A case of choking phobia: towards a conceptual approach

Abstract

Choking phobia, also known as phagophobia or swallowing phobia is an uncommon clinical entity that has been underappreciated and is included in the new DSM-5 and upcoming ICD-11 diagnostic category of avoidant/restrictive food intake disorder. Phenomenologically distinct from other eating disorders, it is characterized by the phobic stimulus of swallowing that results in the avoidance of food or drinks, and ultimately to low weight, social withdrawal, anxiety and depression states. Its prevalence and long-term course on the general population still needs to be determined, probably reflecting years of indefiniteness regarding its nosology and by the absence of a clear set of diagnostic criteria. We present a clinical case of choking phobia in a 32-year-old male patient after an episode of choke when eating chicken. An early diagnosis and distinction from other eating disorders is important for proper treatment and fundamental for prognosis. We also make a thorough revision on literature in clinical features, differential diagnosis and treatment approaches, suggesting a conceptual approach for choking phobia as a clinical spectrum settled by different degrees of phobic subtypes, which may depend on a varied number of clinical variables.

Enfermería en el tratamiento de la fobia a tragar en la infancia y la adolescencia: una revisión bibliográfica

“…En la mayoría de las publicaciones, no se menciona el papel fundamental que posee el equipo multidisciplinario en el tratamiento de las fobias específicas. En un artículo reciente de Lopes et al 21 , se hace énfasis en la necesidad de la aproximación multidisciplinaria de estos trastornos. El papel que la enfermera de los equipos de salud mental infantojuvenil puede desempeñar no se refleja en la mayoría de publica-La enfermera puede realizar una aportación importante al proceso de valoración y tratamiento en los diversos niveles de atención ciones, incluso, en aquellas en que el tratamiento se realiza en las unidades de hospitalización.…”

Treatment methods of avoidant/restrictive food intake disorder: Review with therapeutic implications

“…When the child swallowed the food at stable rates bite volume was gradually increased. Based on Sharp and colleagues [37] structured parental trainings were added in meal 12 and 13. By meal 14, parents fed their children; with the therapist's feedbacks, if needed.…”

“…However, evidences for the efficacy of pharmacotherapy methods in ARFID are lacking [33], and Norris and colleagues [36] referred on its lower efficacy. While Lopes and colleagues [37] used it efficiently combined with various methods of CBT. Therefore the combination of pharmacotherapy with psychotherapy can be rather supported, but specific medication definitely needs to be tested by further clinical studies.…”

“…Lopes and colleagues [37] presented an adult AFRID patient suffered from chocking phobia treated with combined treatment included pharmacotherapy (SSRIs), nutritional management, psychoeducation about consequences of nutritional deficiency and treatment goals. CBT was also implemented with three aims: (1) cognitive restructuring as cognitive distortions lead to generalized avoidance behavior.…”

“…Bryant-Waugh [19] emphasized that necessity of treatments that commonly include medical intervention, nutritional management and psychotherapies. Most case studies generally reflect a CBT approach with restructuring of the avoidant cognitive distortions, gradual exposure of the feared stimuli, changing eating patterns and introduction of new foods, combined with anxiety management like progressive relaxation [11,14,19,37]. In child and adolescent ARFID patients the parents' involvement in the treatment plan and psychoeducation is essential [37,38]; and a successful family-based treatment can be combined with anxiety and feeding management [36].…”