Penelope Ling is an award-winning solution-focused hypnotherapist specialising in phobias. She founded Penelope Ling Hypnotherapy and is the author of the book Driving me crazy - overcome the fear of driving. She regularly contributes to magazines like Happiful and guests on podcasts and BBC local radio.
Discover what lies behind the little-known issue of pseudo dysphagia or phagophobia, otherwise known as fear of swallowing. We’ll show you everything you need to know to free yourself from this debilitating problem and have a normal life again. From what exactly it is, to practical tips and tools to help change your responses.
What is phagophobia?
Phagophobia is a fear of swallowing. Whether it’s from choking on food or gagging at the dentists, the fear can stop someone from eating and drinking and, if left unchecked, can lead to hospitalization. Sometimes it may manifest as not being able to speak, often when having to address a large audience. Perhaps trying to swallow medication is the issue. There are many scenarios where phagophobia plays a role.
What is really going on with phagophobia?
The most important thing to remember is that phagophobia is the body’s reaction to stress. When we go into fight or flight, our muscles instantly tense up. This is to run away from the predator. We stop digesting because the body can’t cope with eating and running away. In our modern world, we don’t have lions or polar bears roaming around, but unfortunately for us, with wild imaginations, just a thought of being threatened will land us there. In some people, it will result in Bruxism or teeth grinding, in other's tense neck and shoulder muscles. Irritable bowel syndrome happens because our bodies do not want to be digesting whilst running away from being the lunch of a tiger. Phagophobia is the opposite end. It’s our body trying to stop us from eating.
Can phagophobia be cured?
Specific phobias can be dealt with using techniques such as Rewind, EMDR or brain working recursive therapy. Non-specific phobias, such as phagophobia, are more the emptying of one’s stress bucket that will slowly decrease the times this problem happens. Learning to change the cue for getting stressed about eating or going to the dentist. Realising that you’re trying to fit in too many activities during the day or living in a toxic environment at home or at work.
Is phagophobia always caused by fear?
Phagophobia is the physical manifestation of stress, however, problems swallowing can be caused by all kinds of health problems. This is why you must get a doctor to rule those conditions out first. The part of the brain most likely to be involved with swallowing issues is the dorsal medulla. When things go wrong here, it can be because of concussion or brain injury, strokes and blood clots, cancerous tumours or other disorders related to the nerves which usually affect all functions, not just the swallowing reflex. Even dementia can cause swallowing problems, so all these things need to be ruled out and you need to be given a full bill of health before phagophobia treatment.
What other problems can affect phagophobia?
Conditions such as OCD and ADHD can affect anxiety levels and that can manifest as phagophobia. Straight forward talking therapies can help, but some find medication helpful. I suggest always to get a proper diagnosis before seeking therapeutic help. Some physical issues such as anaemia can cause the heart to beat quickly and make you feel as if your breath is being taken or you’re having a panic attack. This then can make phagophobia feel worse. Some medications can cause a similar effect, so always check up on their potential side effects.
What other practises help phagophobia?
Distraction techniques can lessen phagophobia. Distract yourself during meals with activities such as listening to music, watching TV, or talking with someone. Distraction can help reduce the focus on the fear of swallowing. A client I once worked with online from Germany was receiving distraction therapy from her health provider. She had to eat whilst sat bouncing on a yoga ball and watching TV. It proved somewhat effective. Eating around other people works for some but not all with phagophobia as many do not want other people to know.
Develop a support system for phagophobia
Share your experiences with phagophobia with friends and family. Having a support system can provide emotional encouragement. Many people with the condition isolate themselves from eating with family, but this reinforces the thoughts and ideas around phagophobia that there is something wrong with them. Encouraging friends where you can go out and socialise, it doesn’t matter if you just pick at your food, or only eat soup. They won’t care about the phagophobia they care about you and will want to be supportive.
How can hypnotherapy help phagophobia?
Hypnotherapy is a deeply relaxing therapy which uses your imagination positively. When you are relaxed and can visualise yourself doing certain things, your brain will fire as if it were really happening. The idea that neurons which fire together wire together supports the idea of mental rehearsal. In sports this helps people hone their motor skills or get over a certain mindset. I once worked with a lady with brain damage from a stroke. She had to take medication but couldn’t. I worked with her over the period of a month and finally she managed to overcome the fear of choking and could take the medication. When her doctors scanned her brain for her up-and-coming operation, they noted that the area associated with swallowing had changed.
What other therapies help or don’t help phagophobia?
Any therapy which helps destress can reduce the symptoms of phagophobia. Talking therapies which focus on the problem of swallowing don’t help. Sometimes I work with clients who are having cognitive behavioural therapy, and the therapist insists on focusing purely on the act of swallowing, not the stresses in the person’s life. No change occurs. Forward looking therapies that keep you feeling positive help like solution-focused therapy and Human Givens, which looks at needs being met. Acceptance and commitment therapy (ACT therapy) helps you stay focused on the present moment and accept thoughts and feelings without judgment. Compassion Focused Therapy is for people who have high levels of shame and self-criticism.
10 tips on beating phagophobia
Assess what problems are currently in your stress bucket
Assessing every factor in your life, causing you to feel stressed and being able to deal with them, will help decrease instances of phagophobia. I often get my clients to draw up a grid into three. In the first column, they write problems. Second column is about what control you have over the situation and the third are the things you have no control over. Focus purely on the problems where you can find solutions and accept that some things are outside your control. Once you work through the second column, you will find the times phagophobia happens becomes less and fewer.
