It’s Time To Talk About Chewing And Spitting Disorder

Photographed by Danny Kim
It’s exactly what it sounds like. 'Chewing and spitting' – occasionally known as 'c/s' to sufferers and 'CHSP' to psychologists – is a disordered eating behaviour where individuals chew up and then spit out their food in an effort to lose weight. But it’s so much more than that. It’s hundreds of pounds spent on snacks to binge chew. It’s the crippling guilt of wasted food. It’s swollen jaws, rotten teeth, and stomach ulcers. It’s as real and as serious as bulimia purges, abusing laxatives, or anorexia nervosa. But unlike these more common disordered behaviours, it is rarely talked about. “A possible reason for this is that the behaviour is not socially acceptable,” Dr Kathryn Kinmond, a Senior Lecturer from the Health, Rehabilitation and Psychology centre at Manchester Metropolitan University, tells me over email. CHSP is not referenced anywhere near as often as anorexia or bulimia in films and TV shows; there are no celebrities associated with it; and it often doesn’t result in pictures shocking enough for the pulpy pages of women's weeklies. Most importantly, it’s harder for professionals to study because, as Dr Kinmond notes: “It is largely a hidden disorder, in that people are not hospitalised for chewing and spitting.” In 1988, psychiatrists at Minnesota Medical School first examined chewing and spitting as a clinical feature of bulimia. Since then, a variety of studies have discovered that people living with anorexia, especially those with the most severe cases of the disease, also engage in the behaviour. But even though 24.5% (according to NCBI) of eating disorder sufferers have been found to chew and spit, it was called a “neglected symptom” in the International Journal of Eating Disorders as recently as 2006. The UK’s leading eating disorder charity Beat told me, “it doesn’t really come into our remit at the moment”, because it is a symptom, not a disorder in its own right.
Up until 2013, chewing and spitting was featured as a symptom of an ‘Eating Disorder Not Otherwise Specified’ (EDNOS) in the Diagnostic and Statistical Manual of Mental Disorders. One example of EDNOS behaviour in the DSM-IV was “repeatedly chewing and spitting out, but not swallowing, large amounts of food.” However, EDNOS was replaced by ‘Other Specified Feeding or Eating Disorder’ (OSFED) in the DSM-V, and there is now no mention of CHSP at all. Like Beat, health professionals continue to consider CHSP a mere symptom, despite the fact online comments show that some people only chew and spit, and do not appear to also have anorexia or bulimia.

One day I just thought, ‘What if I just don’t swallow my food?'

In fact, if it wasn’t for the internet, the scale of the problem would be incomprehensible. Apart from a three-paragraphed Glamour article from 2008 which erroneously calls it a “new” disorder, the behaviour has not been covered much in the mainstream media. A quick Google search of “chewing and spitting” produces half a million results, largely blogs and forums from the many sufferers desperate to feel less alone. These stories shed light on the reality of a problem that doctors, and the media, have neglected. “I was bulimic for five or six years,” Hannah*, who had previously posted about her chewing and spitting problem on Reddit, told me. “One day I just thought, ‘What if I just don’t swallow my food?’ The guilt after the act was still there, I was being so wasteful but I couldn’t really stop doing it. In a vain attempt to make myself feel less wasteful, sometimes I’d collect it and put it outside for the birds. Gross, I know.”
Hannah is one of three women who agreed to speak to me about their chewing and spitting when I reached out to them after finding their posts on forums. All three are young (aged between 18 and 24), suffer from body image issues, and wished to remain anonymous. This desire for anonymity sheds light on one of the most pervasive and crippling aspects of CHSP: the shame. “When I first had a problem, I was so ashamed that I didn't tell anyone,” a 21-year-old intern at a financial institute – who wishes to be identified as ‘L’ – told me. Like the online commenters mentioned above, L only sufferers from CHSP, and does not have an additional eating disorder. “It's not something easily recognisable or serious like anorexia or bulimia. To me, it was just a weird and gross habit that I would have to explain to whoever I told,” she says.

