Pseudodysphagia, in its severe form, is the irrational fear of swallowing or, in its minor form, of choking. The symptoms are psychosomatic, so while the sensation of difficult swallowing feels authentic to the individual, it is not based on a real physical symptom. It is important that dysphagia (difficult or painful swallowing) be ruled out before a diagnosis of pseudodysphagia is made. Fear of choking is associated with anxiety, depression, panic attacks, hypochondriasis, and weight loss. The condition can occur in children and adults, and is equally common in men and women. Quality of life can be severely affected. Symptoms Individuals with pseudodysphagia have difficulty swallowing, and may experience panic before or during the act of swallowing. This can therefore lead to the avoidance of swallowing solid foods and liquids, taking any forms of tablets or pills without the presence of physiological or anatomical abnormalities. Avoidance of restaurants or social settings is common, since sometimes food can only be taken in small bites or with liquid. Furthermore, the resulting avoidance of food and drinks caused by the phobic stimulus may ultimately lead to weight loss, anxiety, depressions and social withdrawal. The strain is generally bounded to solids, however the essence of the difficulty can vary where most patients are able to consume semi solids or soft foods, whereas some are able to only consume when the food is properly lubricated or only solid foods in small pieces. Furthermore, some patients experience the inability to swallow pills or are afraid to drink liquids. Causes It has been suggested that pseudodysphagia occurs most frequently secondary to a traumatic experience of being choked by food. The act of swallowing becomes mentally linked with choking or with reduced capacity of the opening of the throat. Pseudodysphagia has a tendency to evolve progressively, as the patient becomes more and more preoccupied with the idea that swallowing will lead to choking, until this anxiety becomes a constant sensation whenever food is being consumed. Such events cause negative internal feedback to obtain exponential momentum, as the initial presence of fear gradually mounts into an inevitable and immense obsession. This anxiety will in time become strong enough to cause psychosomatic choking symptoms. Psychological and psychiatric studies In 1982, Di Scipio and Kaslon conducted a controlled study with children within 1 year of having surgery for their cleft palate. Through the use of a questionnaire, a comparison was made