From Fear to Recovery - Psychogenic Dysphagia and Eating Phobia: A Case Report

Introduction: Psychogenic dysphagia is a rare swallowing disorder with psychological origins, classified under Avoidant/Restrictive Food Intake Disorder (ARFID) in the DSM-5. It often leads to significant social withdrawal, malnutrition, and weight loss, and is commonly associated with anxiety, depression, and PTSD. Case Presentation: This case involves a 21-year-old Palestinian female who developed phagophobia after a choking incident at age 11. Over time, her fear of choking led to the avoidance of solid foods and a shift to a liquid diet. Her condition worsened, resulting in significant weight loss (55 kg to 46 kg) and severe malnutrition. She also experienced daily panic attacks and had a history of generalized anxiety disorder and other phobias. Investigation and Diagnosis: Comprehensive medical investigations, including neck ultrasound, blood tests, upper endoscopy, and flexible endoscopic evaluation of swallowing (FEES), revealed no structural abnormalities, rolling out organic causes. Psychiatric assessment confirmed a diagnosis of eating phobia. Management and Outcome: Treatment included pharmacotherapy (SSRIs, antipsychotics, anxiolytics) and Cognitive Behavioral Therapy (CBT). After three months, the patient reported a 30% improvement in symptoms and dietary intake. Long-term follow-up was recommended. Conclusion: This case highlights the importance of recognizing psychogenic dysphagia as a psychological disorder with physical manifestations. Early intervention with pharmacotherapy and Cognitive Behavioral Therapy can significantly improve symptoms and dietary intake, emphasizing the need for a multidisciplinary approach in managing such complex cases.