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Learn more about the results we get at Within

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Chew and spit disorder (CHSP)

While some people with eating disorders strictly limit their food intake, and others struggle with overeating, some attempt to get the most out of their meals without committing to the consequences.

People who struggle with chew and spit (CHSP) disorder often aim for this middle road, but the behaviors they rely on to get there can be dangerous.

Last updated on 
March 22, 2023
January 18, 2024
Chew and spit disorder
In this article

What is chew and spit disorder?

Chewing and spitting behavior is a pattern of disordered eating that occurs when someone chews food but spits it out instead of swallowing it. The behavior is typically considered an attempt to get pleasure from eating without ingesting calories.

CHSP has not been officially pathologized nor described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the record of all medically-recognized mental health conditions. 

Chewing food and spitting it out can cause dental issues, and gastrointestinal problems and may also lead to weight gain.

Instead, CHSP is considered an eating disorder not otherwise specified (EDNOS).1 This umbrella term describes patterns of disordered eating behavior that have been seen in clinical practice but have not yet been understood as specific conditions.

Who gets CHSP disorder?

While CHSP has not been thoroughly studied in and of itself, patterns of this behavior have been noted in patients hospitalized for other disordered eating patterns and mental health issues. 

One study found that 21% of patients in a hospitalization program for eating disorders reported engaging in CHSP behavior once a week before their hospitalization.2

In general, these patients were also found to engage in behaviors such as excessive exercise, laxative abuse, and restrictive dieting as part of their disorder.2

Side effects of chewing and spitting food

Even though the DSM hasn’t officially described chewing and spitting disorder, the behaviors generally involved in this condition have been connected to some physical consequences.

Chewing is the first step in the digestive process, which typically sets off a chain reaction in the body, anticipating an influx of food. However, when no food arrives, some of the mechanisms put into motion by chewing can potentially cause problems.

Dental issues, such as cavities, gum disease, and gastrointestinal distress, such as acid reflux, are possible, thanks to the stomach acid that gets churned up when chewing takes place.3 Excess stomach acids can also lead to stomach ulcers.5

And while it’s frequently used as a strategy to avoid gaining weight, CHSP can have the opposite effect. Experts aren’t quite sure what drives the connection between CHSP and weight gain. However, some theorize that many people trying this method severely restrict their caloric intake, which can cause them to overeat or start binge eating later on.3

If someone you know is exhibiting CHSP or other disordered eating behaviors, help is available.

Behavioral signs

Some behavioral signs that may indicate someone is chewing food and spitting it out, include:

  • Eating alone
  • Avoiding events or occasions that center around meals
  • Lying about eating

Diagnosis of CHSP disorder

As CHSP remains officially unrecognized as a disorder, no current methods exist to diagnose the issue. 

Instead, physicians may make a “clinical" diagnosis,” which is when they base a diagnosis on factors like a patient's description of how they feel, visible signs and symptoms, behavioral severity, and a patient's history, as opposed to medical tests.

Many physicians may frame chewing and spitting food out as a symptom of other eating disorders rather than a disorder in its own right. These doctors are more likely to see chewing and spitting behaviors in the same vein as laxative abuse or excessive exercise and may understand it as an indicator that other disordered eating habits are going on or worsening.

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Treating chew and spit disorder

Since there aren't official eating disorder diagnoses for chew and spit disorder, there are no official treatment recommendations for this condition. However, some general tips may help someone overcome the urge to use compensatory behaviors like spitting out their food.

Building a balanced diet could help someone avoid common triggers for disordered eating. Proper nutrition can help people feel more naturally satiated and help eliminate cravings that might tempt someone to use CHSP.4

And incorporating “bad foods" into a regular diet by learning to enjoy them in moderation can help remove the stigma behind the substance, giving someone less reason to spit these foods out.4

Eating mindfully and intuitively

Changing one’s perspective can be just as powerful as changing one’s diet. 

Mindful eating, which promotes staying present, eating slowly, and focusing on the sensory aspects of food, can help someone cultivate a greater sense of gratitude for what they’re eating and build a healthier relationship with food in general.4

Intuitive eating is a similar practice, which focuses on tuning in to the body’s hunger cues and giving it what it wants, when it wants, without feeling any attached guilt.

At Within Health, we want to help all people create healthier, happier relationships with their food and the world around them. Contact our team to learn more about treatment for an eating disorder or CHSP.

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.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

Resources

  1. Aouad, P., Hay, P., Soh, N., & Touyz, S. (2016). Chew and Spit (CHSP): a systematic review. Journal of Eating Disorders, 4(1), 23.
  2. Makhzoumi, S. H., Guarda, A. S., Schreyer, C. C., Reinblatt, S. P., Redgrave, G. W., & Coughlin, J. W. (2015). Chewing and spitting: a marker of psychopathology and behavioral severity in inpatients with an eating disorder. Eating behaviors, 17, 59–61.
  3. What Are the Health Effects of Chewing and Spitting Out Food? Johns Hopkins All Children’s Hospital. Accessed March, 2023.
  4. Chewing and Spitting Food. (n.d.). National Centre for Eating Disorders. Accessed March 2023.
  5. MacGill, M. (2023). Everything you need to know about stomach ulcers. MedicalNewsToday. Accessed March 16, 2023.

FAQs

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