Fears about swallowing

What is swallowing related OCD?

Fear of swallowing in OCD involves fears about the bodily process or sensation of swallowing. The swallowing fear may stand alone or along other types of sensorimotor processes like blinking, breathing, yawning, or sweating.  A person who suffers with this subtype may hyperfocus on how many times they are swallowing in a specific amount of time, feel an urge to swallow more often than what would be considered “normal,” remain hyper aware of sensations at the back of their throat, or may be overly aware of the sensation of swallowing. Someone who focuses on swallowing symptoms may also have an obsessive fear of choking. They might focus on the sensation or feeling like something is stuck in the throat, blocking the airway, or a pain or tightening awareness during swallowing.   Consider an example: Juniper is a 21 year old college student who was recently diagnosed with OCD by her therapist. She came to her therapist because she was struggling mainly with perfectionism when doing her homework for school—she would have to reread papers over and over before turning them in, eventually having to drop a class because of time constraints—and harm thoughts about her roommate. Juniper has been doing well and has used Exposure and Response Prevention for the past 2 months. She has noticed a drastic reduction in her perfectionism symptoms and her intrusive thoughts of harm, and had been feeling pretty good until a few days ago, when she started to notice something new. She woke up feeling like she had a lump in her throat. She wondered if she was getting sick and even went to the urgent care center on campus to have her throat checked. The doctor told her her throat looks healthy and she has no fever and a negative COVID test.  Knowing her diagnosis of OCD, the doctor suggested that maybe the feeling in her throat could be due to anxiety. Juniper left feeling discouraged because she has never had this symptom before, and she was doing so well in OCD treatment.  Over the next week things get progressively worse. The feeling in Juniper’s throat persists as she continues to pay attention to it, and she notices that she is frequently drinking water and swallowing to test the sensation. She begins to also count how many times she is swallowing per minute and then researches what the “standard” amount of swallowing is. She continues to compare her experience to others that she finds online, and returns to research throat cancer, various infections, and other conditions that affect the throat, just in case the doctor missed something.

OCD fear of swallowing – Common obsessions

• Paying close attention to the sensation of swallowing liquids, food, or saliva
• Counting how many times you swallow
• Hyper-awareness of swallowing
• Hyper-awareness of sensations in the mouth and throat
• Fear of choking
• Fear of throat cancer or other ailment of the throat.

Common triggers

• Eating
• Drinking
• Swallowing medications
• Sore throat
• Dry Throat
• Awareness of a new sensation in the throat/feeling a lump in the throat
• The act of swallowing 
• Seeing others swallow
• Acid reflux

As a side note, it is very important to recognize that these triggers are often associated with social situations, and sometimes OCD may present itself as Social Anxiety Disorder. This often is not the case, as speaking perfectionism is more a result of intrusive thoughts or feelings around speaking, and not necessarily from being with groups of people. 

It is also important to remember that triggers for perfectionism and speaking OCD include many situations where people are speaking with or to others. If a person feels like they are being judged, credited, or evaluated, then intrusive thought patterns may be stronger. These triggers can appear at home, work, school or even at the grocery store when you run into an old friend. 

How can I tell if it’s swallowing OCD fears, and not anxiety, cautiousness, or stress? 

A person can tell if they are experiencing Sensorimotor OCD with a focus on swallowing more than typical stress and anxiety when the attention on swallowing becomes a primary focus.  More than one hour in a day will be spent thinking about, directing attention toward,  feeling the sensation of swallowing, engaging in checking, reassurance seeking, and other compulsive behaviors.  Level of distress around swallowing will be high.

Compulsions performed mentally or physically by people with OCD related to swallowing include:

• Counting the number of times they swallow in a minute. 
• Researching disorders that have symptoms of excessive swallowing or difficult swallowing
• Avoiding things that involve swallowing (eating and drinking)
• Avoiding people when they are eating or drinking
• Excessively chewing food to avoid choking. 
• Excessive spitting to remove anything in the mouth or throat
• Distraction
• Rumination
• Seeking reassurance
• Physical sensation checking
• Repeating the act of swallowing several times

How to treat fear of swallowing

Fear of swallowing can be debilitating for people who struggle with it, but it is highly treatable. By doing exposure and response prevention (ERP) therapy with a trained therapist, there is hope for overcoming this subtype of OCD. 

An ERP therapist will have you work through exposures involving swallowing—or circumstances that trigger the anxiety or distress that comes with obsessions— then guide you in practicing acceptance of sensations without engaging in rituals or compulsions, allowing you to develop a tolerance of discomfort or uncertainty, and causing your obsessions around swallowing to cause less distress and anxiety in the long term.

I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

We look forward to working with you.