5 Emotional (Psychological) Causes of Hiccups & How to recognize them.
Our content is not intended nor recommended as a substitute for medical advice by your doctor. Use for informational purposes only.
1. Anxiety disorders.
According to the NIMH (National Institue of Mental Health), about 18% of US adults suffer from anxiety.
Anxiety is defined as a constant feeling f tension and worrying thoughts. It is often combined with physical symptoms such as raised blood pressure, shortness of breath, headaches, and even hiccups.
Anxiety is not a single disease; several types of anxiety exist. Its main types are:
- Generalized Anxiety Disorder: Excessive and uncontrollable fear or worries about various life aspects (two or more) such as work or school performance.
- Social anxiety.
- Specific phobias such as animal phobias, blood injections, etc.
- Social anxiety.
- Post-traumatic stress disorders: hiccups may start after a traumatic event, such as the death of a loved one. Anxiety and hiccups may persist for years after the traumatic event.
Symptoms and effects of anxiety:
- Irrational fears or worrying even from the usual daily events.
- Restlessness and chronic fatigue.
- Lack of concentration and sleep disturbances.
- Chronic stress may increase your risk of heart problems, hypertension, and diabetes.
- In addition, chronic severe anxiety may turn into depression.
- Anxiety may cause real physical symptoms and diseases such as Irritable bowel syndrome, diarrhea, abdominal pain, nausea, anorexia, hiccups, fast heartbeat, sweating, etc.
- Severe anxiety may interfere with the person’s daily life and work.
Although not common, hiccups are reported with various anxiety disorders (reference). Hiccups with anxiety can present in many ways:
- Occasional attacks of acute hiccups (less than 48 hours).
- Chronic (persistent) hiccups come and go more systematically.
- Chronic intractable hiccups that may last for months or years.
Hiccups resulting from emotional reasons (including anxiety) often disappear by sleep and appear during the waking hours. Conversely, hiccups that persist during sleep are unlikely to have an emotional cause (reference).
Stressful situations can trigger hiccups. Stress is different from anxiety; Stress is your body’s reaction to external stressors.
With anxiety, something is coming from inside and isn’t leaving. The fear is irrational in people with anxiety as there is no (rational) reason for the fear and worry.
Hiccups start after exposure to a very stressful event (emotional stress) with stress. The stressful event often results in an acute attack of hiccups. However, the episode will soon terminate after the disappearance of the emotional stress.
Examples of emotional stressors:
- Loss of a job.
- Death of a loved one.
- Increasing financial problems.
Due to the acute nature of hiccups in such cases, No studies accurately assessed the prevalence of acute hiccups with emotional stress.
3. Sudden Intense Emotions (Excitement).
Sudden intense emotions such as excitement. Both positive and negative sudden emotions can trigger hiccups.
- Sudden or intense fear.
- Sudden excitement for any reason.
Sudden exposure to such extreme emotion can trigger acute attacks of hiccups. This is particularly more common in females. No accurate data assessing the frequency of hiccups with intense emotions.
Somatization is a term that describes people who tend to experience psychological (emotional) problems in the form of somatic symptoms (reference).
Somatization is frequent in people with mood disorders (such as depression).
Patients with somatization often report multiple and recurrent medical problems with no apparent organic dysfunction in their body organs.
Some examples of somatization:
- Throwing up with stress, anxiety, or any intense emotions.
- Chronic headaches due to stress.
- Unexplained abdominal pain.
- Unexplained shortness of breath.
- Hiccups, anorexia, constant nausea.
Although rare, Hiccups can be a form of somatization. Intractable (chronic resistant hiccups) is linked to somatization in the studies (reference).
Some people may pretend that they’re hiccuping. Several Emotional reasons lead a person to act to have a disease or a condition like hiccups:
- To gain the attention of the others.
- To avoid punishment or unwanted tasks (as with prisoners and military service).
- Having a personality or mood disorder.
- Common in people under social and economic stress.
Always consider malingering as one of the emotional reasons for hiccups especially if no other explanations exist.
Tips on how to recognize psychological causes of hiccups.
- Acute (< 48 hours), persistent (> 48hours), or intractable (> a month) hiccups can be due to psychological reasons.
- Your doctor should evaluate any persistent or intractable hiccups.
- Your doctor should exclude all the causes of persistent hiccups before considering emotional reasons.
- Psychogenic hiccups are often more common in people with psychological problems (such as anxiety, depression, post-traumatic stress syndrome).
- Psychological hiccups often disappear entirely during sleep.
The causes of chronic (persistent and intractable) hiccups are in the table below (reference):
Causes of Chronic Hiccups.
|1. Digestive system||– Gastric distension|
– Chronic gastritis and peptic ulcer disease.
– GERD and esophagitis.
– Stomach or esophageal cancer.
– Pancreatitis and pancreatic cancer.
– Gallbladder diseases (as gallstone disease).
– Inflammatory bowel disease, Bowel obstruction.
|2. Toxic/ Metabolic.||– Alcoholoabuse.|
– Diabetes Mellitus.
– Renal failure.
– Hypocalcemia, Hyponatremia (↓ sodium).
|3. Neurological diseases||– Cerebral stroke.|
– Severe head trauma.
– Brain tumors.
– Multiple sclerosis.
– Infections (brain abscess, meningitis, encephalitis).
– Malformation of brain blood vessels.
– Inflammations of the vessel wall (as temporal arteritis)
|4. Diseases in the Chest||– Pneumonia, bronchitis.|
– enlarged lymph nodes around the esophagus (mediastinal LNs).
– Bronchial asthma.
– Inflammation of the lung envelope (pleurisy) or pus (empyema).
– Tumors and trauma of the mediastinum.
|5. Vagus & phrenic nerve irritation||– Pharyngitis and laryngitis.|
– FB or hair inside the air (irritation of eardrum).
– Enlarged thyroid gland (goiter).
– Neck cysts or neck tumors.
|6. Drugs that cause Hiccups||– Chemotherapy (as carboplatin).|
– Corticosteroids(as dexamethasone).
– Some anti-hypertensives such as Alphamethyldopa.
– Sedativesosuch as Barbituratesoandodiazipam.
|7. Psychogenic||– Anorexia Nervosa.|
– Post-traumatic stress disorder.
– Extreme excitement, stress.
– Schizophrenia, conversion reactions.
|8. After operations||– General Anaesthesia (anesthetic medications affect digestive system motility).|
– Insertion of the endotracheal tube (during general anesthesia).
|9. Others.||– Myocardial infarction.|
– Inflammation of the membrane surrounding your heart (pericarditis).
– Access under the diaphragm (subphrenic abscess).
– Malaria, TB, Herpes Zoster, and Covid-19 (reference).