Dysphagia as a Symptom of Anorexia

The weight loss and malnutrition associated with anorexia can lead to dysphagia, which is defined as difficulty swallowing due to physical or mental illness.

Dysphagia can result in additional medical problems that can be dangerous and even fatal. As a result, it's essential to diagnose and treat dysphagia in a person with anorexia.

This article will start by defining dysphagia and identifying the two kinds of dysphagia that people with anorexia are most likely to experience: functional dysphagia and oropharyngeal dysphagia. It also explores the symptoms, diagnosis, and treatment of each.

What Is Dysphagia?

Dysphagia is a dysfunction of the swallowing muscles. It can involve any of the apparatuses involved in moving food from the mouth to the stomach. People with anorexia who develop dysphagia usually experience one of two kinds:

1. Functional dysphagia: When an individual has difficulty swallowing, but there is no anatomical abnormality or injury involved, they have functional dysphagia. Functional dysphagia is especially prevalent in people with mental illness.
   
2. Oropharyngeal dysphagia: When individuals have oropharyngeal dysphagia, they have difficulty moving food, liquid, and even saliva from their mouth into their throat. This may lead to coughing and choking while consuming food or liquid, food getting stuck in the throat, and regurgitation of food.
   

Functional Dysphagia as a Symptom of Anorexia

There are very few studies about the association between dysphagia and anorexia. One investigation noted people with functional dysphagia are often diagnosed with anorexia because the two conditions share many clinical characteristics. For example, both conditions include symptoms like reduced appetite, weight loss, changes in food selection, and decreased food intake.

However, researchers found that the answers people with psychogenic functional dysphagia gave on a series of questionnaires were distinct from those of people with anorexia. As a result, they suggested that people with functional dysphagia don't have eating disorders but suffer from various forms of psychological distress, especially anxiety.

Similarly, another study found that functional dysphagia is present in 6% of people with eating disorders, including anorexia and bulimia.

Nonetheless, if a doctor suspects someone with anorexia has functional dysphagia, they will likely refer the patient to a speech-language pathologist who will perform an exam that rules out gastroesophageal reflux disorder (GERD) and structural abnormalities or motor disorders in the mouth and throat.

If none of these underlying issues are found but the individual is still complaining of difficulty swallowing, they will be diagnosed with functional dysphagia.

Treatment

Treatment for functional dysphagia can vary, but for people with anorexia they may be likely to include:

• Cognitive-behavioral therapy
• Hypnosis
• Relaxation therapy
• Alternative therapies (e.g., acupuncture)
  

Oropharyngeal Dysphagia as a Symptom of Anorexia

The severe restrictions in food consumption and excessive weight loss characteristic of anorexia often lead to muscle weakness, which can extend to the swallowing muscles, resulting in oropharyngeal dysphagia.

This is especially problematic because oropharyngeal dysphagia can lead to aspiration (i.e., taking in food or liquid into the lungs instead of the stomach), which increases the risk of pneumonia, a possibly life-threatening lung infection.

To determine if a patient has oropharyngeal dysphagia, a speech-language pathologist will take the same steps to diagnose oropharyngeal dysphagia in an individual with anorexia as they would anyone else. These steps are likely to include:

• A swallow evaluation in which the doctor looks and listens as the patient swallows. This will enable them to assess any impairment to the swallowing muscles.
• A modified barium swallow in which an individual swallows barium while X-rays are taken of their mouth and throat. These images will be reviewed to determine if the swallowing apparatus is functioning properly, and if not, where the problem lies.
  

The Likelihood of Developing Oropharyngeal Dysphagia

Oropharyngeal dysphagia may be especially likely in anorexia patients who are severely ill.

For example, an extensive retrospective review of 206 adults with severe anorexia admitted to the hospital over a five-year period found that 42 had oropharyngeal dysphagia. And, this group had significantly lower BMI when they were admitted to the hospital, stayed in the hospital a week longer on average, and were much sicker than anorexia patients without oropharyngeal dysphagia.

Treatment

In two case studies (one describing three individuals with severe anorexia who had symptoms of oropharyngeal dysphagia and one describing an individual with severe anorexia and oropharyngeal dysphagia who had developed aspiration pneumonia), speech-language pathologists administered treatment for dysphagia that involved the following:

• Swallowing therapy includes exercises to strengthen and build coordination in the muscles involved in swallowing and compensatory strategies to alter the swallow, such as changes in posture or timing. 
  
• Neuromuscular electrical stimulation administers a low electric current via electrodes applied to the skin to stimulate the muscles for chewing and swallowing.
  

Of course, any treatment for dysphagia in anorexia patients should be administered in conjunction with treatment for anorexia, given dysphagia is merely a symptom of the eating disorder.

Because aspiration due to oropharyngeal dysphagia is life-threatening if someone with anorexia is coughing when they consume liquids or finding it takes a lot of effort to swallow food, it's important to consult an expert and get treatment as soon as possible.