There are two distinct types of eating phobia. One is an inability
to swallow for fear of choking, which may lead to the rejection of most solid foods.
The other is more a food aversion, where certain food textures or odours cause
nauseous feelings or even vomiting. Neither of these food phobias is linked with anorexia,
which is a disturbance of the body image. Anorexics believe they are fat regardless of
their actual size, and refuse food for this reason.
WHAT EXACTLY IS A PHOBIA?
Phobias are fears. Fear is a normal part of life, and there are many
things in life which can be dangerous or painful – such as savage dogs, muggers, car
crashes, and having operations. Anyone might be afraid of such things – or at least
anxious about them. This is normal. Sensible people take precautions to avoid being hurt
or injured by things that are genuinely dangerous.
In this sense, anxiety is very useful. It warns you when danger is
threatening. Severe anxiety – fear – can be useful too. When we find ourselves in a
situation of real danger – like being faced by a robber in a dark alley – the fear
reaction is just what we need.
It releases adrenaline and other chemicals into our blood, and these
speed up our heart-beat, sharpen our senses and heighten our physical powers. These
changes prepare us for what is called ‘flight or fight’ – either to fight for
our lives, or to run for them.
A phobia is a disorder in which the body reacts in exactly the same
way, and we experience exactly the same feelings of anxiety and fear – but in situations
where there is absolutely no need for ’flight or fight’. It is as if our body
and soul have lost all sense of proportion, and internally screams ‘danger!’ at
the least little thing – like crossing a footbridge, meeting a cat, or seeing a snake on
No matter how harmless the feared thing may be, for a phobic person the
fear reaction is every bit as real as if the cause was life threatening. People with
phobias usually realise all too well that their reaction is irrational, but this
makes no difference to its effect.
ABOUT EATING PHOBIAS
1. Food aversion
With food aversion, the phobic response when faced with the food in
question may be a feeling of revulsion rather than intense anxiety, although some
aversion phobics may experience fear. A fear response would usually be associated with
some religious or family ‘taboo’, and might also be linked to past reactions
(such as seeing somebody vomit, or perhaps vomiting themselves after eating this food).
Food aversion can grow very strong, and can last for life. One person
who reported his story to Anxiety Care had, as a child, lived for a time in a house where
mutton was ‘boiled up’ on a regular basis. The unpleasant odour, experienced
often enough to nauseate but not often enough for him to grow immune to it, led him to
reject all such meat in later life.
Most adults with food aversion focus on meat or greasy foods. Food
aversion is a good, life protecting response for any animal – one ‘poisoning’
reaction able to put them off completely. Many animals, and also human children, are wary
of foods which taste bitter or are unfamiliar, and it is not surprising that adult people
can have the same ability.
If the problem has grown from simply being a ‘fad’ to a level
that reduces the quality of life, a desensitisation programme can break the phobia down.
This would be a series of steps, starting with what one can do and
working up to what one wanted to be able to do, using as many intermediate steps as
It should be borne in mind that steps might need to include smell,
taste and watching others eat this object; and that the different types of steps might
need to be approved (or be graded) separately if there are particular difficulties in one
area. For example, the case above concerning mutton might involve very careful steps when
the nauseating smell was dealt with.
2. Inability to swallow
The kind of eating phobia which is due to a fear of choking, is linked
with extreme sensitivity of the ‘gag reflex’ and a gross exaggeration of the
‘tight throat’, or ‘lump in the throat’ response that some people have
to anxiety. It can be present in agoraphobics or in those suffering from extreme general
anxiety. People with this problem may feel incapable of swallowing any solids, and may
exist on some variation of mush or baby food, or even liquids alone.
Someone with a fear of eating that has reached a phobic level – that is
a tightening throat when faced with food has become a chronic habit – must understand that
this phobia is maintained by avoidance of the phobic situation. Every time he or she
manages to avoid what is feared and experiences that "Oh, thank goodness" relief
of sidestepping the anxiety symptoms once again, that instant drop in tension is ensuring
that the same method will be used next time and the person will remain phobic.
Whatever additional support is obtained with overcoming the phobia, it
must be accepted that there is nothing out there in the way of special treatments or
medications that will simply take it away. To be free of the phobia, the person affected
will have to be willing to experience certain levels of anxiety while putting him or
herself into the phobic situation.
This does not have to mean leaping into the worst situation imaginable,
and hanging on until all anxiety passes, because current research suggests that a huge
amount of fear is of no more value than a small amount when this ‘facing it’
technique is used to break down a phobia. The alternative is to find ways of gradually
becoming used to the anxiety by devising a desensitisation programme that fits each
person’s particular needs.
This simply means fitting as many steps as needed between what can be
done and what this person wants to be able to do, and working through them. A first step
can be holding something in the mouth for a little longer than it can be managed at the
moment. From there, a more solid content or food could be introduced, with the goal of
swallowing dry toast, perhaps, as the signal for victory.
