Along the road of secrecy and avoidance, I also adopted another debilitating “eating” habit. It’s referred to as chewing and spitting (or “CHSP” among clinicians). And it’s exactly what it sounds like.
A Perfect Compromise?
One Saturday morning in December 2007 (my junior year of high school), I was at Whole Foods when I saw a clerk offering samples of artisanal pretzels. At the time, I was a devout gym-goer and a staunch dieter. Long story short: a single pretzel wasn’t something I would even go near on a typical day.
But that morning, something shifted. I wanted to taste those pretzels. So I plopped a bag of them in my basket without trying a sample at the store, and walked home with a plan in mind: I would sit in my bathroom and enjoy an illicit snack, making sure to spit out each bite into a paper towel just before I was ready to swallow. It was the best of both worlds, right? No deprivation, no weight gain, and no vomiting. A perfect compromise.
That first time I chewed and spit, I couldn’t believe I hadn’t thought of doing so earlier. I hadn’t tasted anything resembling bread in years, and doing so gave me a nearly-orgasmic amount of pleasure. Still, I got the satisfaction of affirming my immense self-control—enough to force myself to spit out gobs of beige pretzel-sludge into paper towels after chewing handfuls at a time.
For the rest of junior year and for all of senior year—high stress, pre-college time—chewing and spitting was my drug. With an impending move away from home, I was addled with anxiety, and perfectionism helped keep it at bay. I became severely antisocial, as it enabled me to focus solely on schoolwork and SAT prep. In the meantime, I perfected starving myself and chewing and spitting—the latter of which was my only consistent source of pleasure.
I thought about it all the time. In class. On the subway. My go-to picks were granola bars, sugary cereal, and bread. Carbs had always been the scariest to me since I first developed anorexia, so anything carb-y (muffins, scones, cereal, crackers) were obvious contenders. My CHSP episodes were almost always done in binge amounts (e.g. more than one person would typically eat at one time), and always in secret—in the bathroom with a roll of paper towels and a couple of plastic shopping bags on hand to help me clean up the evidence. The only times I did it in public involved bread baskets at restaurants. I was pretty good at hiding the occasional chewed-and-spit bite at the table, though sometimes I would bring a piece to the bathroom when I had to pee.
The only visible signs of my behavior at that point were the hundreds, maybe even thousands, of dollars that disappeared as I’d buy more and more food to chew and spit, and the loaves of bread and boxes of cereal that would vanish from my parents’ kitchen.
The only evident side-effects were my frequent cavities and acute jaw pain. Whether it was stomach acid or simply the excessive amounts of chewing I was doing (or the possible dregs of sugar left in my teeth), I don’t know. But chewing and spitting felt almost as bad for my body as it did for my mind.
The Stress Factor
Things got better in college—somewhat miraculously. Though my chewing and spitting episodes persisted during freshman year (an unsurprisingly anxious time), my busier schedule and less-private living situation cut the frequency down to just a few times a week. On stressful evenings after spending hours at the library, I’d buy a couple of Chocolate Chip Clif bars and a few bags of honey-wheat pretzels from the vending machine in my dorm basement. There was a bathroom down there that people rarely used—perfect for my purposes. These episodes coexisted with my actual diet of beer, pizza, gross dining hall food, and other freshman-15-inducing foods. I started to become skeptical of chewing and spitting as my pants grew progressively tighter.
Over the next two years, my chewing and spitting habit receded. Sophomore year saw me settling into my routines and making connections with mentors, friends, and activities that gave my life meaning beyond chewed-up food. I only ever found myself chewing and spitting on especially stressful days—never in the same compulsive and addictive way that had plagued me those first three years.
Junior year was characterized by a different trauma—an addiction to the amphetamine-based stimulant Adderall, which I abused in response to academic pressure. As a result, chewing and spitting found itself in the metaphorical backseat of my psychiatric issues. Since Adderall decimated my appetite (an added bonus, I felt at the time), I simply never wanted to chew and spit. So I didn’t, and the habit came to a halt without my thinking about it. I stopped using the Adderall after my junior year, and it felt like I’d just fallen out of the habit of using CHSP as a tool for myself.
Since then, I haven’t chewed and spit. I’ve thought about doing it, but the distance I now have from the habit gives me the space I need to remind myself of how awful it was. As for on-and-off anorexia, I finally came clean to myself, my family, my friends—and my shrink—about my history of starving myself. I have begun opening up about my self-esteem issues in therapy, which has helped me get to the “root cause” of my struggles with eating.
In 2015, I landed on the right medication for my diagnosed anxiety and have continued to explore new ways of trying to be kinder to myself with hobbies like yoga, meditation, and writing poetry. Since then, my obsession with thinness and hyper-restrictive ways of eating has ebbed. Yet with all that said, feeling fat and out of control is still my Achilles heel. When I face a tough moment—be it a fight with a friend or work stress—body insecurity is the first place my mind goes. Luckily, today my eating habits don’t change accordingly. On the surface, I eat a pretty normal, healthy-but-not-too-healthy, diet.
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Diagnosis Or Symptom?
Unfortunately, you never really hear about chewing and spitting as an eating disorder behavior quite like you hear about restricting, binge eating, vomiting, or laxative abuse.
Recent changes in the Diagnostics and Statistical Manual of Mental Disorders (DSM) have even brought about confusion regarding where to “place” chewing and spitting on the eating disorder spectrum. In the DSM-4, published in 1994, chewing and spitting was listed as an example disorder of the EDNOS diagnosis—Eating Disorder Not Otherwise Specified. Curiously, in the DSM-5, released in 2013, the EDNOS acronym was changed to OSFED (Otherwise Specified Feeding or Eating Disorder), and chewing and spitting was no longer listed as a common “otherwise specified” disorder.
Several studies, however, including one from Johns Hopkins University, have identified it as a common behavior in individuals with anorexia, bulimia, and/or other eating disorders, and have suggested it may be a marker of disorder severity.
What still remains unclear to clinicians is pinning down what diagnosis exactly corresponds with chewing and spitting. Is it a sign of anorexia? Bulimia? Something entirely different? There’s a bit of controversy.
However, this doesn’t mean that chewing and spitting has been forgotten in the clinical landscape. Jennifer J. Thomas, Ph.D, co-director of the Eating Disorders Clinical Research Program at Massachusetts General Hospital and Associate Professor of Psychology at Harvard Medical School, clarifies a possible meaning for the change: “Chewing and spitting is very rarely a stand-alone syndrome. I think dropping chewing and spitting from DSM-4 to DSM-5 was not meant to diminish its importance, but to recognize it as a symptom rather than as a stand-alone disorder.”
In my case, chewing and spitting was one of many symptoms involved in years of on-and-off anorexia. I did it because I wanted the pleasure of a carbohydrate in my mouth without the risk of gaining weight. Others may do it amidst bulimia—as a gentler alternative to vomiting.
Experts, too, feel that information is too scarce to make formal statements about how, why, and when chewing and spitting occurs in eating disorder patients. Evelyn Attia, M.D., Director of the Center for Eating Disorders at New York Presbyterian Hospital and Professor of Psychiatry at Columbia University Medical Center and Weill Cornell Medicine, explains, “We don’t know enough about how many people engage in chewing and spitting, and whether the behavior always, sometimes, rarely, or never exists together with other symptoms of a given disorder.” One thing is clear: Chewing and spitting still exists in the shadows.