Can swallowing problems sometimes be psychological?

Written by: Professor Martin Anthony Birchall
Published: | Updated: 21/01/2019
Edited by: Laura Burgess

“A poem begins with a lump in the throat; a homesickness or a love sickness. It is a reaching-out toward expression; an effort to find fulfilment. A complete poem is one where an emotion has found its thought and the thought has found words.” ― Robert Frost, American poet.

Eating is a fundamental part of human existence, not just for sustenance, but also for participation in society. Perhaps it is not surprising, therefore, that the throat can become a fulcrum of expression for wider problems in our lives.

True difficulty in swallowing is called dysphagia (derived from Greek) and has physical causes that require investigation by a throat or GI specialist. However, the sensation of a lump in the throat is a very common problem and doesn’t usually affect the ability to swallow food and drink. This sensation is called globus, an ancient English term meaning “round lump”. It used to be called globus hystericus, a term that has been replaced by globus pharyngeus since hystericus was thought to be rather sexist (“hysteros” means womb!). However, the older term shows that the sensation of a lump in the throat has long been recognised as associated with psychological troubles.

Can stress or anxiety cause swallowing problems?

True swallowing problems are due to changes in the structure or function of the mouth, throat and gullet (oesophagus). However, with anxiety and stress, the muscles of the throat (and there are lots of them) tighten up, which makes it feel as though the food is “catching” a little on the way down.

What causes the sensation that there is something in your throat?

Many people who experience this sensation regularly and strongly become concerned that may be a real lump inside their throat, and often are frightened they may have throat cancer. However, in the absence of other symptoms such as real dysphagia, ear pain, a palpable neck lump or bleeding, the chances of a lump sensation being due to cancer are very small.
(Note: if you do have a lump feeling with any of these other symptoms, however, you should consult your GP or a throat specialist straight away).

The real cause of the lump feeling is a tightening of the muscles of the throat. There are over forty muscles making the throat work and they are all finely tuned and sensitive. Perhaps it is not surprising, therefore, that the throat is one of the commonest areas to tighten up when we are anxious.

Is there anything you can do yourself to overcome these issues?

If you are suffering from globus, and this is persistent, it is important to talk to your doctor. They will check you don’t have any of the “alarm” symptoms above, but also explore how you are generally placed in life, what pressures and stresses you are under and how you are reacting to those.

When is it worth seeing a specialist?

If there remains uncertainty as to whether this is true, anxiety-related, globus, and particularly if there are other symptoms, you may be referred to a throat specialist (laryngologist, ENT surgeon). The surgeon will question you in more detail, examine your mouth and neck, and perform an examination of your throat with a small telescope passed through the nose to give a bird’s eye view of the throat from above. Modern digital nasendoscopes provide a detailed view of the mucous membranes and other structures of the throat and will be able to check for any potential disease-related cause for your symptoms.

One condition that can be associated is reflux disease (acid coming up from the stomach). However, studies have shown that the majority of patients with globus, whilst they may have reflux anyway as it is a common disease, are not experiencing throat symptoms because of this. Nonetheless, specialists sometimes try patients with globus on short courses of anti-acid medication and suggest dietary changes, partly as a diagnostic method. If the lump, and other reflux symptoms such as heartburn, respond to this, then long-term acid control may be advised.

What kind of specialist treats psychosomatic swallowing problems?

So the vast majority of patients with a lump in the throat (globus) have a strong underlying psychological cause, ranging from anxiety to depression and response to external stress. Studies have shown that treating patients with globus with medicine to treat such disorders generally results in patients’ not taking the medicines and seeking other ways of changing their lives. Therefore, first-line treatment would be to consult a psychologist for a course of therapy, possibly including cognitive behavioural therapy (CBT) in the most persistent cases. Your GP or throat specialist would be able to advise.

By Professor Martin Anthony Birchall
Otolaryngology / ENT

Professor Martin Birchall is a world-leading academic, renowned surgeon, and pioneer in the field of laryngology. He is a specialist in voice, swallowing and breathing problems as well as coughs and neck lumps. He co-led the first team that used stem cell-based organ transplants and continues to dedicate himself to pioneering life-altering techniques via his active research and presence in the field.

He is currently the principal investigator on four clinical trials, including one which is exploring a new way to restore voice functions using the drive from unaffected nerves. He treats vocal cord weakness (palsy) using the latest technology such as laryngeal reinnervation and transcutaneous vocal cord injections and is an expert in managing dysphagia (difficulty swallowing) using techniques including lasers and transnasal oesophagoscopy. He is a supporter and medical advisor to a number of charities including the National Association of Laryngectomee Clubs, Shout Against Cancer and Youth Against Crime. 

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