Understanding Chewing and Spitting in Eating Disorders

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Among the lesser-known and less-studied eating disorder behaviors is chew and spit (CHSP) behavior. This behavior consists of chewing a highly palatable and energy-dense food and spitting it out instead of swallowing it.

The intent of chewing and spitting is to enjoy food’s flavor without ingesting calories. CHSP is similar to bingeing because it involves larger than intended quantities of high-calorie foods. It also shares elements of restrictive eating because the food is not actually consumed.

While a 2018 large-scale study published in the International Journal of Eating Disorders showed that the prevalence of CHSP amassed 0.4% of adults (predominantly females), a 2019 study in the Eating Disorders: The Journal of Treatment & Prevention found that CHSP can occur in as many as 12% of adolescents.

Chewing and Spitting in the DSM-V-TR

Initially, spitting was believed to be an alternative to purging. Therefore, the behavior was primarily studied in individuals with bulimia nervosa. In the fourth version of the Diagnostic and Statistical Manual (DSM-IV), chewing and spitting was listed as a potential symptom of eating disorder not otherwise specified (EDNOS).

The diagnosis of EDNOS was replaced with the category of other specified feeding and eating disorder (OSFED) in the DSM-V. However, the DSM-V, nor the latest version of the DSM (DSM-V-TR) does not list CHSP under any single disorder because this behavior may occur across other eating disorder diagnoses.

Chewing and spitting can be seen in patients diagnosed with anorexia nervosa, bulimia nervosa, or other specified eating disorders.

Potential Causes of CHSP

Eating disorders can impact people from all different walks of life. Research shows that those with a family history of eating disorders are more likely to develop them, but genetics don't always play a role.

A preoccupation with body image and a desire for control are commonly associated with eating disorders, like CHSP. Other mental disorders like anxiety, obsessive-compulsive disorder, depression, or drug abuse may also accompany disordered eating habits, along with more severe symptoms—including suicidal ideation.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Medical Consequences of CHSP

While it might seem like a relatively benign habit when compared to other disordered behaviors like vomiting, the physical consequences of CHSP can be serious. Some of the health effects of CHSP include:

  • Dental problems: Cavities and gum disease result when teeth are exposed to frequent contact with sugary foods.
  • Stomach issues: The production of stomach acid is triggered by chewing but then no food is made available for digestion. This could potentially lead to ulcers or acid reflux.
  • Weight gain: This is a surprising side-effect of chewing and spitting behavior which researchers suspect relates to overeating later in the day.

Patients should see a medical doctor and a dentist to discuss potential treatment options for gastrointestinal, hormonal, and dental issues. Proper mental health support can help reduce further physical and emotional damage.

Diagnosis and Treatment

The shame and stigma associated with CHSP can be a barrier to seeking treatment. As with other eating disorders, psychotherapy and nutritional counseling can help. Diagnosing an eating disorder requires a health professional to assess the following factors:

  • Body image questions, including thoughts and perceptions about food and other possible eating disorder symptoms (like bingeing or misuse of laxatives)
  • Current eating habits, including the quantity and variety of foods eaten and meal patterns
  • Medical history, including any substance abuse, mental health issues, current medications, and weight changes
  • Other lifestyle factors, including exercise habits, menstrual cycle, and stress levels

Cognitive behavioral therapy (CBT) may be used to address eating disorders including chewing and spitting. Components may include acknowledgment of feelings of shame, challenging of dietary rules, management of emotional distress, and practice of increased flexibility.

The CBT strategies that are used to address chewing and spitting behaviors are similar to those used with other eating disorders. The strategies are focused on challenging a person's irrational thoughts involving fear of food, fear of weight gain, and body image concerns.

Advice for Family Members

If a loved one is displays signs of an eating disorder, it's helpful to understand which behaviors they are engaging in. You may notice certain symptoms such as:

  • Discolored or stained teeth
  • Excessive and rigid exercise behaviors
  • Fear of eating in public or with others
  • Preoccupation with weight and dieting
  • Unusual disappearance of food from the pantry
  • Wearing baggy clothes to hide appearance
  • Weight changes

Chewing and spitting may be a symptom of a larger eating disorder. Speak to your loved one about your concerns and encourage them to accept help from a qualified professional. Avoid providing criticism or judgment, and instead, focus on showing them how much you care about their well-being.

A Word From Verywell

CHSP may not seem like a big deal, but it's a sign of having a dysfunctional relationship with food. If you or someone you care about is chewing and spitting, it's best to seek treatment before the behavior continues to progress. There are ways to find peace with food and body image. Sometimes, we just need a little extra help and support to start moving in the right direction.

7 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Aouad P, Hay P, Soh N, Touyz S. Prevalence of chew and spit and its relation to other features of disordered eating in a community sampleInt J Eat Disord. 2018;51(8):968-972. doi:10.1002/eat.22873

  3. Aouad P, Hay P, Soh N, Touyz S, Mannan H, Mitchison D. Chew and spit (Chsp) in a large adolescent sample: prevalence, impact on health-related quality of life, and relation to other disordered eating featuresEating Disorders. 2021;29(5):509-522. doi:10.1080/10640266.2019.1695449

  4. Cleveland Clinic. Eating disorders.

  5. Bachmann S. Epidemiology of suicide and the psychiatric perspective. Int J Environ Res Public Health. 2018;15(7). doi:10.3390/ijerph15071425

  6. John Hopkins Medicine. What are the health effects of chewing and spitting out food?.

  7. National Eating Disorders Association. Other specified feeding or eating disorder.

By Lauren Muhlheim, PsyD, CEDS
 Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy.