Swallowing, Choking, and Vomiting Phobias

Fear of Food (That is NOT an Eating Disorder)

Are you afraid of eating? Are you fearful of choking or throwing up?

Where phobias and eating collide, we can help you. As specialists trained in both eating disorders and cognitive-behavioral therapy—the treatment of choice for anxiety and phobias— we are uniquely qualified to help with these problems.

A phobia is an intense anxiety disorder that manifests in relation to certain commonly feared objects or situations. Some common phobias include situations that affect eating. These include specific phobia of swallowing (Phagophobia), choking (Pseudodysphagia), and vomiting (Emetophobia). These phobias can occur in children or adults and may often occur after an incident such as being sick, observing others being sick, a choking incident, or the like.

People who experience these phobias may start to avoid eating certain foods or eating altogether, or may engage in safety behaviors:  behaviors they feel protect them from the danger, such as taking tiny bites or chewing excessively. They may also avoid being around people who are sick, places where they believe people are more likely to be sick, or any situation that could produce motion sickness. These phobias are often accompanied by a number of physical complaints including nausea, stomach aches, and reflux and look a lot like a medical problem. This is why it is important to see a medical doctor to rule out any medical problems.

Over time, if people with any of these phobias continue to avoid eating certain foods or eating enough, additional problems can develop.  These problems may include delayed gastric emptying (gastroparesis) and malnutrition. Significant weight loss and dehydration may occur. People with these phobias may also qualify for a diagnosis of Avoidant Restrictive Food Intake Disorder (ARFID). In order to meet criteria for this eating disorder, individuals must experience one or more of the following: weight loss, nutritional deficiency, dependence on nutritional supplementation, and impairment in psychosocial functioning. There are three major types of ARFID: 1) Textural sensitivity, 2) Low interest, and 3) Fear of traumatic consequences. While some people with ARFID may have symptoms of more than one type of ARFID, the three phobias discussed here overlap mostly with the fear of traumatic consequences type of ARFID.

The more one avoids the thing that makes them scared, the worse the fear gets. Treatment for these phobias and the ARFID related to fear of traumatic consequences entail exposure—that is, facing the fears. Don’t worry! This doesn’t sound as bad as it is. We won’t make you throw up!

We conduct a thorough assessment that allows us to individualize your treatment. We then work together to create a hierarchy (ladder) of your fears and develop a plan to help you gradually face those scary things you’ve been avoiding. We also provide education about the anxiety cycle, the physical symptoms of anxiety, and strategies for coping with uncomfortable feelings and physical sensations. In session, we will work together on exposure and we may assign homework. Exposure activities we may suggest include spinning around (to induce sensations of nausea), eating different foods, practicing swallowing M and M’s (or half or quarter M and M’s), and looking at cartoons about vomiting. We don’t move on to any step until you are ready.

Over time, you will be able to overcome your fear. If you have lost weight and need to regain it we will also guide you in strategies to stop and reverse weight loss. When working with children with these issues, we use a family-based approach.