Dysphagia and Eating Disorders: Understanding Swallowing Difficulties in the Recovery Journey
Eating disorders don’t just affect nutrition and weight — they can also impact the body’s ability to eat safely. One symptom that can be frightening, misunderstood, and often overlooked is dysphagia, or difficulty swallowing.
For individuals with anorexia, ARFID, or other restrictive eating patterns, dysphagia can be both a symptom and a complication — one that may make recovery feel even harder.
Let’s explore what it is, why it happens, and how it can be treated.
What Is Dysphagia?
Dysphagia means difficulty swallowing. It can occur at any stage of the swallowing process:
Oral: trouble chewing or moving food in the mouth
Pharyngeal: food feels “stuck” or hard to move down the throat
Esophageal: food gets caught in the chest or causes discomfort after swallowing
People with dysphagia may describe:
Choking or coughing while eating
Fear of swallowing
Feeling like food or pills won’t go down
Avoiding certain textures or consistencies
Needing water to help swallow food
Weight loss due to fear or avoidance of eating
How Is It Connected to Eating Disorders?
1. Prolonged Restriction
In conditions like anorexia nervosa, prolonged undernourishment can cause:
Muscle weakness, including in the swallowing muscles
Poor coordination of the tongue, throat, or esophagus
Physical fatigue that makes chewing or swallowing feel exhausting
2. Anxiety Around Swallowing
Especially in ARFID (Avoidant/Restrictive Food Intake Disorder), fear of choking or vomiting may lead to:
Muscle tension in the throat
Psychogenic dysphagia (where fear triggers a physical block)
Selective avoidance of foods requiring more effort to swallow
3. Purging Behaviors
In bulimia nervosa or purging-type anorexia, frequent vomiting can lead to:
Throat irritation or inflammation
Esophageal spasms
Damage to swallowing muscles or the esophagus itself
4. Gastrointestinal Discomfort
Eating disorders often cause delayed gastric emptying, bloating, and reflux — which can all lead to a feeling of fullness or obstruction, mimicking dysphagia.
How Is Dysphagia Diagnosed?
If someone with an eating disorder reports swallowing difficulty, a multidisciplinary assessment is key.
Evaluation may include:
Swallowing screening by a speech-language pathologist (SLP)
A modified barium swallow (MBS) or FEES exam
Medical imaging to rule out structural problems
GI referral (especially if there’s suspected reflux or motility issues)
Psychological assessment for anxiety-related dysphagia
Treatment: A Team Approach
Dysphagia in eating disorders must be addressed gently and holistically. Treatment often includes:
Medical stabilization
Re-nourishment to rebuild muscle strength
Hydration and gentle progression of food textures
GI management (reflux, motility)
Speech Therapy (SLP)
Swallowing exercises
Safe food/liquid consistency strategies
Techniques to reduce choking anxiety
Psychological Support
Addressing fear of choking or vomiting (often via CBT or exposure therapy)
Supporting distress tolerance and body awareness
Nutritional Support
Stepwise reintroduction of safe foods
Soft, well-lubricated, low-anxiety meals
Possible supplements or tube feeding in severe cases
Final Thought
If someone with an eating disorder struggles with swallowing, it’s not “just in their head” — it’s a real and treatable part of their recovery.
By recognizing dysphagia early and treating it with skill and compassion, we help people feel safe in their bodies again — and safe with food.
Need Support?
We specialize in working with children, teens, and young adults navigating eating disorders and complex feeding challenges, including dysphagia, ARFID, and medical trauma.