Start exercising
Even going for a daily walk can offer improvements in phagophobia. Exercise helps us get rid of the stress. It helps us relax more, especially if we walk mindfully and are present and appreciate where we walk. Stretching and movement such as Yoga, Pilates and Tai chi can all help as our focus is away from the stressors and more on our body. It can also focus our attention away from swallowing. Some clients have found eating directly after exercising to help their phagophobia greatly.
Deal with any grief
Next to overwork or no work, grief often is a factor in cases of phagophobia. Since the pandemic in 2020, the number of cases of dealing with emotions such as fear, anger and frustration around the death of a loved one has risen considerably. I help my clients find ways of changing the way they feel. Donating to charity, or running a marathon, or just being able to write down how you felt about the loss can move you forward. If the loved one who passed was a long way from home and you felt guilty about not attending, then accepting they were unusual circumstances and even thanking those who looked after them can be a practical way to deal with such unpleasant emotions. Reduce those feeling of guilt and blame and it will help unload your stress bucket and improvements happen with the phagophobia.
Use a relaxation MP3 for better sleep
Sometimes we’re just too tense for our own good. Relaxation can help reduce the phagophobia and help with sleep, too. During sleep, we process a lot of our emotional baggage, and our brains can come up with solutions, so sorting one’s sleep out is possibly the first goal to conquer. Don’t eat late and close to going to bed. Switch off the TV and other screens, learn to love reading books. Have a warm shower, or a bath to unwind. Only use your bedroom for sleep and sex. Don’t use it as a workspace or watch TV there. When your eyes feel tired, put on the relaxation mp3 and allow it to wash over you to fall asleep. If you would like a copy of my mp3 to help with your phagophobia, contact me.
Mindful practices
Learn to practice mindful skills throughout the day to help reduce the stress around phagophobia. Mindful walking when you’re walking around your house or around the office can stop worry and over thinking. Mindful eating by chewing food thoroughly and slowly can help. Pay attention to the textures and flavors of food to stay present and reduce anxiety. Are you a nose or mouth breather? Breathing through the mouth whilst eating can often lead to choking, so it’s a very common trait in phagophobia. Be mindful of breathing through one’s nose.
Hydration and lubrication
Stay well-hydrated and consider using sauces, gravies, or soups to make swallowing easier and less anxiety-provoking and triggering of phagophobia. It may mean having to adjust your diet for a while until you’ve sorted your other stressors out. Some clients have benefited from protein shakes, others find eating cold food easier. It varies from person to person, so experiment. What I would add though is that gut flora and mood are interlinked, so a change in your diet is worth noting in a diary to see if there is a change in mood and improvement or worsening of the phagophobia. try to take probiotics such as kefir, yogurt and kombucha.
Look out for exceptions
Exceptions in phagophobia are looking for the times or foods which do not trigger the response. Exceptions are very important because with most non-specific phobias there are times they don’t get triggered, but you need to know what they are. The more times you can do something without triggering, the more you retrain your brain’s response to phagophobia.
Consult a therapist
When looking for a therapist to help with phagophobia, there are several things to remember–not all therapy is the same. Look for a therapist you feel you connect with. Ask questions about the style of therapy and what may be better for you. Make sure they have experience with the condition, don’t go to the most convenient or cheapest therapist around. Do your homework. Decide if cognitive behavioural therapy is right for you. Do you want to go over the past or do you want to learn ways of solving problems–solution-focused therapy? Would you like to feel relaxed and to learn coping techniques? Then hypnotherapy or Human Givens therapy may suit you more. You may like to read more about the different techniques on my website: https://www.oxford-hypnotherapy.co.uk/problems/phobias/phagophobia/
Learn to embrace uncertainty and change
Embracing uncertainty and change are a fundamental aspect of modern western lifestyles. Adaptability and flexibility are key traits for navigating the quick changing political world around us. Some issues in a client’s stress bucket have been about the uncertainty in their lives, whether it’s work, political landscape, education, or the health of loved ones. Perfectionism is trying to control everything in our lives, much of which is not within our control. The pandemic is an excellent example of this. Those who embraced the uncertainty as an opportunity for growth and learning found that they were able to get through it possibly better off mentally. I, for example, worked online and in the quieter times wrote and kept learning, knowing that it would end and, by being open and curious, could break into new markets and challenge myself.
Find work-life balance
Maintaining a healthy work-life balance is essential for your well-being and long-term success when conquering phagophobia. Set boundaries between work and leisure time, and prioritize self-care activities such as hobbies, exercise, relaxation, and socializing. Strive for balance in your daily routines and activities to avoid stress and boredom. Two clients I saw at the same time were both students, working with part-time jobs to support them. One took the information and stopped many of the stressful activities, including putting her degree on pause whilst she dealt with it. The other one didn’t make any lifestyle change and made no progress at all. Sometimes you may have to put on hold some activities to move forward, then you can kick the phagophobia and then go back to your studies.
Ready to break free from phagophobia?
Ready to change your life around and go back to feeling like you did pre-phagophobia? As a solution-focused hypnotherapist, I'm here to guide you every step of the way. Working together to create a personalized therapy plan which you can implement over a period of a few months. With my expertise and support, you'll learn more about what’s driving your anxiety, tools which can help, find triggers and exceptions. Contact me today to take the first step towards life free of phagophobia!
Penelope Ling, Solution-focused Hypnotherapist
Penelope Ling BA is a solution-focused hypnotherapist and author. She became a specialist in phobias having many as a child and a fear of driving as an adult, which left her unable to drive for 13 years. Having conquered those fears during training, the decision to help others overcome their limitations was simple. She helps her clients overcome their fears, and phobias achieving a more fulfilling anxiety-free life.
