Psychiatric Causes of Dysphagia (Difficulty Swallowing)

Dysphagia is the medical term for difficulty when swallowing. Swallowing is complex. It involves coordination from around 50 different nerves and muscles in the mouth, throat, and esophagus.

There are many physical and medical causes of dysphagia. People with psychological issues or mental illness are also prone to dysphagia, though the reasons for that aren't completely understood.

This article discusses dysphagia due to psychiatric causes, as well as symptoms, diagnosis, and treatment.

Types of Dysphagia

Verywell / Dennis Madamba

What Is Dysphagia?

Dysphagia is when you have difficulty swallowing. It may feel as if the food is stuck in your throat or chest, or that your neck is "full."

Dysphagia can be serious if you choke and food gets into your airways and blocks them, known as aspiration. If the dysphagia is worse with solids than liquids, make sure to see a healthcare provider, as this can be a sign of esophageal tumor.

About one in 25 adults in the U.S. will have some form of dysphagia in their lifetime, but some experts think that estimate is low.

There is a high incidence of dysphagia among people with mental health conditions, which may be due to a side effect of medication, a phobia, or abnormal eating behaviors.

Dysphagia is a symptom of a health concern rather than a disease or medical condition itself. There are four types of dysphagia:

  • Oropharyngeal dysphagia: Difficulty moving food from the mouth to the throat
  • Esophageal dysphagia: Difficulty moving food down the esophagus
  • Neuromuscular symptom complex: A symptom of a progressive neurological disease or neurological damage
  • Functional dysphagia: Trouble swallowing when there seems to be no structural or medical reason for it (this can be psychosomatic, meaning it's related to a mental disorder, though not always)

Underlying Causes for Dysphagia

It can be difficult to get to the root cause of dysphagia in some people. One older study found that two thirds of the people who were initially diagnosed with dysphagia due to mental health reasons were later found to have medical causes for their swallowing difficulty.

Psychiatric Causes

There are many reasons why people may experience dysphagia.

However, mental health disorders are a somewhat common cause among those with functional dysphagia. These disorders include:

For these individuals, dysphagia may be a result of somatic symptom disorder (SSD), which is an intense focus on physical symptoms, enough to disrupt daily activities.

People are diagnosed with SSD if they have at least two of the following characteristics:

  • High level of health-related anxiety
  • Ongoing and exaggerated concerns about the severity of a health concern
  • Excessive attention to the health concerns

If the symptoms last for more than six months, it's considered chronic.

Among people with SSD who have dysphagia, functional dysphagia is the most common. It's also called medically unexplained oropharyngeal dysphagia, or MUNOD. People with MUNOD feel like food is stuck in their throat. If they feel the food is stuck in the esophagus, which may be accompanied by choking, it's called esophageal dysphagia.

Sometimes, though rare, dysphagia is a form of a phobia. These phobias include:

  • Phagophobia: Fear of swallowing, due to a psychogenic (psychological rather than physical) reason
  • Pseudodysphagia: Fear of choking

Others individuals with mental illnesses may have episodes of dysphagia because they have trouble sitting still when eating, which increases the chance of food getting stuck. Or, they are hyperactive and bolt their food down too quickly.

Medications and Other Causes

Dysphagia may also occur as a side effect of medication. Medications associated with mental illness that can induce dysphagia include:

  • Antipsychotics: Can weaken the esophagus (windpipe), increasing the risk of food getting stuck. These medications can also cause xerostomia, better known as dry mouth, which can make it harder to swallow. Anticholergenic drugs, which affect the nervous system, may be given along with antipsychotics, and increase the risk of developing dysphagia.
  • Tardive dyskinesia: Some medications for mental illness can cause this involuntary movement disorder as a side effect. Tardive dyskinesia can affect the swallowing reflex in either the throat or esophagus.

In the past few years, experts have noted a strong link between anxiety and the severity of dysphagia symptoms. Anxiety can cause "esophageal hypervigilance," an intense, exaggerated focus on swallowing. It occurs more often in people who have been treated for a medical condition involving the esophagus.

Medical Causes

Medical causes of dysphagia include neurological conditions like multiple sclerosis, myasthenia gravis, and Parkinson's disease. It can also be caused by structural abnormalities, stroke, cancer of the head and neck, scarring from surgery or radiation treatment, or inflammation of the esophagus. If you experience esophageal dysphagia that is worse with solids, consult a healthcare provider right away, as this can be a sign of a tumor.

