Hello, mariannepanda-ga!
It is very common for underlying stress and anxiety to manifest
itself in nagging physical symptoms and for secondary fears or
anxieties to erupt in the wake of a period of severe panic attacks.
Though you are no longer suffering from full-blown panic attacks,
constriction and pressure in the throat is just one of many very
common attendant symptoms of stress. The various sensations of throat
constriction and pressure in the absence of a known medical problem is
referred to as Globus sensation, Globus hystericus or Globus
pharyngis.
While the symptoms are very real, ** and are a bit different for each
individual, ** actual medical conditions are usually not the cause of
the pressure - although some studies do mention the possibility of
increased restriction in the throat muscles due to tension or stress.
This does not make it any less real for you, and you are definitely
not alone in your suffering!!
The good news is that various interventions might help you gain
control over this feeling. As you have stated, the symptoms pop up
under stress, or, in your own words, "Only when I think about it." You
have stated that "I feel this sensation very often, when I am not
engrossed in something or when Iīm drunk. Stress makes it worse.."
I f you can learn some methods of relaxation therapy or biofeedback,
or work with a cognitive therapist as well as realize that while this
is an uncomfortable feeling, it is not dangerous to your health and
should not be a cause for fear, you may well find it fading more and
more into the background as time goes on.
You mentioned taking antidepressants in the past, but you might want
to consider a low dose anti-anxiety medication along with cognitive or
relaxation therapy until you feel you have gained some control over
this feeling. You will need to speak to a therapist about this
approach.
The subconscious mind is very powerful, but it is not something to be
feared. Subconscious thoughts and fears which lead to stress can be
re-routed and realigned with a little work, and the end result is
often a more relaxed and happier voyage through life!
GENERAL INFORMATION about Globus sensation
===========================================
Note that a sensation of a lump in the throat is a common description,
but various other descriptions such as throat pressure, constriction,
etc are also grouped under this syndrome.
From The Merck Manual - scroll down to Globus Sensation:
http://www.merck.com/mmhe/sec09/ch119/ch119b.html#sec09-ch119-ch119b-77
"Globus sensation (previously called globus hystericus) is the
sensation of having a lump in the throat when there is no lump. Globus
sensation may result from abnormal muscle activity or sensitivity of
the esophagus. It sometimes occurs when stomach acid and enzymes flow
backward from the stomach into the esophagus (gastroesophageal
reflux). Globus sensation also may occur with frequent swallowing and
drying of the throat brought on by anxiety or another strong emotion
or by rapid breathing."
"The feeling produced by globus sensation is similar to that
experienced when feeling all choked up, such as during events that
trigger grief, anxiety, anger, pride, or happiness."
==
About "Globus hystericus."
http://www.health24.com/mind/Psychology_A_Z/1284-1307,13467.asp
What is globus hystericus?
"This describes the subjective sensation of a lump or mass in the
throat, which is usually associated with certain mood states."
What causes globus hystericus?
"The exact mechanism which causes this is not known. The sensation
may result from frequent swallowing and drying of the throat
associated with anxiety or other emotional states."
"Globus is probably a physiological symptom of certain mood states. It
is not associated with a specific psychiatric disorder or set of
stress factors. Certain people may have an inherent predisposition to
respond in this way."
How is globus hystericus treated?
"Treatment is usually through reassurance and sympathetic concern
about the sensation. There is no drug which has any proven benefit.
Any underlying depression or anxiety should be managed."
==
From "Globus Pharyngis."
http://www.nexiumresearch.com/globus_pharyngis.html
"Some cases are probably due to increased tension in the muscles of
the throat, others due to irritation or swelling of the lining of the
throat and others from altered perception or awareness of the throat.
==
Read about Globus hystericus (Lump in the throat) and the other causes
that should be ruled out:
http://www.nexiumresearch.com/lump_in_throat_globus_hystericus.html
Also read about potential causes in "Globus Pharyngis."
http://www.medicdirect.co.uk/clinics/default.ihtml?step=4&pid=1850
==
From the "NPS quick guide to anxiety disorders."
http://www.phobics-society.org.uk/quickguide.shtml#12
Choking phobia, Globus Hystericus & Swallowing phobia
These phobias result from anxiety which results in tension affecting
the throat area. Sufferers have difficulties in swallowing, and often
describe themselves as "having a lump in the throat".