I can’t recall the last day where I didn’t chew and spit at all. I will constantly walk away from what I’m doing to do this. Some days it could take up hours of my time.

Despite the accompanying feelings of shame, each sufferer I speak to confesses the same thing: they find chewing and spitting highly addictive. “I would absolutely, 100% consider it an addiction,” says Frances*, a full-time student in the U.S., who has been chewing and spitting for two years. “I can’t recall the last day where I didn’t chew and spit at all. I will constantly walk away from what I’m doing to do this. Some days it could take up hours of my time.” “There is potential in any behaviour for addiction,” says Dr Kinmond, going on to note that CHSP could be considered a form of self-harm. But scientifically, there is an additional argument for CHSP being addictive. Writing on her personal blog, molecular neuroscientist and science writer Shelly Fan explains one study that found chewing and spitting causes an increase in ghrelin, a hormone that promotes hunger. “It is conceivable that chew and spit may increase hunger levels in AN [anorexia nervosa] patients," she writes, "leading to feelings of a lack of control over eating." She then adds that "this may counteract the patients’ rigid control over food intake and promote more chewing and spitting (or binge eating), resulting in a downward spiral."
Photo: Eric Helgas
Similarly, CHSP can also become a compulsion for an individual suffering from OCD. Dr Kimberley Quinlan, a licensed California-based therapist who specialises in co-existing eating and anxiety disorders, notes how to tell to the difference. “The content of the obsessions is the most clinically correct way to differentiate between the two,” she told me over email. “If someone is compulsively chewing and spitting to control or reduce a fear related to body weight or body image, it is almost always an eating disorder.” She goes on to say that for those with OCD, chewing and spitting is unrelated to body size, but is instead done for a variety of reasons such as an attempt to neutralise intrusive thoughts or a fear of food making them unwell. “The behaviours might look very similar, but the fear behind them is very different,” she says. Addiction and compulsion aren’t the only harmful side effects of CHSP. Most of the women I talked to “figured out” chewing and spitting on their own (one got the idea from the MTV comedy show Girl Code and another from an episode of Sex and the City) because they erroneously assumed that it would allow them to taste and enjoy food without any 'negative' consequences – calorific or otherwise. Distressingly for sufferers, however, chewing and spitting often causes more weight gain than they originally thought. This is because saliva contains enzymes that start the digestion process, meaning many more calories are absorbed than you’d first assume. Additionally, because sufferers tend to chew and spit large amounts of food in a session (like a bulimic’s binge), they often swallow more than they imagine. Hannah admits she tried to avoid this by chewing with her head facing down, often over a bin in the kitchen. She also says that CHSP sessions made her vision “go white” and her body feel weak and lightheaded. Other side effects reported by those I talked to include stomach and mouth ulcers, swelling of the jaw from the repeated chewing motion, and a build up of gas.

I get extremely anxious when I go out with other people because I know I can’t get away with this behaviour

Hannah, Frances, and L noticed negative social and psychological consequences too. Each admits to spending too much time and money on the habit. “I spend up to $10 (£7) a day on it,” says Frances. “I get extremely anxious when I go out with other people because I know I can’t get away with this behaviour. I used to be very outgoing and always wanted to go out, and now I am much more withdrawn, and would rather be alone so that I can chew and spit at times.” L says that the compulsion to CHSP distracts her both at work and during the middle of assignments, while Hannah admitted it puts her “in a suicidal state” because of the feelings of guilt tied up with it. Ultimately, we need to assess our acknowledgement of CHSP as a disorder if people are to be able to seek treatment for it, says Dr Kinmond. “If CHSP is not included in the DSM then this may make it easier for some people to come forward, as they will not feel they are psychiatrically ill or being labelled. However, in order to receive the relevant treatment, it may be helpful to have a recognised label. Arguably, there may be people engaging in this behaviour who either do not see it as a problem, or do see it as a problem but do not know where to go for help.”

*Names have been changed as interviewees wished to stay anonymous

If you would like to talk to somebody about CHSP, please contact your GP or a medical professional.

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