Symptoms

The symptoms of dysphagia can differ based on the cause. If it's associated with SSD, including phobias, signs and symptoms can include:

  • Pain when swallowing
  • Feeling that food is stuck in the throat or chest
  • Inability to swallow
  • Heartburn
  • Drooling
  • Hoarseness
  • Regurgitation

If associated with phagophobia, signs and symptoms include:

  • Avoidance of certain foods
  • Hypermastication (over chewing)
  • Feeling of food sticking in throat or esophagus
  • Weight loss
  • Anxiety and social withdrawal

If associated with pseudodysphagia, symptoms include:

  • Feelings of panic about swallowing
  • Difficulty swallowing
  • Avoiding eating solid food
  • Weight loss
  • Anxiety and depression

Diagnosis

Healthcare providers use a variety of tests, exams, and questions to diagnose dysphagia. Even if they suspect functional dysphagia, they will rule out medical causes first, including:

  • Structural abnormalities
  • Gastroesophageal reflux disease (GERD)
  • Cancer of the throat, neck, or esophagus
  • Neuromuscular diseases that can weaken the muscles of the throat

If a provider suspects functional dysphagia, diagnostic procedures and tests include:

  • Fiberoptic functional endoscopic examination of swallowing (FEES): Examination of the swallowing mechanism using a thin flexible tube with a fiberoptic camera at the end
  • Evaluation on the Dysphagia Severity Scale: The patient rates their difficulty in swallowing on a scale of 1 to 100, with 100 being normal

To reach a diagnosis of functional dysphagia due to a mental disorder, a person must meet the criteria established by the Diagnostic and Statistic Manual of Mental Disorders, 5th Edition (DSM-5). These include:

  • One or more symptoms that affect body movement or senses (in this case swallowing)
  • Symptoms are not attributable to a neurological or other medical condition, or another mental health disorder
  • Symptoms cause significant distress or problems in social settings, work, or other areas

MUNOD does not fall within the DSM criteria. Patients with MUNOD may be diagnosed instead with functional dysphagia, or possibly phagophobia (fear of swallowing).

A diagnosis of phagophobia requires that other psychiatric or physical conditions are excluded. The DSM-5 criteria for phagophobia are:

  • An anxiety response to the prospect of swallowing
  • Avoidance of eating or feeling severe distress when eating
  • Interference with normal daily and social routines

Treatment

Treatment for dysphagia depends on the cause. If it is due to a psychiatric cause, treatment can include:

  • Medication change: Providers may lower the dose or try a different medication for people with mental disorders in which dysphagia may be a side effect
  • Psychotherapy or behavioral therapy: Including cognitive behavioral therapy (CBT), hypnosis, or relaxation therapy
  • Chewing and swallowing therapy: Sometimes as adjunct to psychotherapy

Summary

Dysphagia is a term for when swallowing is difficult. If severe, dysphagia can make it difficult to eat, lead to a higher risk of choking, and disrupt normal routines.

Dysphagia can have many different causes. Some cases of dysphagia are due to structural abnormalities or disease, and some are considered functional, where there is no apparent physical cause. Psychiatric reasons for dysphagia include anxiety disorders, phobias, somatic symptom disorder, and more.

To diagnose functional dysphagia, a healthcare provider will rule out physical causes. Treatment includes therapy or changes in medication and/or dosages, which may help alleviate symptoms so that they do not interfere with daily life.

A Word From Verywell

If you have trouble swallowing, are losing weight, or you avoid social situations where you may have to eat, contact a healthcare provider. Dysphagia may not be life-threatening, but it can affect your quality of life. Providers can refer you to a mental health professional who may be able to help you overcome your dysphagia.

Frequently Asked Questions

  • What Is phagophobia?

    Phagophobia is the fear of swallowing. It is a psychological form of dysphagia where a person avoids swallowing food, liquid, or pills. It is sometimes associated with a fear of choking. 

  • What is pseudodysphagia?

    Pseudodysphagia is a fear of choking. People with pseudodysphagia often have difficulty eating solid foods. In some cases, people with pseudodysphagia resort to eating only pureed foods, baby food, or protein shakes to ensure proper nutrition. 

  • Can anxiety cause difficulty swallowing?

    Yes, anxiety and panic attacks can cause the throat muscles to tighten and constrict. Some people report anxiety makes them feel as if they are being choked. This can make swallowing difficult.

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15 Sources
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