Chew and spit disorder (CHSP)

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What is chew and spit disorder?

Chew and Spit Disorder (CHSP) is a pattern of disordered eating that occurs when someone chews food but instead of swallowing, spits the food out. The drive to spit out the food is an attempt to get pleasure from eating without ingesting any calories. This behavior falls on the spectrum of disordered eating behaviors.

CHSP is not an official eating disorder, nor is it recognized in the DSM-5 as an established eating disorder, CHSP is considered an Eating Disorder Not Otherwise Specified (EDNOS). This category of eating disorder is for disorders that don’t really fit in any other categories. However it is one of the manifestations and behaviors of disordered eating that has been seen in clinical practice. 

CHSP isn’t well studied and in 2016, there were only nine studies done on the topic. In one study of 11 to 19-year-olds by a leading researcher on this topic over twelve percent of those studied reported chewing and spitting out food at least once a week. (4) This study surveyed 5,111 students from thirteen different schools in New South Wales.

CHSP is frequently found in hospitalized patients with eating disorders. (2)

Signs and symptoms of CHSP disorder

Australian researchers reported signs of CHSP disorder in their 2016 report on the illness in the Journal of Eating Disorders, which include: (1)

  • Concerns about body shape
  • Moodiness, depression
  • Food cravings and desire to consume foods
  • Anxiety 
  • Considering ideas of suicide
  • Exhibits signs of other eating disorders, such as purging
  • Eats a restricted diet
  • Eat quantities of food that would be defined as a binge (1000+ calories)
  • Evidence of laxative abuse, diet pills, or over-exercise
  • Evidence of chewed foods in the garbage
  • Observance of chewing and spitting up foods
  • Digestive disorders
  • Heartburn
  • May have a diagnosis of bulimia nervosa or anorexia nervosa
  • Loss of control felt over eating at some point in their lifetime
  • Wants to taste foods and chew them but not consume them
  • Equates some foods to a ‘bad’ category
  • Chews and spits up food frequently

Diagnosis of CHSP disorder

CHSP disorder is mostly diagnosed in any individual that is chewing and spitting out food with the intention of avoiding weight gain/calorie intake. There are no laboratory tests available to confirm such a diagnosis. It is what is called a “clinical diagnosis” meaning it is based just on what the patient admits alongside what the physician observes.

Treatment of CHSP disorder

The best treatment of CHSP disorder hasn’t been reported in the medical literature yet but since those with CHSP often have other eating disorders, they are being treated for those other eating disorders. Thus, they may be receiving cognitive behavioral therapy, weight regain therapies, medications, or other therapies that address the bigger picture of eating disorders in the person. A comprehensive approach is ideal, addressing the root causes of why an individual is engaging in disordered eating behaviors. Reach out to our team at Within Health to begin treatment for an eating disorder, or CHSP disorder.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Aouad P, Hay P, Soh N, Touyz S. Chew and spit (CHSP): a systematic review. J Eat Disord. 2016;4(1):23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994215/
  2. Makhzoumi S, Guarda A, Schreyer C, Reinblatt SP, Redgrave GW, Coughlin JW. Chewing and spitting: a marker of psychopathology and behavioral severity in inpatients with an eating disorder. Eat Behav. 2015 Apr;17:59-61. https://pubmed.ncbi.nlm.nih.gov/25580013/ 
  3. What’s the difference between signs and symptoms? Algester Family Practice. https://www.brisbanebulkbillingdoctor.com.au/news/whats-the-difference-between-signs-and-symptoms/
  4. Aubusson, K. Chew and spit: high rate of eating disorder warning sign among school kids. The Sydney Morning Herald. Dec. 1, 2019. https://www.smh.com.au/national/chew-and-spit-high-rate-of-eating-disorder-warning-sign-among-school-kids-20191127-p53em1.html

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