Each person’s experience with coughing is unique. The habit cough1 is a debilitating disorder that is challenging to diagnose and treat in everyday clinical visits. It impairs your quality of life even though, as you will come to learn below, it does not have a physical cause. Habit coughs are usually seen in children and teenagers, but even adults can develop them. 

In this article, we will find out what the habit cough is, its symptoms and potential causes, and its diagnosis and treatment.

What Is Habit Cough?

A habit cough is a recurrent cough that happens without any underlying physical condition. Other names that have been used to refer to this potential cause of chronic cough in research include2

  • Psychogenic cough
  • Tic cough
  • Honking cough
  • Barking cough

However, in 2015, the American College of Chest Physicians (ACCP) recommended that the name Somatic Cough Syndrome and tic cough replace the terms psychogenic and habit cough respectively, so as to be aligned with the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) terminology.3

Causes of the Habit Cough

While there is no physical abnormality that causes this symptom, in some cases upper respiratory tract infections trigger the habit cough4, but once the infection resolves, the cough remains out of habit. Such a cough can persists for weeks, months, or even years, which can then be categorized as a chronic cough (lasting more than four weeks).

Psychosocial stressors have also been linked to habit coughing5. This occurs in such a way that the individual exhibits a conversion disorder. This is a psychiatric disorder in which one may use a physical symptom – such as cough – to divert attention and feelings away from disruptive stressors. These stressors, much like other medical symptoms like headaches and stomachaches, can make the habit cough worse. In adults, such stressors can include:

  • Marital issues 
  • Work stress
  • Death of a loved one

In children such stressors can include:

  • Academic challenges at school
  • Bullying
  • Parental strife
  • Parents’ divorce 
  • Generalized anxiety
  • The loss of a cherished family member or pet

Additionally, in some children researchers linked habit cough to psychiatric disorders such as tic disorders and Tourette syndrome.

Symptoms of a Habit Cough

The typical presentation of a habit cough is6:

  • Harsh sound
  • Loud honking7
  • Barking cough
  • Repetitive coughing (i.e occurs several times per minute for hours on end)
  • No sputum production
  • No history of breathlessness
  • No signs of weariness 
  • No alterations in voice quality or pitch

Other Valuable Clues for Identifying a Habit Cough:

  • Contrary to most underlying causes of cough, habit cough often gets better or goes away entirely with sleep (only occurs when one is awake8)
  • The symptoms of the habit cough escalate during stressful life situations9 and subside when the patient is focused on or distracted by other activities, such as exercise.
  • The affected person shows a stereotypic posture of the “chin-on-chest” posture, which is keeping the chin on the chest and holding the hand against the throat as if to support the larynx10.
  • In certain instances, a startling lack of distress or a relative lack of concern about the symptoms (also known as “la belle indifference”) toward the cough, despite its persistence and bothersome character11, may indicate an early diagnosis of the habit cough.
  • In some cases, psychological stressors tend to give the affected person an advantage; there is a possibility of a secondary gain. Such advantages include absenteeism (i.e., time off school or work). This is one of most prevalent gains in children at school since persistent, loud coughing can be very upsetting in a classroom and may cause absenteeism. This will begin a reward cycle if school or work is the site of the psychological stressors affecting the cough.

Diagnosis

Psychogenic cough is diagnosed by excluding other causes. 

Therefore, your doctor can identify habit cough by confirming the presence of the aforementioned symptoms and ruling out any underlying medical disorders that may be the culprit. This calls for an examination of the body and potentially doing various diagnostic tests such as:

  • Testing of lung function
  • A blood examination
  • A chest X-ray

Your physician can suggest that you seek additional evaluation and care from a pediatrician if the patient is a child.

Treatments

Habit cough typically does not respond to medication because there is no e.g., infection to treat. Consequently, it should come as no surprise that treatment with antibiotics and antitussives will be ineffective. 

For this reason, it is crucial to take habit cough into account when making a diagnosis of chronic cough, particularly in people who don’t respond to standard treatment for other, more prevalent causes of cough, such as asthma, GERD, and postnasal drip, among others.

Therapy and hypnosis treatment have been shown to be effective12. There are many suggestion/behavioral therapy techniques, in which patients are told repeatedly that they can control the cough, that have successfully reduced cough. 

Hypnosis in Treating Habit Cough

Hypnosis has also been proven to be a useful and safe method for treating habit cough13. Self-hypnosis is recommended as part of the primary treatment plan for children who have a habit cough14.

Hypnosis can help children ignore the urge to cough by teaching them how to relax, picture controlling their cough with a dial, or determine whether a stressful situation may be prolonging their cough and how to deal with it more effectively. Half of the time and for the majority of patients, hypnosis can cure habit cough with just one session15.

A brief example of how this hypnotic suggestion could be done is for a child telling them that their cough has been in charge of their lives and the lives of their caregivers and that it is now time to regain control. After that, ask the child to keep score: if they can control their coughing, they gain a point; if not, the cough receives the point.

