Psychiatric Causes of Dysphagia (Difficulty Swallowing)

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Dysphagia is the medical term for swallowing difficulties. Difficulty swallowing is typically caused by a physical condition—like a stroke, head injury, some types of cancer, and gastroesophageal reflux disease (GERD).

While dysphagia has been reported to occur in 6% of the general population, it is thought to be a more common problem in the population of adults with mental illness. The cause of this specific type of dysphagia is poorly understood but may be related to behavioral changes associated with mental illness, anxieties, phobias, and side effects of medication.

Woman touching her throat in pain

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What Is Dysphagia?

Dysphagia most frequently occurs when there is a problem with the nerve control or the structures involved in any part of the swallowing process. It occurs when you need to take more time or effort to move food from your mouth to your stomach, or you may not be able to move the food from your mouth, resulting in choking or aspiration of the food.

Dysphagia is a symptom rather than a medical condition in its own right. Dysphagia is sometimes divided into these four types::

  • Oropharyngeal dysphagia: With oropharyngeal dysphagia, you have trouble moving food, liquid, or saliva from your mouth into your throat. Patients with oropharyngeal dysphagia present with difficulty in initiating swallowing and may also have associated coughing, choking, or nasal regurgitation. 
  • Esophageal (or obstructive) dysphagia: Patients with esophageal dysphagia present with the sensation of food sticking in their throat or chest. With esophageal dysphagia, you have difficulty passing food down the esophagus (the tube which goes from your mouth to your stomach).
  • Neuromuscular symptom complex: Those with neuromuscular dysphagia experience gradually progressive difficulty in swallowing solid food and liquids due to neurodegenerative diseases including Parkinson's diseasemultiple sclerosis, and motor neuron disease or damage to the central nervous system.
  • Functional dysphagia: This is the sensation of difficulty swallowing and is not associated with anatomic abnormalities or injury. Functional dysphagia may or may not be related to a mental disorder. In people diagnosed with mental illness, dysphagia is seen to be a common occurrence.

Psychiatric Causes

Functional dysphagia is a symptom commonly noted in people with:

  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Generalized anxiety disorder
  • Depression
  • Panic disorder
  • Social phobia

In certain instances, dysphagia may reflect a somatic symptom disorder (SSD) or a specific phobia.

Medically unexplained oropharyngeal dysphagia (MUNOD) can sometimes occur in people with SSD.

Dysphagia can also be a symptom of a specific phobia, such as:

  • Phagophobia: Phagophobia is a fear of swallowing. Anxiety and tension can cause the throat muscles to constrict, feeling to some like "a lump in the throat." Those who fear swallowing may find themselves physically unable to do so once they become too anxious.
  • Pseudodysphagia: Choking phobia is a rare condition characterized by an intense fear of choking, accompanied by avoidance of swallowing solid food, liquids, and taking pills/ tablets.

Medications and Other Causes

Sometimes side effects of the medication used to help treat disorders can cause difficulty swallowing. These include:

  • Antipsychotic medication can impair the function of the muscles which aid swallowing and increase the risk of esophageal dysphagia.
  • Tardive dyskinesia (involuntary repetitive movements that usually involve the tongue and face) can impair the swallowing reflex, causing oropharyngeal or esophageal dysphagia.
  • Several types of psychiatric medications can also cause xerostomia (dry mouth), which can lead to oropharyngeal dysphagia.

These side effects can occur on their own or be exacerbated by anxiety or panic attacks which can result in a feeling of tightness, a lump in the throat, or even a sensation of choking.

Symptoms

When you have difficulty swallowing due to functional dysphagia, you may be experiencing one or more of the following symptoms:

  • The sensation of food and/or medication getting stuck in the esophagus
  • Regurgitation of food
  • Coughing and/or choking with eating and drinking

With phagophobia (fear of swallowing), individuals may:

  • Avoid certain types of food or textures
  • Hyper-masticate (over-chew) their food
  • Complain of food sticking
  • Exhibit difficulty getting the swallow “started”
  • Lose weight

All of these symptoms can create elevated levels of anxiety and cause patients to socially isolate themselves during mealtimes.

Those suffering from pseudodysphagia (fear of choking) often have difficulty eating solid foods. Anxiety and tension cause throat muscles to constrict, which further increases the chance of choking. Many people find that excessive chewing and swallowing each bite with a large sip of liquid can help to ease their symptoms.

Diagnosis

Tests and measures that your doctor may perform to diagnose your dysphagia may include:

  • In-office clinical examination: Your doctor will look and listen as you swallow to determine which muscles are working properly or are impaired.
  • Barium swallowing exam with videofluoroscopy: During this examination, an X-ray will be taken of your swallowing mechanism as you swallow barium. The barium is opaque on the X-ray, and your doctor can assess where it goes in your mouth and throat as you swallow. The examination can be captured on video in real-time for review.
  • Fiberoptic endoscopic examination of swallowing (FEES): A FEES entails having a small flexible fiberoptic tube inserted into your nasal cavity. A tiny camera is on the end of the tube. Your nasal area may be anesthetized prior to insertion of the tube. Once the camera is situated up your nose and into the back of your throat, you eat bits of food, and your doctor can see where food or drink is getting caught while you swallow. The test can be recorded on video for later review.

Medical reasons for difficulty swallowing need to be ruled out prior to a diagnosis of functional dysphagia. These include:

Speak With a Healthcare Professional

Some studies have suggested that a medical cause was found in two-thirds of the cases of what was thought to be functional dysphagia, illustrating that the pursuit of a complete differential diagnosis is always needed.

A diagnosis of functional dysphagia typically isn't made until a person has experienced a stream of unexplained physical symptoms, medical tests, and treatments.

If your primary care physician suspects you have this, they may refer to you a psychiatrist who will ask questions to determine if you have any contributing psychiatric diagnoses whose criteria are established in the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders, Issue 5" (DSM-5).

Treatment

The treatment of functional dysphagia may vary from person to person.

CBT is often used in tandem with mindfulness-based therapy and mind-body interventions to help people better understand and change maladaptive thoughts and behavioral reactions that may be contributing to the symptoms.

If you have a phobia that is affecting your ability to swallow, which in turn is impacting or restricting your eating habits, professional assistance may be required. Find a therapist who will work with you to develop a treatment plan that addresses your phobia and any related disorders.

If the cause of dysphagia is a side effect of medication, discuss this with your physician, as it may be possible to reduce your medication dose or change treatment, particularly if the side-effects are having a major impact on your life.

A Word From Verywell

If you are experiencing chronic dysphagia, speak to your primary care physician. Swallowing problems can be managed well if they are diagnosed properly and if the right treatment is applied.

If a physical cause cannot be found, a consultation with a psychiatrist is recommended if you have a history of anxiety, depression, or other mental health problems.

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