Habit cough is a functional disorder because its persistence is not the result of physical symptoms. Because many physicians do not consider psychological triggers of physical symptoms early in the diagnostic process, patients presenting with habit cough are often first diagnosed as dealing with upper respiratory infections, asthma, allergies leading to post-nasal drip, gastroesophageal reflux, or pneumonia.

Cough that is caused by habit typically starts because of an infection—but once the infection resolves, the cough remains out of habit. Such a cough can last for months or even years. The cough can occur as frequently as every couple of seconds, but sometimes as infrequently as a few times an hour. Other names of habit cough include psychogenic cough, cough tic, and somatic cough syndrome (Anbar & Hall, 2004).

Diagnosis of Habit Cough

Clues that a cough might be caused by a habit include that it almost always stops when a patient falls asleep, and often improves when a patient is distracted, such as by a video game. Habit cough often is loud, disruptive, and sometimes even honking. It is considered a “dry” cough because affected patients do not cough up lung secretions.

In children, habit cough often is associated with missed school and stomachaches. Habit cough generally is unrecognized as a cause of chronic cough in adults, and therefore is rarely considered as a possible diagnosis by health care providers for adults. However, there are recent anecdotal reports that long-term cough in adults can resolve with therapy for habit cough (Weinberger & Hurvitz, 2020). Further, based on my experience as a pulmonologist, I suspect that habit cough is a common issue for adults with chronic dry cough that does not improve with medications.

Like other medical symptoms such as headaches and stomachaches, habit cough sometimes is worsened by psychological stressors in children such as academic difficulties at school, bullying, or distress within the family such as related to divorce of the parents or the death of a beloved family member or pet. In adults, habit cough can occur in association with marital problems, job-related stress, or the loss of a loved one.

Medications do not help improve habit cough because there is no physical cause that is triggering its perpetuation. However, since many doctors are slow to recognize habit cough, patients often are treated with medications for asthma, allergies, acid reflux, and/or tic disorders with no improvement before a diagnosis is made.

Treatment of Habit Cough with Hypnosis

Treatments that work for habit cough include wrapping a bed sheet around the abdomen and tightening it each time that the patient feels that he or she might need to cough, suggestion therapy, in which patients are told repeatedly that they can control the cough, and hypnosis.

Children who have developed a habit cough often describe a tickle in their throat that they cannot control and that causes them to cough. I explain to them that when they cough they further irritate their throat, which is how a cycle of coughing can continue. The key to learning how to control the cough is to be able to ignore the tickle.

Hypnosis can help with ignoring the need to cough by teaching patients how to calm themselves, imagine turning down a dial that controls the cough, or figuring out whether a stressful issue might be contributing to the cough prolongation and how to better deal with the issue. With hypnosis, habit cough in children has been shown to resolve within a single session half of the time, and within a month for most patients (Anbar & Hall, 2004).

Cough that results from illnesses that cause spitting out of lung secretions (such as asthma or pneumonia) should not be treated with hypnosis with the purpose of reducing the cough because such coughing helps clear the body of secretions that otherwise could prove damaging to the lungs.

Takeaway

As hypnosis has been shown to be effective in the treatment of habit cough and has no side effects, this therapy should be considered early in the therapeutic plan for any individual with chronic dry cough that does not improve with medications.

Copyright Ran D. Anbar