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Summary
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A reader with longstanding anxiety describes a fear of choking that has progressively restricted eating to liquids. They distrust mental health professionals but want treatment that can help the fear stop dominating daily life.
The response affirms that a person is more than a diagnosis and describes how avoidance can allow anxiety to spread into more activities.
It suggests structured Cognitive behavioral therapy (CBT) focused on thoughts and behavior, including reducing avoidance, and encourages finding a therapist even when beginning that relationship feels difficult.
Question
Reader · Identity withheldDear Dr. Schwartz,
\nI am a 32-year-old woman who has been diagnosed with numerous mental health conditions. Over the years, I have received diagnoses of Major Anxiety Disorder, Major Depression, Bipolar Disorder, Borderline Personality Disorder, Agoraphobia, Post-traumatic stress disorder (PTSD), Short-Term Memory Loss, and several others I can’t recall.
\nTo say the least, my childhood was very difficult, and I lived in constant fear of dying. Trusting others has been a lifelong struggle for me. I don’t currently see a therapist or mental health professional because I find it hard to trust them. I work from home and receive disability benefits.
\nMy current concern is that about six months ago I suddenly developed a fear of choking. I understand this fear is linked to my anxiety about dying, but it has started to dominate my life. My diet has progressively changed from eating meat to only vegetables, then to a vegan diet, and now I am limited to liquids.
\nWhen I try to eat solids, I feel like the food gets stuck in the back of my throat. No matter how long I chew, I panic, convinced I will choke on the food.
\nI deeply resent all of my diagnoses and this new fear feels like my mind is torturing me. Could you please recommend any type of treatment or solution that might help?
\nThank you very much for your time and consideration.
\nSincerely.
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Answer
Allan Schwartz, Ph.D.It is understandable that you hate all of your diagnoses. People are not diagnoses. They are people with individual personalities and characteristics. However, from what you write, you do seem to experience a lot of anxiety and that is preventing you from doing so much of what you like.
\nAnxiety is an important emotion that we need because it warns us of danger ahead. Because human beings are complicated, they experience painful amount of painful anxiety even when there is an absence of danger. Always, when experiencing this emotion, we seek to escape it either by fleeing or fighting. Most human beings want to flee when they nervousness takes over.
\nDepending on what a person fears, they try to escape by avoiding situations that they believe cause their fears. For example, they will avoid certain foods that they believe will hurt them, or not leave the house for fear of some danger outside, or avoid any number of situations that they associate with danger.
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The problem with anxiety is that, left untreated, spreads like a virus. So, what may start as a fear of elevators can gradually spread to anything with the end result of fearing just about anything. This is why it feels like it’s taken over your life.
\nWhat is the best way to treat this type of thing? In fact, what is the best way of treating many psychological problems? The answer often is Cognitive Behavioral Therapy also known as CBT. Here, you and the therapist identify the exaggerated thinking that increases fear and depression. Once identified, you and the therapist work on forming new, healthier thoughts to replace those that were exaggerated. Part of this is also learning to replace the ones that are avoidant. Part of CBT is also replacing avoidant behaviors with those that are healthier.
\nI suggest that you find a therapist who uses Cognitive Behavioral Therapy. I know that you do not trust them but it’s important that you start somewhere. In this type of therapy you do not dig up the past and you don’t have to talk endlessly. It’s a very structured type of therapy, unlike the other types.
\nYou will also not be a “diagnosis” because the therapy is based on thinking and behavior and not on endless talking. Do not let this thing take over any more of your life. There is help for you.
\nBest of luck.
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