Skip to main content

Advertisement

SpringerLink
Log in

Re-examination of chewing and spitting behavior: characteristics within and across eating disorder diagnoses

  • Original Article
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Chewing and spitting (CS) out food is a relatively understudied eating disorder behavior. The aim of this study was to examine lifetime and current frequencies of CS across eating disorder diagnostic groups and to compare the severity of eating disorder symptomatology between participants who did and did not endorse CS. A total of 972 individuals presenting for outpatient eating disorder treatment between 1985 and 1996 completed a questionnaire that included items regarding current and lifetime eating disorder behaviors, including CS. Results indicated that both lifetime and current prevalence estimates of CS varied cross-diagnostically, with CS being more common among those with anorexia nervosa and bulimia nervosa compared to those with eating disorder not otherwise specified. CS was significantly associated with several eating disorder symptoms, including compensatory behaviors, meal restriction, and lower BMI. Those who reported CS were also younger in age compared to those who did not report CS. These findings indicate that CS is associated with more severe eating and weight pathology and is not equally prevalent across eating disorder diagnoses. These results also support the relatively high occurrence of CS and the importance of targeting this behavior in eating disorder treatment. Future research should clarify the correlates, mechanisms, and function of CS in eating disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Smith GR, Ross RL (1989) Chewing and spitting associated with a protein sparing modified fast and psychosocial stressors. Psychosomatics 30:224–226

    Article  PubMed  Google Scholar 

  2. Fairburn CG, Cooper PJ (1984) The clinical features of bulimia nervosa. Br J Psychiatry 144:238–246

    Article  CAS  PubMed  Google Scholar 

  3. Guarda AS, Coughlin JW, Cummings M, Marinilli A, Haug N, Boucher M et al (2004) Chewing and spitting in eating disorders and its relationship to binge eating. Eat Behav 5:231–239. doi:10.1016/j.eatbeh.2004.01.001

    Article  PubMed  Google Scholar 

  4. Kovacs D, Mahon J, Palmer RL (2002) Chewing and spitting out food among eating-disordered patients. Int J Eat Disord 32:112–115. doi:10.1002/eat.10073

    Article  PubMed  Google Scholar 

  5. Mitchell JE, Hatsukami D, Eckert ED, Pyle RL (1985) Characteristics of 275 patients with bulimia. Am J Psychiatry 142:482–485

    CAS  PubMed  Google Scholar 

  6. Mitchell JE, Pyle R, Hatsukami D, Eckert E (1988) Chewing and spitting out food as a clinical feature of bulimia. Psychosomatics 29:81–84. doi:10.1016/S0033-3182(88)72425-1

    Article  CAS  PubMed  Google Scholar 

  7. McCutcheon R, Nolan A (1995) Chewing and spitting out food—a neglected symptom? Int J Eat Disord 17:197–200

    Article  CAS  PubMed  Google Scholar 

  8. De Zwaan M (1997) Chewing and spitting out food in eating disorder. Int J Psychiatry Clin Pract 1:37–38

    Article  PubMed  Google Scholar 

  9. Mitchell J, Hatsukami D, Eckert E, Pyle R (1985) Eating disorders questionnaire. Psychopharmacol Bull 21:1025–1043

    Google Scholar 

  10. Keel PK, Crow S, Davis TL, Mitchell JE (2002) Assessment of eating disorders: comparison of interview and questionnaire data from a long-term follow-up study of bulimia nervosa. J Psychosom Res 53:1043–1047

    Article  PubMed  Google Scholar 

  11. Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED et al (2009) Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry 166:1342–1346. doi:10.1176/appi.ajp.2009.09020247

    Article  PubMed  Google Scholar 

  12. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders. 4th edn. Washington, DC

  13. R Core Team (2013) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-9000051-07-0. http://www.R-project.org/

  14. Fairburn CG (2008) Cognitive behavior therapy and eating disorders. Guilford, New York

    Google Scholar 

  15. Smyth JM, Wonderlich SA, Heron KE, Sliwinski MJ, Crosby RD, Mitchell JE et al (2007) Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment. J Consult Clin Psychol 75:629–638. doi:10.1037/0022-006X.75.4.629

    Article  PubMed  Google Scholar 

  16. Shiffman S, Stone AA, Hufford MR (2008) Ecological momentary assessment. Annu Rev Clin Psychol 4:1–32

    Article  PubMed  Google Scholar 

  17. Calzo JP, Sonneville KR, Haines J, Blood EA, Field AE, Austin SB (2012) The development of associations among body mass index, body dissatisfaction, and weight and shape concern in adolescent boys and girls. J Adolesc Health 51:517–523. doi:10.1016/j.jadohealth.2012.02.021

    Article  PubMed Central  PubMed  Google Scholar 

  18. de Zwaan M, Hilbert A, Swan-Kremeier L, Simonich H, Lancaster K, Howell LM et al (2010) Comprehensive interview assessment of eating behavior 18–35 months after gastric bypass surgery for morbid obesity. Surg Obes Relat Dis 6:79–85. doi:10.1016/j.soard.2009.08.011

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors report the following financial disclosures: Ms. Durkin, none; Ms. Swanson, none; Dr. Crow, research grants from Novartis, Shire, and Alkermes; Dr. Mitchell, none; Dr. Peterson, none; Dr. Crosby, none.

Author information

Authors and Affiliations

  1. Department of Psychiatry, University of Minnesota Medical School, F282/2A West, 2450 Riverside Avenue South, Minneapolis, MN, 55454, USA

    Nora E. Durkin, Scott J. Crow & Carol B. Peterson

  2. Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue Kresge 9th Floor, Boston, MA, 02115, USA

    Sonja A. Swanson

  3. Department of Clinical Research, Neuropsychiatric Research Institute, 700 First Avenue South, Fargo, ND, 58103, USA

    James Mitchell & Ross Crosby

  4. Department of Clinical Neuroscience, School of Medicine and Health Sciences, University of North Dakota, 120 8th Street South, Fargo, ND, 58102, USA

    James Mitchell & Ross Crosby

Authors
  1. Nora E. Durkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sonja A. Swanson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scott J. Crow
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carol B. Peterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ross Crosby
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nora E. Durkin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Durkin, N.E., Swanson, S.A., Crow, S.J. et al. Re-examination of chewing and spitting behavior: characteristics within and across eating disorder diagnoses. Eat Weight Disord 19, 315–320 (2014). https://doi.org/10.1007/s40519-013-0090-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-013-0090-3

Keywords

Search

Navigation