Psychogenic dysphagia and eating phobia in a young adult female managed with multidisciplinary therapy: 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 (55–46 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.