What is Pnigophobia? (An Overview)

In this blog we will discuss the symptoms, causes and treatment of Pnigophobia. 

Pnigophobia is the fear of choking or being smothered. The sensations felt when choking are very uneasy and no one likes it.

The difficulty in breathing is what one fears. 

Though, people suffering from this specific phobia feel extreme anxiety when exposed to a situation one might choke.

Because Pnigophobia comes under the category of anxiety disorders in the DSM-V, one gets extremely anxious at the mere thought of choking or being smothered. 

These overwhelmingly high levels of anxiety cause hindrances in the sufferers day-to-day activities. According to the DSM-V, hurdles in daily activities are called social and occupational dysfunction. 

Repetitive avoidance, caused by anxiety is what leads to this dysfunction.

For example, one will avoid eating medicines and or certain foods (such as nuts, bread etc) for the fear that they might choke. 

In the worst case scenario, drinking water can also be traumatizing because they develop an intense fear of being choked. 

These avoidances and social occupational dysfunction can make the sufferer feel safe and pleasant.

This sense of security maintains their phobia because it proves to them that their fear stimulus is dangerous and threatening. 

Though, these feelings are short-lived. In the future, an individual is very likely to develop OCD and or depression. 

Pnigophobia can also cause the sufferer to develop a fear of eating (Cibophobia), fear of medicines (Pharmacophobia) and or fear of drinking water (Aquaphobia). 

An individual suffers from misery, which can give rise to full-blown panic attacks if exposed to a situation one feels he might choke/get smothered. One may require hospitalization as a result. 

Pnigophobia, also known as Pnigerophobia is the irrational fear of choking or being smothered.

The name originates from the Greek word ‘pnigo’ meaning choke and ‘phobos’ meaning fear. 

Symptoms of Pnigophobia 

The Diagnostic and Statistical Manual for Mental Disorders-5th Edition (DSM-V) suggests a number of symptoms one suffers from in all specific phobias, including Pnigophobia. 

This irrational fear of choking is a part of anxiety disorders, thus anxiety is it’s focal symptom.

It aggravates other physiological symptoms, such as heart rate, breathing rate and one’s mood.

These symptoms persuade the repetitive acts of avoidance as mentioned earlier. 

Because each individual experiences Pnigophobia differently (based on their past experiences), one will  suffer from more severe symptoms , as compared to someone else. 

According to the DSM-V, anxiety that one experiences in Pnigophobia should last for at least 6-months.

Other than this, one should also suffer from 3-5 symptoms for the list mentioned below. 

• Excessive anxiety when exposed to choking or being smothered 
• Excessive anxiety when thinking about choking or being smothered 
• Inability to manage anxiety 
• Full-blown panic attacks 
• Avoiding situations in which one might choke 
• Increased heart beat 
• Breathlessness 
• Muscle tension 
• Nausea 
• Feelings of dizziness/fainting 
• Feeling depressed 
• Fear of an impending doom 
• Excessive sweating 
• Tremors 
• Hot/cold flashes 
• Butterflies in the stomach 
• Drying up of the mouth 
• Disorientation 
• Migraine 

Causes of Pnigophobia 

It is argued that all anxiety disorders, including specific phobias have no real cause.

They are caused by either a genetic predisposition and or environmental factors. 

According to the genetic/biological model, specific phobias are developed due to a genetic predisposition.

Someone who has a family history of anxiety disorder has a higher chance of developing Pnigophobia. This is because any alteration in the genes of his parents will be transferred to him. 

This genetic tendency to develop a specific phobia is further explained by the Diathesis-stress relationship.

This suggests that someone with a genetic predisposition will develop Pingophobia only in the presence of the correct environmental trigger event. 

Those environmental trigger events refer to the past-traumatic experiences associated with one’s fear stimuli.

For example, one might have developed Pnigophobia because of the near to death experience he had in his childhood when he choked.

Someone who has experienced the terrifying, uneasy sensations felt when choking will fear it. 

Additionally, watching or listening to someone else’s unpleasant experience with choking can also cause Pnigophobia. 

An individual who has heard of cases or watched news of people dying because of choking are also very likely to develop this phobia. 

Also, someone who had overprotective parents also has a higher chance of suffering from this phobia because parents warn their children to be safe while eating to avoid getting choked and face its consequences. 

Thus, there is no definite cause as to why one develops Pnigophobia. Both genetics and environmental factors play significant roles in it’s development. 

Treatment of Pnigophobia 

Pnigophobia, like all other specific phobias, has no exclusive type of treatment that is specifically designed to treat it.

Like all the other specific phobias, Pnigophobia is treated by a number of different therapies including Cognitive-behavioral Therapy (CBT) and exposure therapy to lower anxiety. 

• Cognitive-Behavioral Therapy (CBT) 

It is one of the most frequently used treatments for patients with almost all kinds of mental disorders.

Pnigophobia is defined as the irrational fear of choking or being smothered. Thus, the therapist helps the patient in replacing these irrational thoughts with more rational ones. 

The patients are helped out in analyzing and justifying the way they feel about their fear stimuli.

Therapists assist them in uncovering the reasons behind their fear and later they provide them with alternate, pleasant thoughts. 

The patient is told to maintain a thought diary (with ABCD column) which provides them a replacement for every irrational thought they have, when thinking about a particular situation.

The ABCD stands for: 

i. A (antecedents) a situation or triggering event.

ii. B (belief) the thought that comes to one’s mind when in that triggering situation.

iii. C (consequences) the symptoms/feelings caused by that event/thought 

iv. D (dispute) alternate, rational thoughts provided by the therapist in an attempt to        dispute/challenge those irrational beliefs.

This last section of the thought diary is what really plays a role in helping the person feel good/less anxious.  

