One of the most injurious facets of eating disorders is the stigma surrounding them. Despite a growing body of research confirming neurobiological and genetic causes of eating disorders, there are persisting misconceptions that these illnesses are lifestyles choices caused primarily by social or psychological factors. Such stigma contributes to the all-too-common picture the public paints of eating disorders: teenage white girl who engages in self-starvation in pursuit of the ever-elusive beauty ideal.

In reality, this story describes only a small number of individuals suffering from eating disorders. However, the story continues to be told, which can be just as dangerous as the actual illnesses are. Stigma is the primary barrier to seeking professional help. When society says that there is only one “way” to have an eating disorder, individuals who don’t resonate with this particular way (and most don’t!) may not see themselves as sick, or sick enough. And this can cause feelings of guilt, shame and self-blame, ultimately delaying treatment.

Anorexia, bulimia and binge-eating disorder are pretty widely known, and knowledge of the lesser-known OSFED and orthorexia (although currently unrecognized by the DSM) is increasing, too.

But have you heard of chewing and spitting (CHSP) disorder? It is exactly what it sounds like: chewing bites of food and spitting them out, rather than swallowing. Despite its lesser-known status, it is still a significant and dangerous disorder. Here are five things to know:

1. It is a real eating disorder.

While originally associated with bulimia, research has shown that CHSP behaviors are not exclusive to bulimic individuals. Furthermore, CHSP has been associated with food restriction, excessive exercise, increased use of diet pills and laxatives and other mental health issues such as depression and body dissatisfaction.

2. The behavior can be addictive.

For the most part, the foods that get chewed and spit are foods high in sugar, salt and fat. As these foods are held in the mouth long enough to activate the brain’s pleasure centers, individuals who engage in CHSP may get a certain high or rush from the behavior. There may be a biological reason for this: research suggests CHSP increases levels of ghrelin, the hormone that promotes hunger, thus perpetuating the behavior.

3. There are serious effects.

Because food is being spit out, CHSP can lead to malnourishment. Additionally, the excessive chewing can lead to swollen salivary glands and dental issues such as cavities and tooth decay. Most significant is the possibility of altering the release and regulation of hormones crucial to metabolism, including insulin.  

4. It is more common than you think.

Despite the relatively unknown status of the disorder, a simple Google search of “chewing and spitting disorder” turns up millions of results. A recent survey found that 34% of individuals suffering from disordered eating engage in CHSP.        

5. Recovery is possible.

As is true for all eating disorders, professional help is available and effective for CHSP. For recovery resources and treatment options, call the National Eating Disorders Association Helpline at 800-931-2237.

It’s time we re-tell the story of eating disorders by telling all the stories. This means having a more inclusive understanding of who develops eating disorders, as well as expanding our knowledge of the actual illnesses. By educating yourself and others, you help break the stigma surrounding little-known eating disorders.

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Ariel Beccia majored in neuroscience while at St. Lawrence University and is now researching eating disorder treatments at the National College of Natural Medicine.