Raising Awareness Around Chewing and Spitting

The eating disorder part of you wants the taste of food but not the calories.

You want some pleasure but don’t want to binge.

You are so overwhelmed with emotions and struggling to cope and the food is there for you.

Chewing and spitting (CHSP) is a behavior that for some with disordered eating, can be a way to cope with these thoughts and urges. I see it often in practice. While restricting may be socially sanctioned, behaviors like chewing and spitting are stigmatized.

CHSP is chewing food and then spitting it out. People do this behavior for many reasons, to get taste, an increase in dopamine, to experience relief from emotions, to manage restriction with some pleasure from food and more.

There are strategies that can help reduce and eliminate this behavior. (See tips below!)

It’s time to bring chewing and spitting out of the dark and remind ourselves that we are humans who use many ways to cope.

It is also important to help those close to us, who may notice it and be concerned, support us. (See tips for caregivers below!)

CHSP was listed as a symptom of Eating Disorders Not Otherwise Specified in the Diagnostic and Statistical Manual of Mental Disorders, until it was removed in 2013.

Lack of general awareness and screening has led to misconceptions of its prevalence, which is thought to be the reason for its removal. However, this has, unfortunately, caused the behavior to go further unacknowledged and unaddressed in the treatment of eating disorders.

Despite its removal from such diagnostic manuals, case studies suggest that CHSP behaviors are still prevalent among adults and adolescents. More research is needed to gain a better understanding of the prevalence and mechanisms of CHSP to better address its impact on psychological well-being. There are literally two studies on CHSP!

It is also extremely important that eating disorder practitioners continue to talk about CHSP to gain a better collective understanding and bring it back into focus.

People struggling with CHSP typically experience a large amount of shame and/or guilt with this behavior, which is only further perpetuated by its elusiveness. Similar to purging, it is often done in secret and feels quite dysregulating. This can make it even more difficult to detect and address.

It is likely that CHSP behaviors involve similar brain processing and reward mechanisms to restrictive behaviors typically exhibited in Anorexia Nervosa.

So, why is one widely discussed while the other is falling to the back burner? Let's talk about it.

If you are using this behavior, you are not doing anything wrong. You are coping with things the best you can, and trying to stay safe.

Behaviors that can lead to or leave us vulnerable to chewing and spitting include:

• Restricting food

• Rigidity in other areas of life

• Isolation

• History of using other compensatory behaviors like compulsive exercise, purging, etc

• Challenges with feeling feelings or tolerating feelings and distress

• Body dissatisfaction and focus on weight, weight affecting mood negatively

• A drive for the brain to experience increased serotonin and dopamine from the act of chewing, which can provide relief and release.

There are physical and mental health consequences of chewing and spitting, which include:

• Emotional distress like shame and guilt

• Damage to the teeth like cavities or gum disease

• Stomach ulcers and/or reflux from increased acid in stomach when chewing is initiated

• Increase in other eating disorder behaviors to manage the distress around chewing/spitting

  
  

What to do if you suspect someone close to you is chewing and spitting

If you think that someone could be struggling with CHSP, it can be a very difficult topic to approach, especially with the limited resources available. Approaching the situation from a place of empathy and interest in understanding by offering a warm, non-judgmental ear is a great place to start.

I implore my peers in the eating disorder space to talk about CHSP. Share your experiences, ask colleagues about theirs, and look into the literature.

If you are not an eating disorder expert, giving assurance, first and foremost, that there is nothing shameful about the behavior and offering to help find the necessary support is the best thing you can do for someone close to you.

What to do if you are struggling with chewing and spitting

Some things that can help you reduce chewing and spitting include:

• Eating with others

• Eating regular and adequate meals and snacks

• Working on feeling feelings and processing through them

• Using other ways of coping like journaling, using an ice pack or the 5 Senses activity when you’re in distress, talking to a friend, mindfulness, gentle movement, and more

• Exposure to any fear foods in planned, intentional ways

• Creating flexibility in other areas of life, potentially with the help of a therapist

• Talking to your team about any psychiatric medication options

More research will help provide more links and associations with other eating disorder behaviors. This can also help lead to more possible treatments.

As always, I highly recommend working with a trained eating disorder expert to get help around chewing and spitting.