logemann, J.A. ( 1998). Evaluation and treatment of swallowing disorders (2nd ed.). Austin, TX: Pro-Ed.
26.
McClintock, J.M., & Evans, I.M. ( 2001). The underlying psychopathology of eating disorders and social phobia: A structural equation analysis. Eating Behaviors , 2, 247-261.
27.
McNally, R.J. ( 1986). Behavioral treatment of a choking phobia. Journal of Behavior Therapy and Experimental Psychiatry, 17, 185-188.
28.
McNally, R.J. ( 1994). Choking phobia: A review of the literature. Comprehensive Psychiatry, 35, 83-89.
MedHelp. (2008/2009). Fear of swallowing food: Panic while swallowing food. Retrieved from http://www.medhelp.org/user_journals/show/3573/Fear-of-swallowing-food--Panic-while-swallowing-food
31.
Miller, A.J. ( 2008). The neurobiology of swallowing and dysphagia. Developmental Disabilities Research Reviews, 14, 77-86.
32.
New York State Psychiatric Institute. (2007 ). Structured Clinical Interview for DSM Disorders. New York, NY: Author.
33.
Nock, M.K. ( 2002). A multiple-baseline evaluation of the treatment of food phobia in a young boy. Journal of Behavior Therapy and Experimental Psychiatry, 33, 217-225.
34.
Okada, A., Tsukamoto, C., Hosogi, M., Yamanaka, E., Watanabe, K., Ootyou, K., & Morishima, T. ( 2007). A study of psycho-pathology and treatment of children with phagophobia. Acta Medica Okayama, 61, 261-269.
35.
Pluess, M., Conrad, A., & Wilhelm, F.H. ( 2009). Muscle tension in generalized anxiety disorder: A critical review of the literature. Journal of Anxiety Disorders, 23, 1-11.
36.
Rachman, S., Radomsky, A.S., & Shafran, R. ( 2007). Safety behaviour: A reconsideration. Behaviour Research and Therapy, 46, 163-173.
Reiss, S. ( 1987). Theoretical perspectives on the fear of anxiety. Clinical Psychology Review, 7, 585-596.
39.
Rozin, P., & Fallon, A.E. ( 1987). A perspective on disgust. Psychological Review, 94, 23-41.
40.
Salkovskis, P.M. ( 1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy , 19, 6-19.
41.
Salkovskis, P.M., Clark, D.M., Hackmann, A., Wells, A., & Gelder, M.G. ( 1999). An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behaviour Research and Therapy, 37, 559-574.
42.
Sallows, G.O. ( 1980). Behavioral treatment of swallowing difficulty. Journal of Behavior Therapy and Experimental Psychiatry, 11, 45-47.
43.
Shapiro, J., Franko, D.L., & Gagne, A. ( 1997). Phagophobia: A form of psychogenic dysphagia-A new entity . Annals of Otology, Rhinology & Laryngology, 106, 286-290.
44.
Sinclair, M. ( 2005, July). Great expectorations. Time Out Chicago, 21, 21-27.
45.
Singer, L.T., Ambuel, B., Wade, S., & Jaffe, A.C. ( 1992). Cognitive-behavioral treatment of health-impairing food phobias in children. Journal of the American Academy of Child & Adolescent Psychiatry, 31, 847-852.
46.
Walco, G.A. ( 1986). A behavioral treatment for difficulty in swallowing pills . Journal of Behavior Therapy and Experimental Psychiatry , 17, 127-128.
47.
Watanabe, Y., Abe, S., Ishikawa, T., Yamada, Y., & Yamane, G. ( 2004). Cortical regulation during the early stage of initiation of voluntary swallowing in humans. Dysphagia, 19, 100-108.
48.
Wegner, D.M., Schneider, D.J., Carter, S.R., & White, T.L. ( 1987). Paradoxical effects of thought suppression. Journal of Personality and Social Psychology, 53, 5-13.
49.
Williams, G.W., & Degenhardt, E.T. (1954). Paruresis: A survey of a disorder of micturition. Journal of General Psychology, 51, 19-29.