Steps need to be progressive. Staying with one too long is not,
‘getting used to it’ but avoiding the next step. If the problem relates to an
increased sensitivity to gagging, this means that the protective ‘gag’ reflex of
the oropharynx that everyone experiences when a finger is placed in the mouth near the
soft palate, has spread to include other ‘foreign objects’. People in this
situation may not be able to brush their teeth or even allow their neck to be touched, as
well as finding solid food impossible to swallow.
This too can be reduced by a desensitisation programme. For example,
ordinary clothing buttons could be used. First, the person learns to tolerate one in their
mouth, then two etc. They might also practise cleaning their teeth for gradually
increasing periods. If the gagging is made worse, as in many cases, by the sufferer’s
tendency to swallow tensely with pursed lips, clenched teeth and the tongue thrust forward
against them, they can learn, or be taught, to swallow with teeth slightly apart and the
tongue relaxed on the floor of the mouth. A therapist (or a friend) could help by gently
stroking the front of the person’s tongue until they habituate to it (i.e. till the
body accepts it), which might take half an hour or so; then work further back on the
tongue, and so on. As people begin to understand what triggers the gagging, this can also
help to decrease the problem to normal proportions.
Whatever the steps, the food phobic must do enough at each one to raise
anxiety. He or she is trying to become used to experiencing the physical symptoms at a
manageable level, where they are in control.
SOME HINTS FOR SELF-EXPOSURE WORK
The first step in the programme can be very simple – perhaps staying in
a situation that can just be managed now, but for a little longer than before.
The steps can be as large or as small as necessary, and big steps can
be broken down into smaller ones. But each step should challenge the anxiety a little more
than the last.
Don’t be overwhelmed by the size of the task. As a rule, the
steps become steadily easier as you work through them.
Don’t expect to be completely free from anxiety before you leave
each step and go onto the next – it will go completely in its own time as you progress.
Do the exercises as often as you can. You are trying to build up
positive memories to replace all the bad ones of being beaten by the phobia, and too long
a gap between efforts makes this more difficult.
An hour or so at a time and repeating this every day is best. Waiting
until you feel ‘strong’ or until you cannot avoid it any longer is not a
Do enough at each step to raise your anxiety. You are trying to get
used to a level of physical symptoms that you can manage, and where you are in control.
Keep a ‘self-exposure diary’ detailing the exposure work
you have undertaken and noting down the way you felt about it.
If it is possible to find someone to work with, who can talk to you
calmly and positively while you are doing the steps (and not over-sympathising or
endlessly asking how bad you are feeling) this can help.
Many people with phobic conditions are terrified of having a panic
attack if they should find themselves in the situation they fear (or which repells them)
and be unable to ‘escape’ quickly enough.
Panic is an very unpleasant experience, and while it is happening it is
very hard to think rationally. Typically, people who are having a panic attack feel that
they are about to have a heart attack, or go mad, or lose control of their bowels, or run
amok and injure themselves and others. The urge to prevent this happening produces a
powerful desire to escape from the situation immediately.
In reality, the imagined horrors simply do not occur. Anxiety Care has
never come across a single instance of someone having a heart attack, stroke, or brain
haemorrhage, or going mad as a result of a panic attack. People don’t collapse or
have ‘fits’ during panic either.
… panic is a dreadful feeling, but it doesn’t cause any permanent harm …
The worst that can happen is that they feel faint or
dizzy and have to sit down.
‘Losing control’ is very rare. People do not shout and
scream, or foam at the mouth, murder children or mow down passers-by during a panic. Even
in the few cases where someone has claimed to have lost control, the reality is a little
different. One person described to Anxiety Care how she ‘rushed screaming out of the
house’ – but it turned out that she had taken the time to close the doors and windows
first. Another ‘kicked insanely at the car window to get out’, but thoughtfully
removed her shoes first to avoid doing any damage!
Panic is basically an internal event. It may feel as though the mind
and body are breaking up, but the truth is that other people seldom even notice when
someone is having an attack, especially in a busy place. They are too busy thinking
about their own affairs, and even if they see someone run out of the park, they are likely
to assume there is a ‘sensible’ reason – like being late for a bus. In any
event, they will have forgotten all about it in a moment or two.
The boring truth about panic is that although it feels dreadful at the
time, and although the overdose of adrenalin and other chemicals can leave a person
feeling drained and shaken:
panic does not cause any permanent harm
it does not drive people insane
panic attacks only last a short time, and then they subside
they subside irrespective of whether you stay in the ‘panic
situation’ or ‘escape’.
The basic reference work on which we have drawn is Fears, Phobias and
Rituals by Professor I M Marks, published by Oxford University Press (1987)