Over my years as a hypnotherapist working with issues like irritable bowel syndrome (IBS), Emetophobia and Avoidant/restrictive food intake disorder (ARFID) I have frequently encountered people suffering from choking anxiety. Concerns over choking are a common experience after you have choked and for some these become an ongoing anxiety.
What is Choking anxiety?
Choking anxiety is the experience of fear when eating and when approaching meals, that you will choke. Clinically choking anxiety is classified as a specific presentation of ARFID. Many people with this fear find themselves behaving in unusual ways, such as:
- Restricting foods to those perceived as easily swallowable.
- Excessive time spent cutting up food into swallowable pieces.
- Extreme chewing.
- Unusual amounts of time spent thinking about and planning food intake.
- Avoiding social eating situations due to the risk of being criticised as a picky eater or because you cannot plan what you eat.
- An overall reduction in food intake, possibly resulting in unwanted weight loss.
So how does someone develop a choking anxiety?
How does choking anxiety develop?
There are several common ways in which a person develops choking anxiety.
Single event traumatic learning.
A person has a choking experience in which they are scared for their life. This may mean that they feel that they nearly died or that they feel that their life has been changed forever. For many people it is a single occasion when a piece of food gets stuck in their throat and they are unable to swallow and breathing was restricted. Sometimes a piece of food gets lodged in such a way that they can still breath, but it restricts eating and leaves them in discomfort for an extended period. This latter example gives time to worry that they may be slowly dying (starving or dehydrating) or that all eating will now be uncomfortable.
Multiple event traumatic learning.
A person experiences several choking events in relatively quick succession. This embeds the fear caused by the initial choking event and convinces them that they are at risk of choking. Commonly choking will have occurred due to a temporary medical issue, or because they are anxious already due to the first event. However, a choking event can reactivate the memory of a bad experience from years before.
Build up of anxiety due to multiple mild events.
A person may experience food catching in their throat, but not full choking, which draws their attention to the possibility of choking and overtime the concern about this grows into a pattern of anxiety.
Anticipated anxiety
With stressed people or high anxiety personalities the knowledge that you can choke may be sufficient to develop this anxiety without substantial experience of choking. For most people who experience this it will pass on as they focus on something else or general stress reduces. However, should they begin to experience food catching in their throat, often as a result of the concern itself interfering with normal swallowing, choking anxiety can develop.
Choking anxiety, what can be done about it?
A therapist is likely to assess the patient for;
- Initial trauma – how much of an ongoing problem this is?
- Beliefs – are they holding unrealistic beliefs about choking?
- Habit – How much are they automatically tensing and questioning both their swallow action. This can occur both at the point of swallowing and in anticipation of swallowing?
They will then put a programme of therapy together to address the elements, typically using techniques like;
- Graded exposure OR Systematic desensitisation.
- Cognitive re-evaluation of and reconstruction of beliefs around swallowing.
- Trauma treatment protocols like EMDR.
For more on Hypnotherapy for choking anxiety click here!
The author
Dr Matt Krouwel PhD is a hypnotherapist who works in Birmingham (UK). He has over 25 years experience as a frontline hypnotherapist and is a member of both the BSCH and the NCH.
