Chewing food and then spitting it out before swallowing—a behavior sometimes called CHSP (chewing and spitting)—is more than just a strange habit. It is a serious eating disorder behavior that can indicate underlying mental health struggles and cause significant physical harm.

People engage in CHSP for various reasons, often related to desires to experience food's taste without consuming calories.

While less discussed than other eating disorder behaviors like purging or restricting, CHSP affects many individuals and requires professional treatment. Understanding this behavior can help you recognize when help is needed for yourself or someone you care about.

What Is Chewing and Spitting (CHSP)?

Chewing and spitting involves putting food in your mouth, chewing it, and then spitting it out before swallowing. This behavior allows someone to taste food without actually consuming the calories or nutrients.

How common is CHSP?

Research on CHSP prevalence is limited because many people feel ashamed and hide the behavior. CHSP appears most commonly in people with anorexia nervosa particularly the binge-eating/purging type, bulimia nervosa, orthorexia nervosa, and other specified feeding or eating disorder (OSFED).

Patterns of CHSP behavior

CHSP typically follows certain patterns. Episodes can last anywhere from a few minutes to several hours.

Frequency ranges from occasional to multiple times daily and often increases over time. People often choose highly palatable foods like sweets or baked goods. CHSP often involves specific rituals, like using particular locations or occurring at certain times of day.

Why Do People Engage in Chewing and Spitting?

Understanding the motivations behind CHSP helps clarify why this behavior develops and persists..

Experiencing taste without calories

The most common motivation is wanting to enjoy food's taste and texture without consuming calories. People with eating disorders often experience intense cravings for foods they avoid due to calorie concerns. CHSP seems to offer a compromise, though this perceived benefit is an illusion.

Managing food cravings

Research found that people use CHSP to manage overwhelming food cravings. When the urge to eat something feels unbearable, chewing and spitting feels like a way to satisfy the craving without "giving in" completely.

Avoiding purging

Some people engage in CHSP as an alternative to vomiting or laxative use. CHSP may seem "less harmful" than purging. However, CHSP is not actually safer and comes with its own serious health risks.

Control and restriction

For people with restrictive eating disorders, CHSP provides a sense of control. found that the behavior reinforces feelings of discipline and willpower.

Coping with emotional distress

Like other eating disorder behaviors, CHSP often serves as a way to manage uncomfortable emotions. According to research, people report using CHSP when feeling anxious, lonely, sad, or frustrated.

Which Eating Disorders Include CHSP?

While CHSP can occur in isolation, it most commonly appears alongside diagnosed eating disorders.

Anorexia nervosa

CHSP occurs frequently in anorexia nervosa, especially the binge-eating/purging subtype.

Research found that people with anorexia use CHSP to experience restricted foods without consuming calories and maintain very low calorie intake. Approximately 34% of people with anorexia report CHSP behavior.

Bulimia nervosa

In bulimia nervosa, CHSP may occur alongside or instead of vomiting and laxative use. Research found that people with bulimia nervosa use CHSP as an additional compensatory behavior to prevent weight gain or an alternative when unable to purge through vomiting.

Orthorexia nervosa

While less researched, CHSP appears in some cases of orthorexia nervosa. People with orthorexia may use CHSP to taste "forbidden" or "unhealthy" foods without violating food purity rules.

Physical Health Risks of Chewing and Spitting

Despite the perception that CHSP is less harmful than other eating disorder behaviors, significant health risks exist.

Dental problems

CHSP exposes teeth to prolonged contact with food sugars and acids without the cleansing action of swallowing. CHSP causes tooth decay and cavities, enamel erosion, increased sensitivity and pain, and higher risk of gum disease.

Digestive problems

Chewing signals your digestive system to prepare for food. When food does not arrive, this creates problems. CHSP causes increased stomach acid production leading to acid reflux and heartburn, bloating and abdominal pain, and disrupted hunger and fullness signals.

Nutritional deficiencies

Even though some nutrients absorb in the mouth during chewing, CHSP prevents adequate nutrition.

