Skip to main content

Symptoms of swallowing anxiety in panic disorder patients and associated psychopathologic factors

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity volume 23, pages 487–497 (2018)Cite this article

Abstract

Aim

The aim of this study was to investigate symptoms of swallowing difficulty in Panic Disorder (PD) patients and the factors associated with these symptoms.

Methods

In the pre-phase of the study, 22 PD patients who were treated in psychiatry outpatient clinics and who were found to have swallowing difficulty were evaluated. PD patients were asked to write about their thoughts, feelings and behaviors associated with swallowing difficulty. Later, these texts were examined and 41 expressions were identified in which patients described their swallowing difficulty. These expressions were evaluated by mental health workers in the field and twelve different swallowing difficulty items were defined. In the main phase of the study, 119 PD outpatients were evaluated using twelve different swallowing difficulty items and psychometric tests [Panic and Agoraphobia Scale (PAS), Separation Anxiety Symptom Inventory (SASI), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI-1/STAI-2)].

Results

As a result of the validity and reliability analysis, a valid one-factor instrument with ten items was obtained. Cronbach’s alpha value for this measurement tool was 0.89 and it was termed the “Swallowing Anxiety Scale (SAS)”. It was found that SAS items “always” accompany PD patients at rates of 5–20.2%. According to hierarchical regression analysis, 35% of SAS scores were explained by PAS, SASI, STAI-2 and BDI scores.

Conclusion

Swallowing difficulty items in PD patients involved anxious, phobic and somatic symptoms associated with swallowing. In addition, swallowing difficulty symptoms in PD patients can be confounded with eating disorder symptoms.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Okada A, Tsukamoto C, Hosogi M, Yamanaka E, Watanabe K, Ootyou K, Morishima T (2007) Study of psychopathology and treatment of children with phagophobia. Acta Med Okayama 61:261–269

    PubMed  Google Scholar 

  2. Lopes R, Melo R, Curral R, Coelho R, Roma-Torres A (2014) A case of choking phobia: towards a conceptual approach. Eat weight disord 19:125–131. doi:10.1007/s40519-013-0048-5

    Article  PubMed  Google Scholar 

  3. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub, Arlington

    Book  Google Scholar 

  4. Bailly D, MB de Chouly de Lenclave, Dhaussy S, Baert F, Turck D (2003) Choking phobia in childhood: a differential diagnosis with anorexia nervosa. Arch Pediatr 10:337–339

    Article  CAS  Google Scholar 

  5. De Jongh A, Broeke E (1998) Treatment of Choking Phobia by Targeting Traumatic Memories with EMDR: A Case Study. Clin Psychol Psychother 5:264–269

    Article  Google Scholar 

  6. De Lucas Taracena TN, Montanes Rada F (2006) Swallowing phobia: symptoms, diagnosis and treatment. Actas Esp Psiquiatr 34:309–316

    Google Scholar 

  7. Marilov VV (2000) Aspects of the development in dysphagia and its functional dynamics. ZhNevrol Psikhiatr Im S S Korsakova 12:32–36

  8. Finkenbine R, Miele VJ (2004) Globus hystericus: a brief review. Gen Hosp Psychiatry 26:78–82

    Article  Google Scholar 

  9. Verdonschot RJ, Baijens LW, Serroyen JL, Leue C, Kremer B (2013) Symptoms of anxiety and depression assessed with the Hospital Anxiety and Depression Scale in patients with oropharyngeal dysphagia. J Psychosom Res 75:451–457. doi:10.1016/j.jpsychores.2013.08.021

    Article  PubMed  Google Scholar 

  10. Kessler RC, Chiu WT, Demler O, Walters EE (2005) Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry 62:617–627. doi:10.1001/archpsyc.62.6.617

    Article  PubMed  PubMed Central  Google Scholar 

  11. Becker ES, Rinck M, Türke V, Kause P, Goodwin R, Neumer S, Margraf J (2007) Epidemiology of specific phobia subtypes: findings from the Dresden Mental Health Study. Eur Psychiatry 22:69–74. doi:10.1016/j.eurpsy.2006.09.006

    Article  PubMed  Google Scholar 

  12. Bruce SE, Yonkers KA, Otto MW, Eisen JL, Weisberg RB, Pagano M, Shea MT, Keller MB (2005) Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry 162:1179–1187. doi:10.1176/appi.ajp.162.6.1179

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bandelow B (1995) Assessing the efficiacy of treatments for panic disorder and agoraphobia. II. The Panic and Agoraphobia Scale. Int Clin Psychopharmacol 10:73–81

    Article  CAS  Google Scholar 

  14. Sheikh JI, Leskin GA, Klein DF (2002) Gender differences in panic disorder: findings from the National Comorbidity Survey. Am J Psychiatry 159:55–58. doi:10.1176/appi.ajp.159.1.55

    Article  PubMed  Google Scholar 

  15. Sawchuk CN, Roy-Byrne P, Noonan C, Craner JR, Goldberg J, Manson S, Buchwald D; AI-SUPERPFP Team (2016) Panic attacks and panic disorder in the American Indian community. J Anxiety Disord. doi:10.1016/j.janxdis.2016.10.004

