Medically-unexplained behaviors and symptoms (MUBS) are challenging for patients, families, and clinicians alike. They demand consideration of more than biological determinants, warranting biopsychosocial assessment as well as psychodynamic formulation. Here we present a case of an 80-year-old woman with a history of multiple oropharyngeal traumas who presented to the emergency department for a recently developed acute anorexia associated with fear of choking (phagophobia). She presented with complex psychological dimensions, such as survivor guilt related to losing her spouse to gastroesophageal cancer. Through a psychodynamic and biopsychosocial lens, we discuss how her predisposing developmental history of trauma and fear responses
perpetuating gastrointestinal issues, unresolved grief, and survivor guilt
and more recent age-related neurocognitive changes inform her presentation and response to treatment. Future directions include broader application of biopsychosocial assessments and psychodynamic formulations to medically-unexplained symptoms and behaviors, with a special emphasis on education of trainees.