The Women Hiding a Secretive, Little-Known Eating Disorder

"Generally, the food chosen is very energy dense, and often contains high amounts of fats and/or carbohydrates," says Phillip Aouad, a PhD candidate at the University of Sydney who is leading the world's first study investigating CS. Aouad says people often chew and spit foods that are seen as "enjoyable but forbidden"—like doughnuts, cakes, cookies, and chips.

People with CS, he adds, tend to feel like the behaviour is a more taboo subject than other disordered eating patterns such as restricting food, or binging and purging.

Aouad suspects CS can lead to a number of problems, including gastric, dental, and hormonal issues. These could in turn lead to distressing cumulative effects, from blood imbalances to weight gain. In recent research, he found evidence that the behavior might appear in eating disordered people who are younger. It may also be associated with pathological eating, feeling out of control, remorse, guilt, and shame.

But it's still early days. "In order to [learn more], researchers such as myself are desperate to have people who have struggled, or are struggling, with CS to actively participate in research relating to it."

Mandy* has suffered from various eating disorders for most of her life. "I started restricting at age 12, and I've been through cycles characterized by both heavily restricting and binging," says the 32-year-old, a participant in Aouad's research.

She started to chew and spit last year, after she came across someone talking about it online. Initially, the behavior helped her manage her anxiety. "When I'm chewing the food, I don't think about my problems or how I'm feeling," she says. "CS allows me to 'eat' for a very long time, so I don't feel compelled to think about the rest of my life."

"I would fast all day at work, then at home, I would chew and spit sweets. While I absorbed calories and maintained my weight, I probably ingested almost no vitamins, minerals or nutrition," she continues.

Mandy has experienced many negative side effects as a result of the disorder: "Starting CS led me to go from restricting to full-on binging and purging," she says. "I know that I have nutrient deficiencies, and I've had bizarre health events from this. A piece of my jaw broke—probably due to osteoporosis—and caused a major infection in my mouth until the dentist removed the bone."

She has tried to quit the behavior, but has had little success. "I truly believe that I am addicted to CS in a way that people are addicted to using drugs. Eventually, I started to chew and spit huge quantities of food, for example a dozen or more doughnuts in a sitting."

"I wish I'd never started," she says. "I can't imagine that I will ever quit doing this, although I hope to limit it. I do risky, embarrassing things like sneak food into bathrooms at parties or at work."

The lack of research into CS makes identifying people who engage in the behavior difficult. Aouad has interviewed many people who engage in the behavior, but personally hasn't been able to "physically identify CS" in anyone. As for how it can be treated, he says that it's still too early to know—"there are far more questions about CS than there are answers," he says.

There also doesn't appear to be a consensus on which eating disorder is most connected to chewing and spitting, says Aouad. "I have spoken to people who only chew and spit, and may not necessarily exhibit other eating disorder symptoms."

"Everyone in society has heard of anorexia and bulimia," says Mandy. "[But] most people who have eating disorders don't fall so neatly into an 'anorexic' or 'bulimic' box."

*Name has been changed.