  16. Tural Ü, Fidaner H, Alkın T, Bandelow B (2000) Panik ve Agorafobi Ölçeğinin Güvenirlik ve Geçerliği. Turk Psikiyatri Derg 11:29–39

    Google Scholar 

  17. Spielberger CD, Gorsuch RL, Lushene RE (1970) State-trait anxiety inventory (self-evaluation questionnaire). Consulting Psychololgists Press. doi:10.1002/9780470479216

  18. Öner N, Le Compte W.A (1983) Durumluk ve Sürekli Kaygı Envanteri El Kitabı. Boğaziçi Üniversitesi Yayınları, İstanbul

  19. Beck AT, Ward C, Mendelson M (1961) Beck depression inventory (BDI). Arch Gen Psychiatry 4:561–571

    Article  CAS  Google Scholar 

  20. Hisli N (1988) Validity and reliability of the Beck Depression Scale in a Turkish sample. Psikoloji Dergisi 6:118–122

  21. Silove D, Manicavasagar V, O’Connell D, Blaszczynski A, Wagner A, Henry J (1993) The development of the Separation Anxiety Symptom Inventory (SASI). Aust NZ J Psychiatry 273:477–488

    Article  Google Scholar 

  22. Diriöz PM, Alkin T, Yemez B, Onur E, Eminağaoğlu PN (2012) The validity and reliability of Turkish version of separation anxiety symptom inventory and adult separation anxiety questionnaire. Turk Psikiyatri Derg 23:108–116

    PubMed  Google Scholar 

  23. Warren SL, Gunnar MR, Kagan J, Anders TF, Simmens SJ, Rones M, Wease S, Aron E, Dahl RE, Sroufe LA (2003) Maternal panic disorder: infant temperament, neurophysiology, and parenting behaviors. J Am Acad Child Adolesc Psychiatry 42:814–825. doi:10.1097/01.CHI.0000046872.56865.02

    Article  PubMed  Google Scholar 

  24. Zou Z, Huang Y, Wang J, He Y, Min W, Chen X, Wang J, Zhou B (2016) Association of childhood trauma and panic symptom severity in panic disorder: Exploring the mediating role of alexithymia. J Affect Disord 206:133–139. doi:10.1016/j.jad.2016.07.027

    Article  PubMed  Google Scholar 

  25. Plehn K, Peterson RA (2002) Anxiety sensitivity as a predictor of thedevelopment of panic symptoms, panic attacks, and panic disorder: a prospective study. J Anxiety Disord 16:455–474

    Article  Google Scholar 

  26. Schmidt NB, Zvolensky MJ, Maner JK (2006) Anxiety sensitivity: Prospective prediction of panic attacks and axis I pathology. J Psychiatr Res 40:691–699. doi:10.1016/j.jpsychires.2006.07.009

    Article  PubMed  Google Scholar 

  27. Anderson ER, Hope DA (2009) The relationship among socialphobia, objective and perceived physiological reactivity, and anxiety sensitivity in an adolescent population. J Anxiety Disord 23:18–26. doi:10.1016/j.janxdis.2008.03.011

    Article  PubMed  Google Scholar 

  28. Bogaerde AV, De Raedt R (2011) The moderational role of anxiety sensitivity in flight phobia. J Anxiety Disord 25:422–426. doi:10.1016/j.janxdis.2010.11.005

    Article  Google Scholar 

  29. Kossowsky J, Pfaltz MC, Schneider S, Taeymans J, Locher C, Gaab J (2013) These paration anxiety hypothesis of panic disorder revisited: a meta-analysis. Am J Psychiatry 170:768–781. doi:10.1176/appi.ajp.2012.12070893

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank everyone who provided assistance for the study including medical secretaries and psychiatry assistants.

Author information

Authors and Affiliations

  1. Psychology Department, Bursa Yüksek İhtisas Training and Research Hospital, Beşevler caddesi Elmas sokak no:1/11 Nilüfer/Bursa, 16100, Bursa, Turkey

    Ersin Budak

  2. Psychiatry Department, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey

    İbrahim Taymur, Sinay Önen & Bilgen Biçer Kanat

  3. Otolaryngology Department, Bursa Esentepe Hospital, Bursa, Turkey

    Önder Akdeniz

  4. Family Physician Department, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey

    Hakan Demirci

Authors
  1. Ersin Budak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. İbrahim Taymur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sinay Önen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bilgen Biçer Kanat
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Önder Akdeniz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hakan Demirci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ersin Budak.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study was conducted in 2014 with Institutional Review Board approval.

Informed consent

Written informed consent was obtained from all the participants included in this study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Budak, E., Taymur, İ., Önen, S. et al. Symptoms of swallowing anxiety in panic disorder patients and associated psychopathologic factors. Eat Weight Disord 23, 487–497 (2018). https://doi.org/10.1007/s40519-017-0367-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-017-0367-z

Keywords

  • Swallowing difficulty
  • Swallowing anxiety
  • Swallowing phobia
  • Panic disorder
  • Eating disorder