Chew and Spit (CHSP): An Investigation onto a Relegated Eating Disorder Symptom

Abstract

Chew and Spit (CHSP) is characterised by individual’s spitting out food after it has been chewed, as a means to control weight or body shape. Chew and Spit, as a symptom, was removed from the DSM-5 following the recategorization of Eating Disorders Not Otherwise Specified (EDNOS; DSM-IV). It is speculated that one possible reason for this removal was due to the dearth in scholarly knowledge surrounding CHSP behaviour. Prior to 2018, studies had focused on clinical eating disorder samples to examine CHSP, of which not many studies exist, despite evidence suggesting the behaviour may be present in other ‘at-risk’ sub-samples. In order to begin to comprehensively examine CHSP, a systematic review was conducted, followed by point-prevalence studies in both adults and adolescents, and a phenomenological study to determine the lived-experience of CHSP on individuals lives. The systematic review found six themes which arose from existing literature using clinical samples. Themes included CHSP appearing in younger individuals, increased pathological eating, increased negative emotions, some feelings of loss on control, appearing transdiagnostic, and possibly being a marker of eating disorder severity. Prevalence studies determined that CHSP had a 0.4% and 12% point-prevalence rate in adults and adolescents respectively, and was associated with other eating disorder behaviours such as laxative abuse, restrictive eating, and purging. Moreover, the prevalence studies highlighted that CHSP was associated with lower quality of life scores. Finally, the phenomenological study found that CHSP may be highly addictive, and associated with maladaptive coping mechanisms, where individuals try to sooth themselves through the repetitive behaviour of CHSP. Overall CHSP appeared to be more prevalent than expected, especially in adolescents. Additionally, distress and implied impaired functioning emphasized the adverse effects of CHSP on individuals. The studies contained in this theses highlight that CHSP as a symptom needs to be given serious consideration for inclusion back in to diagnostic manuals. Moreover, future research should focus on studying CHSP in other groups at risk of developing eating disorders, as well as possible treatment options for patients who have CHSP as a primary disorder.