No Burp Syndrome: Retrograde Cricopharyngeal Dysfunction (R-CPD)

Can you burp? Many people with emetophobia cannot.

Retrograde Cricopharyngeal Dysfunction (R-CPD), also called no-burp syndrome, was first published about in 2019 [1]. The cricopharyngeus muscle sits at the top of the esophagus and normally relaxes for eating and when under gas pressure. However for some this muscle fails to relax when under gas pressure causing pain, bloating, painful hiccups and more.

R-CPD can be successfully treated[2] by applying muscle relaxing medication to the cricopharyngeal muscle.

We don’t know if there is a link between R-CPD and emetophobia. Could the muscle disorder cause nausea and reduce burping which leads to emetophobia? Could emetophobia cause people to suppress the natural muscle movements in the throat leading to R-CPD?

R-CPD is not to be confused with globus pharyngeus which is the feeling of a lump in the throat.

Tightness in the throat muscles is one example of many feedback loops of phobia[3]. Physical discomfort triggers anxiety which increases physical discomfort. Part of phobia recovery is identifying and breaking these feedback loops.

Sources:
[1]: https://svas.com.au/r-cpd/
[2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10444988
[3]: https://www.sciencedirect.com/science/article/abs/pii/S0887618506001009

Burp phobia: when the fear is of burping itself

Some people search for "burp phobia" or "phobia of burps" and find this page. A fear of burping is rarely a phobia of its own. For most people it is emetophobia wearing a different coat: a burp feels like the first warning that vomiting is on its way, so the body learns to treat every burp, hiccup, or gurgle as an alarm. Others fear burping in public, which sits closer to social anxiety. Either way, the problem is not the burp. It is the meaning the brain has attached to it.

This is where no burp syndrome and emetophobia feed each other. If you cannot burp, the trapped air produces exactly the bloating, gurgling, and nausea that we have come to dread with emetophobia. I'm not aware of any research supporting this idea, but from my personal experience, I wonder if my inability to burp was a response of my suppressing urges to burp and once I lost the ability, it was gone and now I am not able to easily gain it back.

The way out is the same as for any phobia: gradual, repeated exposure to the feared sensation until the brain stops sounding the alarm. Letting a burp happen instead of suppressing it, sitting with a full or gassy stomach on purpose, and noticing that nothing follows are all exposures. If R-CPD is the cause, the Botox treatment described above removes the physical block; the fear still has to be unlearned, and that part is what Bia is built for.