Uncontrolled and repeated belching can feel like you are having something akin to a burping panic attack — and, technically, you could be. One common cause of chronic and/or constant burping is anxiety. Psychogenic belching, which has a mental as opposed to physical origin, may be the the cause.
According to the UCLA Robert G. Kardashian Center for Esophageal Health (UCLA), the completely normal act of occasional burping occurs when trapped air gets pushed out of your upper GI tract after you swallow air or drink carbonated drinks.
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But what if many burps happen?
Supragastric Belching and Anxiety
When repetitive burping arises, it's almost always a sign of supragastric belching, UCLA says. And supragastric belching has been linked to anxiety disorders, as well as mental health conditions like OCD and anorexia nervosa.
Typically, this condition involves a lot of burping. A January 2020 review in Neurogastroenterology and GI Motility pegged the average number of supragastric burps per day at more than 100 (as opposed to the more typical up to 30 times per day). And while UCLA points out that the burping tends to stop whenever patients talk or become distracted, it often worsens as stress levels increase.
Burping and Anxiety: A Vicious Cycle
Repetitive burping can itself drive up social anxiety, refueling already high stress levels, says Silver Spring, Maryland-based Lynn Bufka, PhD, senior director of Practice Transformation and Quality at the American Psychological Association.
"So the distress about excessive burping itself — which often begins with anxiety — then amplifies that very same anxiety, in which case, it can cycle upward, and the burping may continue," Bufka says.
It's a good example of the intimate connection between mind and body, says California-based Pamela Rutledge, PhD, MBA, director of the Media Psychology Research Center in Newport Beach and a faculty member in the Media Psychology Program at Fielding Graduate University in Santa Barbara.
"Anxiety produces both a psychological and a physiological response," Rutledge says. "They feed on each other. We know that anxiety and hyperventilation, for example, can go together. And hyperventilation can result in your swallowing more air than usual."
That can trigger aerophagia, she says, which is defined by the University of Michigan as occurring when you swallow large amounts of air. This kind of behavior can cause burping to happen.
"Then to counteract that, and keep you healthy, your body's parasympathetic nervous system — which automatically controls things like your breathing — may kick in," Rutledge says. "And so repeated burping could be seen as your body's way of resetting after its first response to anxiety."
Supragastric Belching Treatment
Per UCLA, supragastric belching is a learned response, and there are no large controlled trials examining the behavior and treatments.
While doctors tend to get pushback from patients on the notion of this condition as a learned behavior, UCLA adds, some evidence supports speech pathology and behavioral therapy to retrain patients and help them treat the issue.
In the Neurogastroenterology and GI Motility review, psychoeducation was found to be the most effective treatment:
- Ten sessions of speech therapy (which employs education and awareness of swallowing and breathing techniques) were found to be effective in 83 percent of patients, and can be practiced by individuals on a daily basis.
- Five sessions of cognitive behavioral therapy (CBT) (which focuses more on noticing the physical warning signs of tightening and swallowing changes early and employing awareness techniques) was found to be effective in 50 percent of patients.
These approaches improved quality of life for many patients in the studies, but because they were small studies (around 50 patients), more research is necessary.
Limited findings support the use of baclofen (a medication typically used for muscle spasms) to help with supragastric belching, and the authors of Neurogastroenterology and GI Motility suggest it could be tried if other treatments fail.
When to See Your Doctor
Mayo Clinic notes that many people who have anxiety may be more sensitive to GI gas but notes that, in most cases, excessive belching will dissipate on its own.
Mayo Clinic cautions that you should seek medical care to screen for potentially serious underlying digestive issues if your chronic belching is accompanied by:
- Ongoing or severe abdominal pain
- Bloody stools
- Changes in poop color or frequency
- Unintended weight loss
- Chest discomfort
- Appetite loss or
feeling full quickly
- Pamela Rutledge, PhD, MBA, director, Media Psychology Research Center, Newport Beach, California, and faculty, Media Psychology Program, Fielding Graduate University, Santa Barbara, California
- Lynn Bufka, PhD, clinical psychologist; senior director, Practice Transformation and Quality, American Psychological Association, Silver Spring, Maryland
- Mayo Clinic: “Functional Dyspepsia: Symptoms & Causes”
- UCLA Health: UCLA Robert G. Kardashian Center for Esophageal Health: “Belching Disorders”
- University of Michigan: Michigan Medicine: “Swallowed Air”
- Mayo Clinic: “Belching, Gas and Bloating: Tips for Reducing Them”
- Neurogastroenterology and GI Motility: “Chronic Burping and Belching”
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.