==
It is always important to rule out other potential medical disorders
before attributing Globus sensation to stress. You have been diligent
in discussing this with your physician, but to rule out any further
possibilities you might want to visit an Ear, Nose and Throat
specialist if you still have doubts.
See "A Feeling Of A Lump In The Throat; Globus Syndrome."
http://sunzi1.lib.hku.hk/hkjo/view/23/2301455.pdf
"Many pharyngeal pathologies may have features in common with Globus
Syndrome but in the majority of cases a careful history will alert the
clinician...... (Read further)
==
The following article mentions some helpful therapies that you might
want to investigate.
"Therapeutic methods for psychosomatic disorders in
oto-rhino-laryngology." Elke Decot. Otorhinolaryngol Head Neck Surg
2005;4:Doc21
http://www.egms.de/en/journals/cto/2005-4/cto000027.shtml
3.3.2 Globus Pharyngeus
"Patients suffer from a lump or foreign body sensation in the throat,
sometimes in combination with increased mucous production and the
feeling of having to clear their throat. Ruling out a malign disease
should be the first task of diagnosis. A gastro-oesophageal reflux
should also be taken into consideration. Most patients have no causal
organ-pathological changes. A study in England found 5 tumours in 699
patients examined retrospectively [79]. A psychogenic globus sensation
is a classical example of a conversion syndrome. In the psychodynamic
sense, conversion means that the symptom is the price patients pay
because they cannot bear and reject strong negative feelings such as
anxiety, shame, sadness and anger. The patient's ego expresses the
suppressed emotions in the form of a physical symptom [4]. The
physical symptom neutralises the psychological conflict. Mostly, the
globus is also associated with a tautness of the pharyngeal and
laryngeal muscles which typically increases in situations of stress."
"Therapy should start with an instructive talk following a careful
ear, nose and throat examination. If the symptoms are recent,
improvement can often already be reached quickly. What is interesting
is that patients with conversion disorders are more willing to undergo
hypnotic suggestion [80]. A randomised, controlled study reported a
significantly improved response to hypnotic therapy in comparison to
the waiting group, which remained stable until the follow-up study six
months later [81]. In the case of problems which have become chronic,
talk therapy also managed to achieve improvements [82]. Several
isolated case descriptions and smaller studies reveal successes with
cognitive behaviour therapy in conversion problems both with children
and with adults [83]. In difficult cases, doctors might consider extra
treatment with anxiolytics or tranquilizers."
Advice for the Doctor: "I consider applying the following measures
derived from behaviour therapy instructions sensible: careful
examination, without any form of flight into extensive therapeutic
measures (patients are normally all too willing to give their
approval, even to operations); explanation of the physiological and
functional mechanisms associated with the conflict constellation;
acceptance of the symptoms without trying to take away the patient's
symptom; setting reachable goals, regarding healthy behaviour and
ignoring pathological behaviour. Hypnosis treatment and cognitive
behaviour therapy require a referral to a psychotherapist."
FORUM GROUPS AND DISCUSSIONS
=============================
The following threads should provide you with ample evidence that you
are not the only one experiencing these symptoms!
From a thread about Globus hysteria treatment:
http://www.diagnosishealth.com/discussion2/_disc86/0000001d.htm
"You are not alone with this condition. You need to see a dr,
psychiatrist or psychologist about it. I have had it on and off since
about the age of 14. I'm 27 now. I was diagnosed with social phobia
and depression at around the age of 15. Since then i have had a
worsening of anxiety related problems along with depression. During
the times i have had globus hystericus in the past i have had the
symptom normally last for no longer than a couple of weeks, normally
during times of extreme stress. I have been on a number of
anti-depressants since the age of 15 but have never really had proper
follow up with counselling or continuation of medication. At present i
have had globus hystericus since feb 2004. EVERYDAY for over a year
now! I have been put on different anti-depressants again and been in
counselling in hope that they might relieve the symptom, but have not
had success. The only thing that i have been able to take to help
relieve it temporarily is xanax. At times i have had to go up to 6mg
of xanax to keep the feeling of the lump away. It is a horrible
horrible life that i am living because of this long standing lump in
my throat. I haven't been able to work for over a year and it has
caused all my other anxiety issues to continue to get worse. I really
wish there was someone out there dedicated to studying this issue more
extensively. I worry it has become chronic and no one can help me to
find something apart from xanax to help it....."