• Exposure Therapy

It is one of the most frequently used ways of treating patients with Pnigophobia (or any other kind of specific phobia).

In this therapy, the patient is exposed to the source of his fear over a certain span of time.

To begin with the therapy, the therapist exposes the patient to the least triggering stimuli, a picture of someone choking for example.

As the therapy progresses and the patient is able to control his anxious feelings, imagery can be used to take the treatment a step further.

In this part of the treatment the patient is asked to visualize/imagine a situation in which he is choking and what should be done in this situation other than panic. 

During this process of imagery, one actually feels being in that particular situation or place, experiencing various senses.

 Once the person successfully, without feeling anxious clears this step of the therapy, he is then exposed to someone who is choking and is asked to help them without feeling anxious. 

While the patient is being exposed to different intensities of stimuli during the various stages of therapy, the therapist simultaneously teaches them coping exercises.

These include, breathing techniques or muscle relaxation methods to lower their anxiety, when in an actual fear/anxiety causing situation.

This teaches them how to remain calm when exposed to the fear stimuli.

Before actually starting the exposure therapy, the therapist needs to figure out the intensity of the patient’s fear, as to deduce whether they will be able to undergo this treatment, without any physical or psychological harm caused to them during the exposure processes.

However, these steps desensitize one to their fear of choking or being smothered, by exposing them to that stimuli repeatedly, until they learn to undergo the situation without anxiety/panic attacks.

• Drug Therapy

Drugs are used to reduce the physical symptoms caused by Pnigophobia.

Drugs are very quick in effectiveness, as they start showing progress in the patients’ health at least 2 weeks after the medicine is taken.

This type of biological treatment is usually more effective if the cause of phobia is only genetic.

However, these drugs/medicines are not to be taken without a doctor’s prescription or consultation.

Two types of drugs are used in the treatment of this phobia:

         i.       Anti-anxiety Drugs

These include medicines like Klonopin.

They are most commonly used with patients who experience panic attacks and also lowers the anxiety by binding to receptor cells of the brain that cause these unpleasant symptoms.

        ii.       Antidepressant Drugs

These drugs as the name suggests don’t only treat depression but are also very effective in treating phobias.

Medicines like Lexapro reduce the anxious feelings of a person and makes him feel calm. They need to be taken on a daily basis but not without a doctor’s advice.

• Yoga/Meditation 

They are not just one of the many treatment therapies used for Pnigophobia, instead they are one of the most common ways of relaxation used by many people.

Yoga tends to stimulate the meditative state of one’s mind while the person is in a particular yoga posture.

Through yoga/meditation the mind is diverted towards something more productive and calm, allowing the person to escape the negative, distress causing thoughts.

Out of a number of yoga types, one can benefit from any yoga type/pose they like. Hatha yoga is one of the different types of yoga.

The breathing techniques or the imagery one creates while in a yoga posture are the real factors that makes the person feel less anxious and diverts their mind, away from the thoughts about their fear stimuli. 

• Dialectical Behavior Therapy (DBT) 

This is another effective therapy used to treat Pnigophobia.

It is more commonly used with people suffering from personality disorders, but is also useful with patients suffering from this type of specific phobia.

Coping skills are taught in the DBT group which lasts for about 6-months and can have a number of people (depending on how many join the group). 

            i.Half-smiling is the first module of DBT. It is a technique that is used with patients who are distressed because of their irrational thoughts.

The technique is known as ‘Half-smiling’ because the person is first advised to think about the stimuli that fears or upsets them, and while doing so they are told to lift the corners of their mouths by subtly smiling.

Smiling is not that will help one get rid of these unpleasant thoughts, it is the person’s ability to constrain itself from thinking about those thoughts while half smiling.

          ii.Mindfulness, the second module, is another technique used in DBT groups which helps the individual in getting rid of those negative thoughts.

Individuals are told to focus on the present and be attentive to what is going on around them at the moment. This helps in breaking the link between their mind and any negative thought that might come to them then. 

For example, a person is told to focus on his breath or on the sound of the wind around them, making use of their auditory sense. 

         iii.The third technique or module of the DBT is distress tolerance skills. This module teaches people to calm themselves down in healthy ways when they are distressed or emotionally overwhelmed.

Individuals are allowed to make wise, rational decisions and take immediate action, rather than being captured by emotionally destructive thoughts that might make the situation worse.

Reality acceptance skills are also learnt under this model so that people fully accept reality and later make plans on how to address the problem.

• Mindfulness-Based Stress Reduction (MBSR) 

MBSR is a meditation therapy, used to manage stress or anxiety. It is an 8-week program which includes group sessions.

Mindfulness meditation and Hatha yoga are practiced in these sessions. Lectures and group discussions are also done to talk about mental health and increase interactivity.

In mindfulness meditation the person is told to, for example, focus on the sensations felt while breathing or the rhythm of the chest rising and falling during the process.

This distracts the person’s attention from something stressful to something which is neutral and soothing. 

For quick and effective treatment, patients are also given a set of home works, for example 45 minutes of yoga and meditation sessions for 6 days a week and to record their results/feelings in a book or diary for 15 minutes a day.

Whether the cause of Pnigophobia, or any other type of specific phobia is genetics, environmental or both, the best and the most effective way of treating them is by using a combination of both biological treatments (drugs) with cognitive treatment (for example CBT/exposure therapy).

nd calm at night.

Frequently Asked Questions 

Citations 

• https://psychtimes.com/pnigophobia-fear-of-choking-or-of-being-smothered/
• https://fearof.org/pnigophobia-or-pnigerophobia/
• https://www.fearofstuff.com/humans/fear-of-choking-or-being-smothered-2/
• https://www.rightdiagnosis.com/p/pnigophobia/intro.htm