Worrying about choking is a legitimate concern, but a severe, irrational fear of choking could be a sign of pseudodysphagia or OCD.
Have you ever drunk something too fast, and it “went down the wrong pipe,” causing you to choke for a few seconds? Unfortunately, choking is something most of us have experienced at one time or another, and it can understandably be super traumatic to go through.
While some people might just be more cautious the next time they have a drink or a bite to eat, others may develop such an intense fear of choking that it could indicate a serious mental health concern, such as a phobia or obsessive-compulsive disorder (OCD).
What is a fear of choking?
A fear of choking is a rare specific phobia known as pseudodysphagia. Specific phobias are anxiety disorders that cause intense, irrational fears of something that poses little to no danger.
If you have pseudodysphagia, you may perform the following safety behaviors or compulsions out of fear:
- Not swallowing foods and liquids or taking pills to prevent choking.
- Avoiding certain foods that are too solid.
- Excessively chewing to ensure your food is small enough to swallow.
- Checking food before eating it.
- Complaining of a globulus sensation (feeling like you have a lump in your throat).
- Avoiding the dentist due to the fear of choking on dental equipment.
In addition to these behaviors, people with a choking phobia may experience anticipatory anxiety, which is a common symptom of anxiety disorders that causes excessive worry about a future event or circumstance, which, in this case, would be choking.
Anticipatory anxiety may cause physical symptoms that resemble an anxiety or panic attack when thinking about or experiencing a choking episode, such as increased heart rate, sweating, heart palpitations, dizziness, and shortness of breath.
Why do I have a fear of choking?
With an understanding of how a fear of choking presents, where exactly does this fear come from? Well, there are several reasons why you might develop intense choking anxiety, including:
Trauma
“You could have a history of choking that felt traumatic or scary,” says Tracie Ibrahim, LMFT, CST, Chief Compliance Officer at NOCD. “You may have watched someone else choke at some point, and that may have been scary, leading to an irrational fear of choking.”
Certain mental health disorders
According to research, people with certain mental health disorders, such as anxiety or depression, are more likely to develop pseudodysphagia. Obsessive-compulsive disorder (OCD) could also be a cause for an intense fear of choking, which we’ll cover in the next section.
Other related fear
You could have a fear of certain foods, chewing, or swallowing that contributes to the development of a fear of choking.
Could a fear of choking be a sign of OCD?
Obsessive-compulsive disorder (OCD) is a mental health disorder that causes a cycle of obsessions and compulsions. Obsessions are intrusive thoughts, images, urges, feelings, and/or sensations that cause intense fear and anxiety. Compulsions are the mental or physical actions performed to relieve distress from obsessions and/or to stop something bad from happening.
Ibrahim says that a fear of choking could be a symptom of somatic or sensorimotor OCD. Somatic OCD is characterized by re-occurring intrusive thoughts and compulsive revolving around your somatic experience—the physical sensations you can’t control.
People with somatic OCD and a fear of choking on food or liquids may have obsessive thoughts like:
- How do I know when to swallow?
- I can’t stop noticing how my throat moves when I swallow. Is that normal?
- Is my tongue moving the right way when I swallow?
- What if I swallow too fast, and the food gets stuck in my throat?
Like people with a choking phobia, if you have somatic or sensorimotor OCD, you may engage in compulsive behaviors to prevent choking, such as:
- Avoiding certain foods that you think could cause choking.
- Drinking excessive amounts of water or other liquids while eating.
- Repeatedly checking physical sensations in your throat.
- Overchewing your food until you deem it “safe” to swallow.
Community discussions
How can I tell if my fear of choking is a phobia or OCD?
At this point, you might be having a hard time differentiating a phobia of choking from somatic or sensorimotor OCD, and that’s completely understandable. While both mental health disorders involve compulsive behaviors to cope with a fear of choking, that’s where the similarities end.
“A phobia would not include specific obsessional fears that are responded to with compulsive behaviors or mental rituals to ‘neutralize’ the fears,” says Ibrahim. “It would be more of a fear-based issue that results in avoiding things that may choke you or hyper-fixation on choking happening.”
If you still aren’t sure whether you’re dealing with a phobia or OCD, your best bet for figuring out what’s going on is to seek help from a therapist—specifically one with knowledge and expertise in these often misunderstood mental health disorders.
A phobia would not include specific obsessional fears that are responded to with compulsive behaviors or mental rituals to ‘neutralize’ the fears. It would be more of a fear-based issue that results in avoiding things that may choke you or hyper-fixation on choking happening.
Tracie Ibrahim, LMFT, CST
How to get over a fear of choking
If your fear of choking is interfering with your day-to-day life, it’s recommended that you seek professional help to get your symptoms under control. For phobias and somatic OCD (or any OCD subtype), the preferred treatment is exposure and response prevention (ERP) therapy.
ERP is a specialized therapy that helps you gradually face your fears and resist the urge to engage in compulsions. ERP can be very effective, with 80% of people with OCD and 80-90% of people with phobias seeing a substantial improvement in their symptoms.
For an intense fear of choking, Ibrahim says ERP may involve exposures (exercises that intentionally trigger your obsessions) like worse-case scenarios, such as “imaging you’re choking and looking at pictures of people who are choking.”
In addition to exposures, a therapist specializing in ERP will teach you response prevention techniques that help you refrain from engaging in compulsions. “Over time, [response prevention techniques] teach our brains that we can live with the uncertainty and possibility of choking without doing compulsions that make our obsessional fears worse,” says Ibrahim.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Bottom line
Experiencing or witnessing choking can be super scary, so, to a certain extent, it’s understandable to be cautious of how you eat and drink. However, an intense fear of choking becomes a serious concern when you’re having obsessive thoughts and engaging in compulsive behaviors—which could be a sign of pseudodysphagia or somatic OCD.
Regardless of whether you’re dealing with a phobia of choking or OCD, working with a therapist specially trained in ERP can help you address your fears.
Key takeaways
- Pseudodysphagia is a rare specific phobia that can cause an intense, irrational fear of choking, typically leading to safety behaviors like avoiding certain foods or overchewing.
- Somatic or sensorimotor OCD is another mental health disorder that can cause a severe fear of choking, leading to obsessive thoughts and compulsive behaviors revolving around choking.
- While both pseudodysphagia and somatic OCD involve compulsive behaviors, they are distinct. Pseudodysphagia is a fear-based avoidance of choking triggers, whereas OCD is marked by intrusive obsessional thoughts and compulsions to neutralize those fears.
- Exposure and response prevention (ERP) therapy is the preferred treatment for addressing pseudodysphagia and OCD.
