Background: Phagophobia, a rare fear of choking, leads to avoidance of swallowing and can result in severe malnutrition and weight loss. It is often triggered by traumatic events and requires differentiation from organic dysphagia and eating disorders. Case Report: We present a 35-year-old woman with severe weight loss and malnutrition due to a persistent fear of choking. After organic causes were excluded, she was diagnosed with specific phobia and treated with Fluoxetine (40 mg/day) and cognitive behavioral therapy (CBT). Gradual exposure and cognitive restructuring led to significant improvement in eating habits and anxiety within three weeks. Discussion: This case highlights the efficacy of combining CBT and pharmacotherapy in managing phagophobia and underscores the importance of distinguishing it from similar conditions for accurate diagnosis and treatment.