Hi XXXXXXX
Thanks for writing in to us.

From your history, it looks like you have been having onset of chocking tendency as a result of underlying anxiety and stress. This has been happening since the year 2006 (for almost 7 years now).

You have also mentioned regarding consultation with a psychiatrist following which you were given some medications but somehow they did not relieve you of your symptoms.

We shall talk a little more in detail about what choking is and I would like to know where you precisely fit into.

Choking is a problem that has affected a large number of anxiety sufferers and continues to be one of the more stressful and disruptive symptoms of an anxiety disorder. Some reasons where this "choking" sensation may occur are as follows:

1. Hyper-sensitivity: You become too sensitive to the way your body feels, so that you start to notice physical sensations that someone without anxiety wouldn't pay any attention to. When you swallow anything, there is going to be a very small physical sensation of the food or drink going down your throat. Without anxiety, you wouldn't even notice, but with anxiety you can't help but notice and feel as though something is wrong with your ability to swallow.

2. Conscious Instinct: Swallowing is also an instinct. Your muscles push food and water down automatically when it is time to swallow. You're swallowing all throughout the day without even realizing it, and when you drink or eat and decide to swallow your muscles do it automatically. When you have anxiety though, more of your body becomes conscious. Your automatic reflexes become less automatic. You try to force the swallowing reflex, and because the reflex itself is not automatic, it doesn't feel like it works. That can make it feel like you're about to choke, or cause you to not swallow as cleanly as you would normally.

3. Nothing to Swallow: Extreme anxiety can cause you to feel like you need to swallow, even when you don't. When you try to force swallowing when there is nothing to swallow, especially when combined with swallowing becoming more conscious, it can occasionally feel as though your swallowing reflex isn't working and causing you to choke.

4. Mild Choking Reaction: If you have taken a pill from the doctor and felt like it didn't go all the way down your throat? That experience can feel like you're choking or about to choke, when it reality it's harmless. Those with anxiety may experience excess saliva, or may simply not be able to swallow as automatically because they're paying too much attention to the way their throat feels, causing their swallowing reflex to be more conscious. When these occur, food feels like you're about to choke on it, but it has already passed into the swallowing tube and is simply caught up slightly, causing this choking feeling.

5. Psychosomatic Sensations – Finally, it's possible that something about anxiety simply causes your throat to feel like there is something inside it, which can make it feel like you are or are about to gag or choke. Generally nothing is actually present and medically there shouldn't be anything causing this sensation, but during periods of intense anxiety when the body is filled with stress, strange sensations are possible.

Having said the above, please tell me in details in which of the situations you exactly fit in. I would be glad to know the name and dosage of medicine given by psychiatrist and for how long you were on the medication.

I would be interested in knowing if there was any stressful life event when this problem first surfaced in 2006. You could also write in details of any particular thoughts or situations precipitating such choking.

Eagerly waiting to further this discussion after hearing from you at the earliest.

Dr. A. Rao Kavoor

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