Page 105 - JCBP-3-2

Journal of Clinical and
Basic Psychosomatics Hypnosis as intervention for globus pharyngeus

phenomenon differently. While ICD-10 categorized globus along with a recommendation for follow-up with a
as a somatoform disorder, recognizing it as a psychiatric gastroenterologist. Two days later, he visited the ER of
disorder, ICD-11 classified globus under functional a different hospital, complaining of “throat pain and
7
esophageal or gastroduodenal disorders, reflecting its dysphagia,” which the ER doctor described. The patient
multifactorial nature, which includes psychological reported intermittent pressure in his throat and chest that
factors. 8 prevented him from eating, along with difficulty breathing.
Current treatments for globus reflect its multifactorial Physical examination was unremarkable, and he was again
etiology, with approaches ranging from pharmacological discharged with a prescription for PPI (omeprazole 20 mg
interventions to reassurance, psychoeducation, twice daily) and an explanation that symptom improvement
and cognitive-behavioral therapies. Proton pump might require a least a week of medication use.
5
inhibitors (PPI) are often prescribed to address potential From that point onward, the patient developed a fear
gastroesophageal reflux. In addition, speech and language of eating. He returned to the ER (Figure 1) with the same
therapy may be employed to address muscle tension difficulty swallowing and was admitted to the internal
dysphonia. 1 medicine ward for further evaluation. Since no underlying
In recent years, there has been growing interest in cause was identified, he was discharged with a prescription
alternative therapies, including hypnosis. Hypnosis can for PPI (esomeprazole 40 mg twice daily) that could
be understood as a meditative state that individuals can be crushed and consumed with liquids, as the patient
consciously and intentionally access for therapeutic could not swallow pills. However, no improvement was
purposes. During this state, suggestions – either verbal or observed, and he was consuming five to six bottles of liquid
through visual imagery – are introduced to achieve specific nutritional supplements per day to maintain functionality.
therapeutic goals. 9 The patient was referred to the Eating Disorders Clinic
Hypnotherapy has demonstrated potential in addressing after his weight dropped from 86 kg to 56 kg. During a
both the physical and psychological components of the psychiatric interview, it was concluded that the event
globus, helping patients relax throat muscles and reduce 6 months earlier was likely an anxiety attack, and the
anxiety associated with the sensation. 10 symptoms now met the criteria for somatization disorder,
which had led to avoidant/restrictive food intake disorder. 11
In this case report, we present an 18-year-old male
patient who developed severe globus pharyngeus, leading Given the patient’s significant weight loss (a third of
to significant weight loss due to difficulty swallowing solid his body weight) and the need for a rapid intervention
foods. This case highlights the potential effectiveness to restore normal eating, hypnosis was chosen as the
of alternative interventions, particularly in cases when treatment method. Furthermore, his young age (at the end
conventional medical treatments have been unsuccessful. of puberty) was considered favorable, as individuals in this
age group are typically more responsive to hypnotization
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2. Case presentation and more open to new ideas and suggestions than adults.
During the initial evaluation, a positive rapport and trust
An 18-year-old male was referred to the Eating Disorders were established. It seemed that reducing his anxiety and
Clinic at Hadassah Hebrew University Medical Center facilitating a positive experience of eating in a protected,
after losing nearly 30 kg over the past 6 months due to hypnotic state could help the patient return to normal
his inability to swallow solid food, leaving him able to eating more quickly. In light of the urgency to address his
consume only liquids. severe weight loss, we initiated two hypnosis sessions per
He reported that 6 months prior, after eating a meal, week for the first 2 weeks, followed by weekly sessions, for
he suddenly felt a lump in his throat and experienced a total of 10 sessions. This initial intensive phase helped
a sensation of suffocation, which prevented him from establish a strong therapeutic foundation and allowed for
swallowing. He attempted to vomit but was unsuccessful. the assessment of early responses to treatment. The chosen
He then drove but soon felt as if he was suffocating and on induction technique involved muscle relaxation and
the verge of losing consciousness. He called an ambulance, gradual relaxation to reduce anxiety, preparing the patient
which transported him to the emergency room (ER). for future encounters with eating. He was trained in self-
Several tests were performed, including laryngoscopy hypnosis using the technique of a “conflict-free place” to
(which was normal) and a gastroscopy (which revealed prevent the recurrence of a “choking attack” in the future.
a small hiatus hernia and distal esophagitis). The patient Metaphors relevant to the patient’s interests in cars and
was discharged with a prescription for a PPI (omeprazole mechanics were incorporated to enhance the hypnotic
20 mg twice daily) to manage gastroesophageal reflux, suggestions.

Volume 3 Issue 2 (2025) 99 doi: 10.36922/jcbp.4944