Our bodies are complex machines conducting numerous functions at any given moment. If we paid attention to all of them, we would never have time for anything else. Indeed, most of us go through our days without giving any thought whatsoever to constant functions like blinking, swallowing, or breathing. But for some of us, thoughts about our own bodily functions don’t go away.
If you can’t stop paying attention to your swallowing, it may seriously impact how you live your life. You might struggle to eat and drink, or spend hours a day stuck in obsessive thoughts about your swallowing. You might fear choking or worry that you’re not swallowing “correctly.” Maybe you fear that your throat is closing up and therefore focus on your swallowing to gauge whether that could be true. You might even worry that you’ll never be able to stop thinking about swallowing.
Here’s good news: it’s been consistently demonstrated that it is possible to free yourself from constant, repetitive thoughts about swallowing. There’s various mental conditions that impact our relationship toward swallowing, but it’s recommended to start with determining if there’s any underlying medical issues affecting the body.
Why am I hyperfixated on swallowing?
If you’re dealing with intrusive thoughts about your swallowing, it’s important to rule out any potential physical causes. If you’re thinking about swallowing simply because it’s painful, that may signal various potential issues, including:
- Sore throat with or without a strep infection
- Dysphagia (difficulty swallowing)
- GERD or less severe forms of acid reflux
- Smoker’s cough, a chronic cough caused by smoking where the body is trying to clear the lungs and throat of irritants and mucus
- Vocal cord growths like polyps, cysts, and nodules, as well as allergies might cause constant throat-clearing that makes swallowing hurt
- Food stuck in the throat
- Certain medications, like angiotensin converting enzyme inhibitors, where post-nasal drip is a side effect
Whether or not there’s any psychological element to your swallowing fixation, it’s best to start with reaching out to your healthcare provider. That could be your primary care physician or an urgent care doctor.
Can excessive swallowing be a sign of a mental health issue?
It’s definitely possible. While it’s mostly an automatic function, swallowing involves both voluntary and involuntary behaviors. You control the action of moving food or drinks to your throat, but then the swallowing reflex takes over. When you feel uncertain about some aspect of this bodily process, it can be extremely overwhelming.
“All of these behaviors could have potentially multiple reasons behind them, so a good mental health diagnostic assessment is always important,” says Dr. Patrick McGrath, PhD, Chief Clinical Officer at NOCD.
What is somatic OCD?
One possibility behind a fixation on swallowing is a subtype of obsessive-compulsive disorder (OCD) called sensorimotor or somatic OCD, also sometimes referred to hyperawareness OCD. It describes a hyper-attentiveness to bodily processes, sensations, and functions, such as breathing, swallowing, the rate or comfort of eye blinking, posture, or gait.
If the person can tell you that they have a fear related to swallowing, then it’s probably going to be OCD versus an actual medical condition,”
Dr. Patrick McGrath
All types of OCD are marked by two main symptoms: obsessions and compulsions. Obsessions are recurrent intrusive thoughts, feelings, sensations, and/or urges that spur a high level of distress. One performs compulsions—mental or physical—to relieve themselves of this anxiety. Since bodily functions are happening constantly, those with somatic OCD can find themselves constantly triggered.
Sensorimotor/somatic OCD obsessions specific to swallowing may include:
- What if I can never stop noticing my swallowing?
- Why is my swallowing so loud?
- What if I forget how to swallow?
- What if I swallow too much or not enough?
- My throat wiggles when I swallow, and I can’t stop noticing it.
- Just to be safe, I can only eat liquids—they’re easier to swallow.
- How will I ever live a normal life if I can’t stop paying attention to my swallowing?
- Will I ever feel present again?
- Magical thinking patterns, such as, “If I have the thought that I’ll never stop noticing my swallowing, then it will become true.”
Mental and/or physical compulsions performed to relieve swallowing-related distress include:
- Seeking reassurance from yourself or others that your fears are not true. This might sound like repeating the thought, “I’ll stop thinking about my swallowing eventually,” or repeatedly asking a loved one, “Do you think I’ll be able to stop thinking about my swallowing?”
- Suppressing your thoughts: Trying to force thoughts to go away and not have them in the first place.
- Distracting yourself with movies, books, friends, etc. in order to escape thinking about your swallowing.
- Mental review, such as looking back through your memories to times where you weren’t paying attention to your swallowing. Or reviewing how it felt to swallow yesterday and comparing it to today.
- Avoiding activities that trigger thoughts about swallowing, such as eating or drinking.
- Excessive research about healthy or “normal” swallowing, or the potential risks of swallowing “wrong.”