These techniques can be applied in many different ways, but all require a bond and level of trust with the medical practitioner.

Final Thoughts

In a nutshell, understanding what a habit cough is and being reassured that nothing else is wrong are the first steps in managing a habit cough. Additionally, correctly diagnosing and treating habit cough can help avoid unnecessary interventions and complications from medical interventions, for instance, the adverse effects from corticosteroids.

While patients may not be concerned about their symptoms, the symptoms are bothersome to others, such as family members, health care professionals, and educational staff. For this reason, habit cough is a condition to look out for because it may disturb other family members’ sleep and can be disruptive for teachers and peers. Additionally, it can be a sign of hidden psychological distress in the cougher.

References

  1. Loo, M. (2009). Cough. Integrative Medicine for Children, 281–285. Elsevier. https://doi.org/10.1016/b978-141602299-2.10027-1
  2. Irwin, R. S., Glomb, W. B., & Chang, A. B. (2006). Habit cough, tic cough, and psychogenic cough in adult and pediatric populations: ACCP evidence-based clinical practice guidelines. Chest, 129(1 Suppl), 174S–179S. https://doi.org/10.1378/chest.129.1_suppl.174S
  3. Vertigan, A. E., Murad, M. H., Pringsheim, T., Feinstein, A., Chang, A. B., Newcombe, P. A., Rubin, B. K., McGarvey, L. P., Weir, K., Altman, K. W., Weinberger, M., Irwin, R. S., Adams, T. M., Altman, K. W., Barker, A. F., Birring, S. S., Blackhall, F., Bolser, D. C., Boulet, L. P., Braman, S. S., … CHEST Expert Cough Panel (2015). Somatic Cough Syndrome (Previously Referred to as Psychogenic Cough) and Tic Cough (Previously Referred to as Habit Cough) in Adults and Children: CHEST Guideline and Expert Panel Report. Chest, 148(1), 24–31. https://doi.org/10.1378/chest.15-0423
  4. Weinberg, E. G. (1980). ‘Honking’: Psychogenic cough tic in children. South African Medical Journal, 57(6), 198–200. https://pubmed.ncbi.nlm.nih.gov/7361211/
  5. Irwin, R. S., Glomb, W. B., & Chang, A. B. (2006). Habit cough, tic cough, and psychogenic cough in adult and pediatric populations: ACCP evidence-based clinical practice guidelines. Chest, 129(1 Suppl), 174S–179S. https://doi.org/10.1378/chest.129.1_suppl.174S
  6. Avramidou, V., Hatziagorou, P., Kirvassilis, F., Gidaris, D., & Tsanakas, J. (2011) Psychogenic cough: Clinical and laboratory characteristics. European Respiratory Journal, 38(S55), 1177. https://erj.ersjournals.com/content/38/Suppl_55/p1177
  7. Weinberg, E. G. (1980). ‘Honking’: Psychogenic cough tic in children. South African Medical Journal, 57(6), 198–200. https://pubmed.ncbi.nlm.nih.gov/7361211/
  8. Haydour, Q., et al. (2014). Management and Diagnosis of Psychogenic Cough, Habit Cough, and Tic Cough. Chest 146(2) 355–372. https://doi.org/10.1378/chest.14-0795
  9. Irwin, R. S., et al. (2006). Habit cough, tic cough, and psychogenic cough in adult and pediatric populations: ACCP evidence-based clinical practice guidelines. Chest, 129(1 Suppl), 174S–179S. https://doi.org/10.1378/chest.129.1_suppl.174S
  10. Irwin, R. S., Glomb, et al. (2006). Habit cough, tic cough, and psychogenic cough in adult and pediatric populations. Chest, 129(1 Suppl), 174S–179S. https://doi.org/10.1378/chest.129.1_suppl.174S
  11. Weinberger, M., & Abu-Hasan, M. (2007). Pseudo-asthma: When Cough, Wheezing, and Dyspnea Are Not Asthma. Pediatrics 120(4), 855–864. https://doi.org/10.1542/peds.2007-0078
  12. Irwin, R. S., Glomb, W. B., & Chang, A. B. (2006). Habit cough, tic cough, and psychogenic cough in adult and pediatric populations: ACCP evidence-based clinical practice guidelines. Chest, 129(1 Suppl), 174S–179S. https://doi.org/10.1378/chest.129.1_suppl.174S
  13. Anbar, R. D. (2002). Hypnosis in pediatrics: applications at a pediatric pulmonary center. BMC Pediatrics, 2(1). https://doi.org/10.1186/1471-2431-2-11
  14. Anbar, R. D., & Hall, H. R. (2004). Childhood habit cough treated with self-hypnosis. The Journal of Pediatrics, 144(2), 213–217. https://doi.org/10.1016/j.jpeds.2003.10.041
  15. Anbar, R. D. (2002). Hypnosis in pediatrics: applications at a pediatric pulmonary center. BMC Pediatrics, 2(1). https://doi.org/10.1186/1471-2431-2-11
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