The distressing feeling of a lump in the throat,sometimes accompanied by choking sensations. When medical examination reveals that there is nothing wrong with the throat, as is usually the case, the condition is diagnosed as globus hystericus—that is, a hysterical, or conversion, reaction in which an acute conflict or threatening impulse is expressed as a physical symptom. There appear to be two general reasons why the throat is affected. It is not only a sensitive part of the body, but is associated with two basic drives: hunger and communication. Sometimes the difficulty can be traced to “distasteful” situations that seem to be symbolically or metaphorically related to the throat as an organ involved in eating: “I couldn’t swallow that kind of treatment.” In other cases it is more directly related to communication: “Whenever I try to answer him, my voice gets stuck in my throat.”A full discussion of current personal problems with a therapist will usually lead to increased self-understanding and more effective ways of coping with the situations that precipitated the symptom. In such cases the lump will almost always disappear. Sometimes, however, the globus is an expression of a more deep-seated neurotic pattern, and there may be other conversion symptoms as well. Such cases require more extended psychotherapy. See CONVERSION REACTION.