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September 29, 2016

Chewing and Spitting: A Little-Known Eating Disorder Symptom

Chewing and Spitting: A Little-Known Eating Disorder Symptom

What is it?

An eating disorder topic that’s been getting a lot of media attention lately is Chewing and Spitting (CHSP). It’s exactly what it sounds like— the habit of chewing food to enjoy the taste, then spitting it out to avoid unwanted calories, or the guilt of eating a “bad” or feared food. CHSP can occur on its own but is more often seen alongside other eating disorders symptoms. A cross-sectional study has shown that there is a strong association between being diagnosed with an eating disorder, like anorexia or bulimia, and lifetime CHSP behavior.1

What do we know?

  • Among individuals with eating disorders, CHSP behavior most often occurs in a younger subset.2

  • CHSP without the presence of an eating disorder often occurs in individuals with diabetes, in those who have undergone bariatric surgery, and in athletes following strict diets.3

  • CHSP is significantly associated with behavior used to compensate for consuming calories, meal restriction, and lower BMI.1

Effects on health and wellbeing

If left untreated, CHSP can have serious health consequences. CHSP can lead to malnourishment, swollen salivary glands, damaged teeth, stomach ulcers, and hormonal imbalances. Other effects include social isolation, financial repercussions, and psychological consequences such as anxiety, low mood, guilt, and shame.

Treatment and recovery

Recovery is possible. If you or someone you know is struggling with chewing and spitting, reach out to us at The Emily Program. Our therapists, dietitians, and medical staff work with all types of disordered eating by developing a personalized treatment plan and addressing the medical, psychological, and social needs of each individual.



1Durkin, N. E., Swanson, S. A., Crow, S. J., Mitchell, J., Peterson, C. B., Crosby, R. (2014). Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. 19, 215-320

2Guarda, A. S., Coughlin, J.W., Cummings, M., Marinilli, A., Haug, N., Boucher, M. & Heinberg, L. J. (2004). Chewing and spitting in eating disorders and its relationship to binge eating. Eating Behaviours. 5(3) 231-239.

3Aouad, P., Hay, P., Soh, N., Touyz, S. (2016). Chew and Spit (CHSP): a systematic review. Journal of Eating Disorders, 4(23), DOI: 10.1186/s40337-016-0115-1


Scott Crow

Scott Crow, MD

As Chief Research Officer at The Emily Program, Scott oversees research that The Emily Program conducts in partnership with the University of Minnesota. He also provides psychiatric evaluations and medication management for a small caseload of individual clients. Scott earned his medical degree and completed his psychiatric residency at the University of Minnesota, where he is now a professor. Scott has been active in national and international eating disorders groups and is Past President of the Academy of Eating Disorders.

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