==
See the following discussion on Healthboards:
http://www.healthboards.com/ubb/Forum126/HTML/004074.html
==
A whole host of groups related to Globus Sensation can be found on the
following link:
http://groups.google.com/groups?sourceid=navclient&ie=UTF-8&rls=GGLD,GGLD:2003-47,GGLD:en&q=globus%20sensation%20AND%20anxiety&sa=N&tab=wg
For example:
"What is it???? Globus sensation, 'lump in the throat', globus
hystericus, cricopharyngeal spasm, Globus Syndrome - call it whatever
you like, this very real physical condition is recognised, discussed
and supported in this forum. This syndrome results from a spasm in
the cricopharyngeus muscle. It is a self limiting disorder that many
people are told will resolve on its own. Do you suffer with this
condition? Do you cope? Do you take preventative measures or
treatments? Join us to meet others who also deal with this condition,
and maybe learn some tips, tricks, ideas on coping as well as know
that it is not 'in your head'! Post your story, your treatment, and
any sucesses you may have."
http://health.groups.yahoo.com/group/globus-sensation/
TECHNICAL ARTICLES
====================
I have compiled a few journal articles touching on globus syndrome,
which may or may not be of interest!
"Study on the function of pharynx & upper esophageal sphincter in
globus hystericus." Jing Sun, Bin Xu, Yao-Zong Yuan, Jia-Yu Xu. World
J Gastroenterol 2002 October 15;8(5):952-955
http://www.wjgnet.com/1007-9327/8/952.asp
"An Esophageal Manometric Analysis Of 23 Patients With Globus
Syndrome." Zhu Y, Zou L, Zhao L, Zhao J.
China Natl J New Gastroenterol 1996 September;2(Suppl 1):tk105a-
http://www.wjgnet.com/1007-9327/abstract_en.asp?f=tk105a&v=2
"Diagnostic yield of barium swallow in Globus syndrome a clinical
audit done at Warrington General Hospital - Warrington." Ehteshamul
Haq Qureshi, Belloso A. Med Channel Jun 2005;11(2):12-4.
http://www.pakmedinet.com/view.php?id=8240
"Effect of occlusal adjustment on globus symptom." Kirveskari P,
Puhakka H. J Prosthet Dent. 1985 Dec;54(6):832-5
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3866069&dopt=Citation
"Globus hystericus: globus syndrome?" Puhakka HJ, Kirveskari P. J
Laryngol Otol. 1988 Mar;102(3):231-4.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3356931&dopt=Abstract
HELPFUL THERAPIES
===================
There are numerous books and tapes which can help you learn basic
relaxation techniques. The main point to remember is that these
techniques should be practiced daily until they become part of your
daily life.
To read about progressive muscle relaxation, see "Relaxation Therapy
for Anxiety Disorders."
http://www.healthyplace.com/Communities/Anxiety/treatment/relaxation_therapy.asp
See the "The Anxiety & Phobia Workbook," by Edmund J. Bourne
http://www.amazon.com/exec/obidos/ASIN/157224223X/healthyplacecom/104-6760542-2931137
"Alternative Treatments for Anxiety Disorders."
http://www.healthyplace.com/Communities/Anxiety/christine/treatments_anxiety_alternatives_4.asp#Meditation
A wide variety of relaxations technigues can be found in the following article:
"Relaxation Techniques for Relief of Anxiety & Stress," by Susan M. Lark M.D.
http://www.healthy.net/asp/templates/article.asp?PageType=article&ID=1205
=
Biofeedback:
You might want to search for a Biofeedback clinic in your area. Read
the following article to see if this interests you:
"Stress Management & Biofeedback."
http://web.missouri.edu/~councwww/stress/stresswebpage.htm
=
Cognitive Therapy:
For an overview of Cognitive Therapy and how it might help, please see
the following;
"Cognitive behavior therapy: The basics." John Winston Bush, PhD
http://www.cognitivetherapy.com/basics.html
"THE COGNITIVE MODEL OF ANXIETY." Robert Westermeyer, Ph.D.
http://www.habitsmart.com/anx.html
"Cognitive Therapy for Depression and Anxiety."
http://mentalhealth.about.com/cs/psychotherapy/a/cogtx.htm
==
I know this is a distressing problem for you. I truly hope the
information I have compiled is helpful and provides you with some
insights and tools to regain control over your symptoms. Best of luck
and good health to you!
Sincerely,
umiat
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