Psychopharmacologic and Behavioral Interventions in Inducible Laryngeal Obstruction: A Psychosomatic Interface Between Psychiatry and Pulmonary Medicine
Year: 2026
Type: article
Abstract: Background: Inducible laryngeal obstruction (ILO), historically referred to as paradoxical vocal fold motion (PVFM) or vocal cord dysfunction (VCD), is a functional upper airway disorder characterized by inappropriate adduction of the vocal folds during inspiration. ILO frequently mimics asthma and represents an important psychosomatic interface between psychiatry and pulmonary medicine. Psychiatric comorbidity is common and may contribute to symptom amplification, autonomic dysregulation, and impaired quality of life. Methods: This narrative review synthesizes case series, retrospective analyses, cohort studies, clinical guidelines, and conceptual literature published primarily between 2000 and 2025 addressing the epidemiology, pathophysiology, diagnosis, psychiatric comorbidity, psychopharmacologic management, and behavioral treatment of ILO. Results: ILO demonstrates substantial psychiatric comorbidity, particularly anxiety disorders, panic symptoms, depression, and posttraumatic stress disorder (PTSD). Speech-language pathology (SLP)-based respiratory retraining remains the cornerstone of treatment and is associated with significant symptom improvement in many patients. Behavioral interventions, including cognitive behavioral therapy (CBT), mindfulness-based interventions, and trauma-focused psychotherapy, may provide additional benefit in selected individuals. Psychopharmacologic interventions, particularly low-dose tricyclic antidepressants such as amitriptyline and selective serotonin reuptake inhibitors (SSRIs), may be useful adjuncts when psychiatric comorbidity or laryngeal sensory hypersensitivity is present, although high-quality randomized controlled evidence remains limited. Conclusions: ILO exemplifies the complex interaction between physiologic airway dysfunction and psychological processes. Effective treatment requires integrated multidisciplinary care involving pulmonology, otolaryngology, speech-language pathology, and psychiatry. Psychiatrists play an important role in identifying psychiatric comorbidity, reducing maladaptive illness behaviors, and implementing individualized psychopharmacologic and behavioral interventions. Further controlled studies are needed to clarify optimal integrated treatment strategies.
Source: Psychopharmacology Bulletin
DOI: 10.64719/pb.21600
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225175648