Health anxiety is a possibility
Another condition that might explain why you can’t stop paying attention to your swallowing is called health anxiety, also known as illness anxiety disorder. Dr. Nicholas Farrell, licensed clinical psychologist and a Regional Clinical Director at NOCD, describes the difference like this: “The fear associated with sensorimotor/somatic OCD is similar to being in quicksand. People worry they’re never going to get out of it. With health anxiety, people are worried that something is seriously wrong with their health.”
In other words, those with sensorimotor/somatic OCD are distressed by their awareness of the sensation, worried they’ll never be able to stop noticing it. Those with health anxiety, on the other hand, are specifically worried that the function they’re fixated on, such as swallowing, is emblematic of a serious illness, and they might even induce swallowing so that they can “check” its normalcy. Despite these key differences, the two conditions are similar in that both are typically accompanied by excessive behavior.
Signs and symptoms of health anxiety include:
- Excessive worry or rumination on what could be wrong with your swallowing and the body parts associated with it. For example, you might spend much of your day thinking about your esophagus and whether or not it’s wide enough for your saliva to go down.
- You may ask yourself a plethora of “what ifs”, such as “what if my throat is closing up?” or “what if I’m producing too much saliva and that means I have a serious illness?”
- Hyper-awareness of bodily sensations/functions. You may find yourself assessing your swallowing multiple times per day to decide whether it’s “normal” or healthy.
- Inducing a bodily sensation or function in order to “check” it.
- Frequent visits to the doctor or hospital, convinced that something is seriously wrong with you.
- Frequent research about what the “symptom” could mean and/or feared diseases/conditions.
- Taking actions you perceive to preserve your health, such as only eating certain foods that you feel like you can swallow “normally” or excessive hand-washing to prevent disease.
What about phagophobia?
Phagophobia, the fear of swallowing, is a specific phobia, which is a condition that centers on a specific source of fear, such as an object or situation.
People with phagopobia usually go to great lengths to avoid swallowing foods, liquids, and/or pills. They also might eat and drink in very specific ways to swallow a certain way. They may experience anticipatory anxiety before they have to eat or drink something, which could lead to physical symptoms like sweating, rapid breathing, or panic attacks. They may be reluctant to eat in front of their peers, and potentially even switch to all-fluid meals to avoid anxiety caused by swallowing food. These practices may result in weight loss.
There’s no set cause for phagophobia, but potential risk factors include:
- Food-related fears, including contamination
- Prior traumatic experiences while eating, like choking fits
- Anxiety and/or tension that causes a lump in the throat, making it difficult to swallow
How can I get help?
If you believe your swallowing fixation is related to a mental health issue, there is evidence-based treatment available. Health anxiety, sensorimotor/somatic OCD, and phagophobia can all be treated with exposure and response prevention therapy (ERP).
ERP involves being exposed to your triggers gradually, meaning you’ll start by facing triggers that bring a low amount of distress and work your way up to more distressing ones. You’ll practice resisting the urge to react with compulsive mental or physical behaviors, such as distraction, checking, reassurance-seeking, or rumination.
Your therapist will design exposure exercises specifically related to swallowing. Those might look like:
- Watching a movie where someone either has a swallowing-related health condition or swallowing is key to the plot
- Resisting the urge to make yourself swallow so you can “check” for normalcy.
- Swallowing without ruminating on whether or not it’s normal or healthy.
- Going to dinner with friends, where you won’t be able to only eat your “safe” foods or spend too much time ruminating on your swallowing.
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.
ERP requires patience, but it’s worth it
It will take time for your triggers not to affect you anymore. Neither sensorimotor/somatic OCD or health anxiety or any of the other conditions listed will be “fixed” overnight—in fact, ERP is not about “fixing” you. It’s about building up tolerance to your triggers. The day can come where you simply notice your swallowing and move on.
Dr. Farrell describes ERP as helping someone “do the opposite of what they’ve been doing.” A key marker across OCD, health anxiety, and phagophobia is that these conditions have convinced you that you need them in order to be safe. Therefore, doing the opposite of what you’ve been doing might sound terrifying. Dr. Farrell reminds us, “In the moment, it might not feel like ERP will reduce awareness of swallowing, but it does.” He says it might feel like a “blind leap of faith”—but it’s a worthwhile one.
Bottom line
You don’t have to live indefinitely with the fatigue and distress that a swallowing fixation comes with. There are mental health professionals ready to help you identify what’s causing this hyperawareness. They’ll be there to guide you through the process of getting your life back from these all-consuming thoughts.