Written by Toni Rudd, RD & reviewed by Talia Cecchele RD
What is Chewing & Spitting Disorder?
Eating is a fundamental part of our daily lives, but for some individuals, eating can be more challenging.
Chewing and spitting (CHSP), is a disordered eating behaviour where individuals chew and then spit out their food. This behaviour can indicate more profound issues with food and the body. Often linked with eating disorders such as anorexia nervosa, bulimia nervosa, binge eating disorder and OFSED (Other Specified Feeding or Eating Disorders).
What is Chewing and Spitting?
CHSP is a behaviour that involves chewing food without swallowing it and then spitting it out. Often the foods chewed are high-calorie, enjoyable foods with the intent of getting pleasure from the taste without ingesting the energy due to concerns regarding weight [1].
CHSP can show up in a variety of ways, some people might CHSP every bite, some may CHSP sporadically which can be linked with stress and emotional reasons and some people may chew their food a specific number of times before spitting it out in a ritualised manner.
One study found that 25% of people with a diagnosed eating disorder engaged in CHSP as a compensatory behaviour [2].
Is Chewing and Spitting an Eating Disorder or Disordered Eating?
CHSP is a behaviour linked to having a disordered relationship with food. However, if CHSP is severe and persistent and the behaviours are having an overall impact on physical and mental health, an assessing practitioner might consider a diagnosis under the ‘Other Specified Feeding and Eating Disorders’ (OFSED) group, especially if other eating disorder behaviours are present and impacting health.
You can read more about OFSED in our blog here.
Causes of Chewing and Spitting
Understanding the root causes of why someone engages in CHSP behaviours can be complex. The behaviour can be linked to several mental health conditions such as anxiety, obsessive-compulsive disorder, substance use and depression.
Low self-esteem and poor body image can also play a role in maintaining this behaviour but more research is needed to understand this behaviour in more detail.
Other individuals may also engage in CHSP such as those adhering to strict dietary guidelines such as undergoing bariatric surgery or athletes. They might use CHSP as a way to ‘taste’ food while following their prescribed and often strict meal plans or eating requirements [1].
Signs and Symptoms of Chewing and Spitting
If you are worried about someone and their eating habits, here are some signs that might indicate that someone is engaging in chewing and spitting behaviours:
Has strict food rules or restrictions
Avoids eating in front of other people or at social events
Lying about what they have eaten or where
Eats and chews, then uses a serviette or napkin often
Gastrointestinal problems such as acid reflux
Dental issues or complaint of a sore jaw
You can read more about common signs of disordered eating in our blog here.
Impact of Chewing and Spitting
Digestive Upset
Chewing is the start of the digestion process. Even if you spit the food out, your salvia has already started to break down the food you are chewing. When you are chewing the stomach reacts by releasing stomach acid to break down the food it is expecting. So spitting food out may cause digestive problems such as stomach ulcers or acid reflux.
Malnutrition
While some calories in the food you chew will be absorbed by the body. Spitting food out can prevent the body from absorbing important and much-needed nutrients to have optimal health, which can lead to nutritional deficiencies.
Impact on Weight
While weight loss can occur when CHSP, it is often linked with weight gain. This can be due to ingesting more calories than needed and/or overeating or even binge eating due to over-restriction of food/calories.
Dental and Mouth Problems
The food used for chewing and spitting are generally high-energy foods such as cakes, desserts, and chocolate. Frequent exposure to these foods can cause damage to the teeth, increasing the risk of tooth decay, cavities and gum disease. Then the repeated chewing motion can cause a painful and swollen jaw.
Impact on Hormones
As discussed, chewing food starts the digestive process and the body reacts to the chewing as a signal that food is incoming. This can cause insulin to be released, potentially leading to blood sugar imbalances. Additionally, the stress associated with CHSP can elevate cortisol levels.
Emotional and Psychological Impact
The emotional and psychological toll of CHSP is deep. Individuals who engage in CHSP often experience:
Guilt and Shame: They may feel guilty about their inability to control their eating habits and may experience intense shame related to their perceived failure.
Anxiety and Depression: The act of "chewing and spitting" can contribute to high levels of anxiety and may lead to or exacerbate symptoms of depression.
Isolation and Secrecy: Many individuals who engage in this behaviour do so in secret, isolating themselves from loved ones, and saying no to social events that revolve around food.
Treatment and Support for CHSP
As there is no official diagnosis of CHSP, treatment support can be difficult to obtain. Seeking help is crucial as early as possible and here are some treatment approaches that may help:
Therapy: Cognitive-behavioural therapy (CBT) and dialectical behaviour therapy (DBT) can help individuals address emotional triggers and develop healthier coping mechanisms.
Nutritional Counselling: Working with an eating disorder dietitian can guide you in establishing balanced eating patterns, challenging thoughts about food and addressing nutritional deficiencies.
Medical Support: In some cases, seeing your GP may be necessary to address physical health issues linked with CHSP.
Raising Awareness
It's essential to raise awareness about disordered eating behaviours like CHSP. By openly discussing these issues, we can reduce stigma and encourage those who need help to seek it without judgement.
CHSP is a disordered eating behaviour and if it gets severe, could lead to meeting criteria for an eating disorder under OFSED diagnosis with other behaviours present. Therefore, it should not not be ignored as it can have an impact on physical and mental health but also it is a sign of deeper emotional and psychological struggles, often associated with eating disorders.
Need support with CHSP or disordered eating?
If you or someone you know is dealing with this behaviour, please know that help and support are available. Recovery is possible, and you are deserving of a healthy and fulfilling relationship with food. We offer 1:1 support at the TCN clinic to help you overcome food rules, find food freedom and kickstart your recovery. You can find out more about how we can support you here.
Toni Rudd
TCN Specialist Dietitian
Toni is passionate about supporting people to achieve a truly healthy relationship with food and body acceptance, by healing their relationship with food and body by establishing sustainable, health-promoting behaviours for life. Toni works for the TCN Clinic alongside her work as @thebingedietitian
Talia Cecchele Nutrition is a team of registered dietitians that specialise in eating disorder recovery, disordered eating, digestive issues and sports nutrition. We aim to bring balance back to nutrition, help you to break free from food rules and find food freedom. We offer virtual consultations and group programs so whether you are based in London, the United Kingdom or around the world we would love to support you. To enquire about a private consultation please fill out a contact form.
REFERENCES:
Aouad, P., Hay, P., Soh, N. and Touyz, S. (2016). Chew and Spit (CHSP): a systematic review. Journal of Eating Disorders, 4(1). doi:https://doi.org/10.1186/s40337-016-0115-1.
Youn Joo Song, Lee, J.-H. and Jung, Y. (2015). Chewing and spitting out food as a compensatory behaviour in patients with eating disorders. Comprehensive Psychiatry, 62, pp.147–151. doi:https://doi.org/10.1016/j.comppsych.2015.07.010.
Aouad, P., Morad, A., Hay, P., Soh, N., Touyz, S. and Rhodes, P. (2020). Chew and Spit (CHSP): An interpretative phenomenological analysis (IPA). Eating Behaviors, 37, p.101388. doi:https://doi.org/10.1016/j.eatbeh.2020.101388.
DSM-V, 2013. Feeding and Eating Disorders. [online] DSM Library. Available at: <https://doi.org/10.1176/appi.books.9780890425596.dsm10> [Accessed 14 August 2023]