People engaging in CHSP frequently experience inadequate calorie intake leading to weight loss, vitamin and mineral deficiencies, weakness and fatigue, and impaired immune function.

Psychological and Social Impact of CHSP

Beyond physical health, CHSP significantly affects mental health and relationships.

Shame and secrecy

CHSP is often accompanied by intense shame. Many people hide the behavior carefully, leading to social isolation, anxiety about being discovered, and decreased self-esteem.

Time consumption

CHSP episodes can consume significant time—sometimes multiple hours daily. This leads to reduced productivity, neglect of responsibilities and relationships, and exhaustion.

Reinforcement of eating disorder thoughts

Rather than reducing eating disorder symptoms, CHSP actually strengthens them. CHSP reinforces beliefs that certain foods are "bad," maintains preoccupation with food, and prevents recovery from underlying eating disorders.

Treatment for CHSP

CHSP requires professional treatment as part of comprehensive eating disorder care. Several evidence-based approaches help address this behavior.

Cognitive behavioral therapy (CBT)

CBT is the most researched treatment for eating disorders, including CHSP behaviors.

CBT for CHSP involves identifying triggers, challenging beliefs about CHSP, developing alternatives, and exposure work—gradually practicing eating and swallowing foods you have been chewing and spitting.

Dialectical behavior therapy (DBT)

DBT teaches skills for managing intense emotions without resorting to harmful behaviors. DBT helps people with CHSP by teaching distress tolerance skills, building emotion regulation, and improving mindfulness around eating.

Nutritional rehabilitation

Working with a registered dietitian addresses the nutritional and behavioral aspects of CHSP. Dietetic treatment includes identifying nutritional requirements for the individual, addressing fears about specific foods, and supporting weight restoration if needed.

Treatment of underlying eating disorder

Since CHSP typically occurs within the context of an eating disorder, treating the underlying condition is essential. CHSP often resolves when the primary eating disorder improves.

Steps to Take If You Engage in CHSP

If you recognize CHSP behavior in yourself, taking action now can prevent worsening symptoms and health complications.

Seek professional help

Research emphasizes the importance of specialized eating disorder treatment.

Contact your primary care doctor, a therapist specializing in eating disorders, a registered dietitian with eating disorder expertise, or an eating disorder treatment program if symptoms are severe.

Be honest about the behavior

CHSP often goes unrecognized because people hide it from healthcare providers. Being truthful about CHSP helps providers give appropriate treatment.

Address underlying restriction

Research found that CHSP often stems from excessive food restriction. Working to eat more regularly and include previously forbidden foods reduces CHSP urges.

Takeaway

Chewing and spitting (CHSP) is a serious eating disorder behavior involving chewing food and spitting it out before swallowing.

People engage in CHSP to experience food's taste without consuming calories, manage cravings, avoid purging, or cope with emotional distress. The behavior occurs most commonly in anorexia nervosa, bulimia nervosa, and orthorexia nervosa.

CHSP causes significant health problems including dental damage, swollen salivary glands, digestive issues, nutritional deficiencies, and metabolic disruption. Psychological impacts include shame, social isolation, and reinforcement of eating disorder thoughts.

Treatment involves cognitive behavioral therapy, dialectical behavior therapy, nutritional rehabilitation, and addressing the underlying eating disorder.

If you engage in CHSP, seek help from eating disorder specialists. With appropriate treatment, you can stop this behavior and develop a healthier relationship with food. Recovery is possible, and you deserve support in achieving it.

References

https://pubmed.ncbi.nlm.nih.gov/27555914/

https://www.sciencedirect.com/science/article/abs/pii/S1471015319302739?via%3Dihub

https://www.lidsen.com/journals/neurobiology/neurobiology-04-03-070

https://eatingdisorders.org.au/eating-disorders-a-z/other-eating-disorders-osfed/

https://www.sciencedirect.com/science/article/abs/pii/S0010440X15001236?via%3Dihub