Difficulty Swallowing and Anxiety

Causes

1. Anxiety-Activated Stress Response

Anxious behavior, such as worry, activates the stress response, which secretes stress hormones into the bloodstream, where they travel to specific locations to immediately prepare the body for emergency action – to fight or flee. This instinctual survival reaction is often referred to as the Fight Or Flight Response.[1][2]

Visit the “Stress Response” article for the many ways the stress response can affect the body and how we feel.

Some of these changes include:

• Tightens muscles so the body is more resilient to harm, including the muscles that control the throat and swallowing reflex.
• Heightens most of the body’s senses to be more sensitive and reactive to stimuli.
• Shunts blood to parts of the body more vital to survival, such as the brain, arms, legs, and vital organs, and away from parts of the body less vital for survival, such as the stomach, digestive system, and skin.
• Suppresses the digestive system so that the body’s resources are used for fighting or fleeing.
• Reduces saliva due to digestive system suppression.

These changes can affect our ability to swallow and how swallowing feels.

For instance, the esophagus (swallowing tube) has two valves. They are normally lightly contracted. They relax when you want to swallow, allowing the material to pass into the stomach. Once the material has passed, these valves gently squeeze closed again to prevent regurgitation of the stomach contents.

Under normal circumstances, we don’t notice this action or its associated sensations because we’ve become used to how the throat and swallowing feel – the mechanism and its actions become subconscious.

However, tightened throat muscles, heightened sensory awareness, and a change in digestive function due to an active stress response can make swallowing more difficult and increase our awareness of it and how it feels.

The higher the degree of stress response, the more likely your throat will feel tight.

Due to these stress response actions, nervousness is often associated with a “lump in the throat” feeling.

Other causes of this sensation include:

• Dryness in the throat due to stress (stress causes saliva to dry up).
• Mild throat infection (due to a cold or flu's early onset or persistence).
• Raw throat from talking, yelling, or swallowing too much (some people swallow more as a nervous habit).
• Stomach and digestive problems, such as gas, bloating, or acid reflux (which puts extra pressure on these closed valves).
• Irritation due to irritants in the air, such as pollutants or strong odors.
• Esophageal Spasms due to tightening muscles.

Since each body is somewhat physically and chemically unique, each person can experience this symptom somewhat differently when stress elevates.

For example, some people experience this symptom to a great degree, while others might not experience this symptom at all.

Even though this symptom can feel serious, there is minimal risk of choking or suffocating under normal conditions.

However, some people are very sensitive to their throats, so caution should be exercised when eating. Chewing food thoroughly and slowly will prevent inadvertently swallowing something that may provoke gagging or choking.

This sensation can vary in intensity, come and go sporadically, and intensify and persist if we focus on it.

Most of us have mild pressure in the throat if we look for it. But because our attention is focused elsewhere, we become unaware of it, making the sensation seem like it’s not there.

This is like many bodily sensations: they are there when we focus on them, but because our attention is diverted to other things, we aren’t consciously aware of them.

A “tight throat” feeling is a common indication of an active stress response or elevating stress overall. It’s also a common indication of stomach problems or distress.

Anxious behavior and the accompanying stress response commonly cause acute difficulty swallowing.

2. Hyperstimulation

When stress responses occur infrequently, the body recovers relatively quickly from its changes. However, frequently activated stress responses, such as from overly anxious behavior, can prevent the body from completely recovering. Incomplete recovery can leave the body in a state of semi-stress-response-readiness, which we call “stress-response hyperstimulation” since stress hormones are powerful stimulants.

Hyperstimulation is also often referred to as “hyperarousal,” “HPA axis dysfunction,” or “nervous system dysregulation.”[3][4]

Visit our “Hyperstimulation And Its Effects” article for more information about the many ways hyperstimulation can affect the body and how we feel.

Hyperstimulation can cause the changes of an active stress response even though a stress response hasn’t been activated.

As long as the body is hyperstimulated, it can produce symptoms of any type, number, severity, duration, frequency, and at any time, including feeling like there are problems swallowing.

Hyperstimulation is a common cause of “difficulty swallowing.”

But that’s not all. Hyperstimulation can cause difficulty swallowing in other ways, too. For instance, hyperstimulation can cause:

• Nervous System Excitation and Dysregulation: A chronically stimulated nervous system can cause all kinds of nervous system, sensory system, and muscle movement problems, such as difficulty swallowing.

• Homeostatic Dysregulation: Homeostasis is the body’s ability to automatically maintain a stable internal environment despite changes in the external environment. Hyperstimulation can cause homeostatic dysregulation, leading to internal regulation problems, which can affect the nervous, sensory, and somatic (muscle control) systems, causing problems with swallowing.

• Hormone changes: Hormones play a crucial role in homeostasis and many bodily functions, which can affect the nervous, sensory, and somatic systems. Since stress hormones affect other hormones, hyperstimulation can cause nervous, sensory, and somatic system problems, such as causing problems with swallowing.

Hyperstimulation is a common cause of chronic swallowing difficulties.

Again, visit our “Hyperstimulation And Its Effects” section for more information about the many ways hyperstimulation can affect the body and why symptoms can persist even though you might not feel anxious or stressed but still have persistent symptoms.

I (Jim Folk) had this symptom, too, and a lot when I struggled with anxiety disorder. I know how unsettling it can be.

3. Behavior

Many anxious people have health and medical sensitivities, making them hyper-aware of and concerned about unusual bodily sensations. When stress response changes occur, they can become hyper-focused on the sensations from these changes, which can magnify the sensation, including the tightening sensation in the throat.

This anxiousness can create a vicious cycle of a heightened sensation in the throat and then worrying about it, causing another stress response, and so on.

Anxious behavior is also a common cause of chronic swallowing difficulties.

Other Factors

Other factors can create stress and cause anxiety-like symptoms, as well as aggravate existing anxiety symptoms, including:

• Medication
• Recreational drugs
• Stimulants
• Sleep deprivation
• Fatigue
• Hyper and hypoventilation
• Low blood sugar
• Nutritional deficiencies
• Dehydration
• Hormone changes
• Pain

Select the relevant link for more information.