Functional dysphagia: Developing a framework for assessment and treatment

Abstract

Purpose: Functional dysphagia is complex, affecting physical health as well as wellbeing. In this expert opinion paper with associated exemplar case series, we propose a framework for understanding functional dysphagia.

Method: A literature review of approaches to understanding and treating functional dysphagia are presented, moving beyond the predominant medical model to encompass psychosocial aspects of the condition. An exemplar case series of six clients is then given. Learnings from fields of laryngology and cognitive and applied behavioural psychology are discussed; and a biopsychosocial framework for assessment and therapy are proposed.

Result: Client presentations can be vastly different yet, for many, relatively quick return to normal eating can be achieved with targeted therapy. Using a biopsychosocial framework allows comprehensive assessment and targeted interventions.

Conclusion: We should consider a broader biopsychosocial framework in dysphagia practice so that those with functional dysphagia no longer go through a process of diagnosis through exclusion. While large scale randomised efficacy trials do not exist-and may not be feasible or useful-clinicians can learn from associated fields of laryngology and psychology, and confidently develop therapy programmes for their clients. The biopsychosocial framework developed in this paper provides guidance to clinicians working in this field.

Keywords: dysphagia; functional dysphagia; functional neurological disorders; phagophobia; psychogenic dysphagia; psychology.