Anginophobia: the fear of choking


The requests for intervention for this phobic disorder are increasing and also in this case, as for all disorders belonging to the phobic-obsessive spectrum in general, Brief Strategic Therapy stands out for its high levels of effectiveness and efficiency in solving the problem.

What's it about

Anginophobia can present with different levels of intensity and severity, both in adulthood and adolescence and pediatric age. It represents the fear, which does not follow the criteria of rational logic, of dying of suffocation due to something that could go wrong: food, pills, in the most serious cases liquids or the saliva itself. Anginophobia should not be confused with dysphagia or pharyngeal hyper-reflexia, two swallowing disorders that cannot be assimilated to the disorder in question.

Fear of choking on bits of food can also manifest itself through fear of airborne contamination of food particles. In these cases, the basic idea is that parts of food present in the dishes of people who are in the same environment, can accidentally end up on their plate and cause an unconscious ingestion with a consequent risk of suffocation. It should be emphasized that in this problem fear does not depend on the action of swallowing itself, but on the effects that it is feared that it may arise.

What are the main traps that the person starts to build?

The Attempted Solutions in Anginophobia

Typically, the patient with anginophobia reports having experienced in the past a traumatic experience related to the ingestion of a bite gone wrong, or having been a spectator of a similar experience that happened to someone else. In both cases, it is not the initial event itself that determines the appearance of the phobic symptomatology, but the way in which the person reacts to the fear arising from the event and what from then on will be implemented to avoid the fear, or the Attempted Solutions. After all, the entire strategic tradition has highlighted how there is no logical causal link between how a problem was formed and its resolution, instead the relationship between how a problem persists and what people put in place, increasingly emerging. bankruptcy way to solve it.

Using the words of Paul Watzlawick: attempted solutions become the problem. In fact, this first experience can begin to trigger over time, in the adult as in the child, a series of reactions and dysfunctional Attempted Solutions which from a strategic point of view represent a real springboard for the structuring of a vicious circle. pathological that keeps the problem and instead of alleviating it feeds it.

Following the first event perceived as traumatic in relation to the fear experienced, a series of thoughts with an obsessive component related to food and meal time begin to recur, characterized by a continuous experience of terror with respect to what could happen to following swallowing. This obsessive ideation and the fear that derives from it can lead the subject to exasperate a rigid control of reality, thus transforming the meal into something rigidly structured and hyper-controlled. Even the moments before the meal begin to be experienced with strong anticipatory anxiety which can reach very intense peaks or panic attacks.

1) The main attempted solution that the person puts in place to try to control and protect himself from the danger of suffocating is the selection and progressive avoidance of some foods perceived as risky. Generally, we start by eliminating the meat first, starting with the red one, then the pasta, the one with the larger format, then some vegetables and so on.

Avoidance, one of the typical behavioral scripts of phobic subjects, makes the person experience an immediate feeling of reassurance and relief from the risk of suffocation but at the same time confirms the danger of avoiding food by acting on the belief "I was not suffocated because I did not ingest that particular food ". The repetition of this attempted solution will therefore increasingly confirm the danger of foods by amplifying the fear connected to their intake, forcing the person to reduce his diet to very few foods.

Each avoidance confirms the danger of the avoided situation and prepares the next avoidance (Giorgio Nardone).

2) The second attempted typical dysfunctional solution involves a sort of regression from a food point of view, it consists in blending / homogenizing foods, bringing the diet to be very similar to that of the weaning age. The phobic picture that begins to take shape has heavy repercussions on the whole social life of the person who will begin to experience a business meal, a dinner with friends or attendance at the school canteen in the case of school-age children. Try to imagine the effects of the repetition of the attempted solutions that the person will implement over time and how much they will limit his social life in an increasingly dramatic way, generalizing over time the fear even towards new foods that were previously considered safe.

Treatment of anginophobia through Brief Strategic Therapy

When the first signs of this problem arise, the first step to take is to exclude any organic causes; if the medical tests give negative results, it is necessary to resort to the treatment of choice for anginophobia, psychotherapy. Among the different models of psychotherapy, Brief Strategic Psychotherapy represents a particularly effective intervention model in the treatment of phobic and obsessive disorders in general, and in the specific case in the treatment of anginophobia in both adult patients and children, in the latter case. through indirect therapy.

Compared to a strongly impeding and pervasive disorder like this, which can have worrying repercussions on the possibility of eating, the efficiency characteristic of a psychotherapy (ability to obtain results in a reasonably short time, i.e. months and not years) and that of efficacy (ability of the model for solving the problem and maintaining results over time) are a requirement of primary importance because they represent the possibility for the patient to go back to eating and regain possession of his own life. The different importance attributed above all to efficiency represents one of the many aspects that differentiate short-term from long-term therapies.

From our point of view, a psychotherapy that is not efficient can hardly be effective, also because in extremely long times it becomes difficult to demonstrate that the change obtained is attributable to the effects of the therapy. In our intervention model, already from the first session, after defining the problem and identifying the attempted solutions through strategic dialogue, the therapist's goal will be to interrupt the vicious circle that has been structured between attempted solutions and persistence of the problem and work on the rigid reactive perceptive system that the person has built around the problem. This through the use of the treatment protocol of choice used in Brief Strategic Therapy for phobic disorders, combined with particular stratagems selected based on the peculiarity of the case and the age of the patient.

This set of strategies will guide the person to experience small and progressive daily risks with respect to food intake (they start reintroducing foods with a crunchy consistency more often) and proceeding one step at a time will allow the person to be able to touch and overcome the its limit through real corrective emotional experiences. Thanks to concrete experience, the patient will be guided to change the perception of her, gradually transforming it from dysfunctional and pathological into functional and healthy.

When anginophobia affects a child - Indirect Therapy

When a child is affected by anginophobia, it is also necessary to work on and through the context in which the disorder is inserted, therefore in addition to the family, the grandparents (if they spend a few hours of the day with them and in particular the moments of meals) and the school context, that is the teachers. Planning an intervention of this type also allows us to work on the attempted dysfunctional solutions of adults inevitably involved in the problem, also because as Oscar Wilde already stated “it is with the best intentions that the worst effects are obtained”.

In these cases, therefore, the factor that makes the therapy truly effective is the systemic nature of the intervention, in order to involve the adults of reference, elected as co-therapists and who will be assigned therapeutic prescriptions built ad hoc for the situation presented and that will indirectly guide our little patient to get out of the trap that he himself has built.

Often the fear of evil leads us to worse evil (N. Boileau)

Dr. Daniela Ambrogio (Official Psychologist-Psychotherapist of the Strategic Therapy Center)


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