Understanding Chewing and Spitting in Eating Disorders

Table of ContentsView AllTable of ContentsClassificationCausesConsequencesDiagnosis and TreatmentAdvice for Family Members

Table of ContentsView All

View All

Table of Contents

Classification

Causes

Consequences

Diagnosis and Treatment

Advice for Family Members

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 InternationalJournal of Eating Disordersshowed that the prevalence of CHSP amassed 0.4% of adults (predominantly females),a 2019 study in theEating Disorders: The Journal of Treatment & Preventionfound that CHSP can occur in as many as 12% of adolescents.

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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 withbulimia nervosa. In the fourth version of theDiagnostic 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 ofother specified feeding and eating disorder (OSFED) in theDSM-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 withanorexia 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 theNational Suicide Prevention Lifelineat988for 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 ourNational Helpline Database.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for 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 ourNational 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:

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.

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:

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.

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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.

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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:

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.

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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 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Aouad P, Hay P, Soh N, Touyz S.Chew and spit (CHSP): a systematic review.J Eat Disord. 2016;4(1):23. doi:10.1186/s40337-016-0115-1Aouad P, Hay P, Soh N, Touyz S.Prevalence of chew and spit and its relation to other features of disordered eating in a community sample.Int J Eat Disord. 2018;51(8):968-972. doi:10.1002/eat.22873Aouad 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 features.Eating Disorders. 2021;29(5):509-522. doi:10.1080/10640266.2019.1695449Cleveland Clinic.Eating disorders.Bachmann S.Epidemiology of suicide and the psychiatric perspective.Int J Environ Res Public Health. 2018;15(7). doi:10.3390/ijerph15071425John Hopkins Medicine.What are the health effects of chewing and spitting out food?.National Eating Disorders Association.Other specified feeding or eating disorder.

7 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Aouad P, Hay P, Soh N, Touyz S.Chew and spit (CHSP): a systematic review.J Eat Disord. 2016;4(1):23. doi:10.1186/s40337-016-0115-1Aouad P, Hay P, Soh N, Touyz S.Prevalence of chew and spit and its relation to other features of disordered eating in a community sample.Int J Eat Disord. 2018;51(8):968-972. doi:10.1002/eat.22873Aouad 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 features.Eating Disorders. 2021;29(5):509-522. doi:10.1080/10640266.2019.1695449Cleveland Clinic.Eating disorders.Bachmann S.Epidemiology of suicide and the psychiatric perspective.Int J Environ Res Public Health. 2018;15(7). doi:10.3390/ijerph15071425John Hopkins Medicine.What are the health effects of chewing and spitting out food?.National Eating Disorders Association.Other specified feeding or eating disorder.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Aouad P, Hay P, Soh N, Touyz S.Chew and spit (CHSP): a systematic review.J Eat Disord. 2016;4(1):23. doi:10.1186/s40337-016-0115-1Aouad P, Hay P, Soh N, Touyz S.Prevalence of chew and spit and its relation to other features of disordered eating in a community sample.Int J Eat Disord. 2018;51(8):968-972. doi:10.1002/eat.22873Aouad 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 features.Eating Disorders. 2021;29(5):509-522. doi:10.1080/10640266.2019.1695449Cleveland Clinic.Eating disorders.Bachmann S.Epidemiology of suicide and the psychiatric perspective.Int J Environ Res Public Health. 2018;15(7). doi:10.3390/ijerph15071425John Hopkins Medicine.What are the health effects of chewing and spitting out food?.National Eating Disorders Association.Other specified feeding or eating disorder.

Aouad P, Hay P, Soh N, Touyz S.Chew and spit (CHSP): a systematic review.J Eat Disord. 2016;4(1):23. doi:10.1186/s40337-016-0115-1

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 sample.Int J Eat Disord. 2018;51(8):968-972. doi:10.1002/eat.22873

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 features.Eating Disorders. 2021;29(5):509-522. doi:10.1080/10640266.2019.1695449

Cleveland Clinic.Eating disorders.

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

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

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

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