‘I Suffered From An Eating Disorder You’ve Probably Never Heard Of Before’

by | Aug 3, 2017

What if I told you that I spent five years of my life chewing up food I would pretend to eat and secretly spitting it out?

My guess is you’d probably be shocked. Then definitely grossed out.
Unfortunately, I’m not capable of writing a transformational personal essay about how I traded in an eating disorder for total self-acceptance. Because I didn’t—after 11 years of severe eating issues, I still struggle with anxiety around eating and my weight on a daily basis. 

My “journey” began with starvation at age 14, triggered by my parents’ brief separation, and my anorexic habits resurfaced during other stressful times throughout high school and college. But I was never formally diagnosed with anorexia nervosa—mostly because I avoided acknowledging my food and body-image struggles, keeping them a secret from my family, my friends, even my therapist. I never even admitted to myself that I had a problem until a couple of years ago.

Along the road of secrecy and avoidance, I also adopted another debilitating “eating” habit. It’s referred to as chewing and spitting (or “CHSP” among clinicians). And it’s exactly what it sounds like.

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A Perfect Compromise?

One Saturday morning in December 2007 (my junior year of high school), I was at Whole Foods when I saw a clerk offering samples of artisanal pretzels. At the time, I was a devout gym-goer and a staunch dieter. Long story short: a single pretzel wasn’t something I would even go near on a typical day.

But that morning, something shifted. I wanted to taste those pretzels. So I plopped a bag of them in my basket without trying a sample at the store, and walked home with a plan in mind: I would sit in my bathroom and enjoy an illicit snack, making sure to spit out each bite into a paper towel just before I was ready to swallow. It was the best of both worlds, right? No deprivation, no weight gain, and no vomiting. A perfect compromise.
That first time I chewed and spit, I couldn’t believe I hadn’t thought of doing so earlier. I hadn’t tasted anything resembling bread in years, and doing so gave me a nearly-orgasmic amount of pleasure. Still, I got the satisfaction of affirming my immense self-control—enough to force myself to spit out gobs of beige pretzel-sludge into paper towels after chewing handfuls at a time. 

For the rest of junior year and for all of senior year—high stress, pre-college time—chewing and spitting was my drug. With an impending move away from home, I was addled with anxiety, and perfectionism helped keep it at bay. I became severely antisocial, as it enabled me to focus solely on schoolwork and SAT prep. In the meantime, I perfected starving myself and chewing and spitting—the latter of which was my only consistent source of pleasure.
I thought about it all the time. In class. On the subway. My go-to picks were granola bars, sugary cereal, and bread. Carbs had always been the scariest to me since I first developed anorexia, so anything carb-y (muffins, scones, cereal, crackers) were obvious contenders. My CHSP episodes were almost always done in binge amounts (e.g. more than one person would typically eat at one time), and always in secret—in the bathroom with a roll of paper towels and a couple of plastic shopping bags on hand to help me clean up the evidence. The only times I did it in public involved bread baskets at restaurants. I was pretty good at hiding the occasional chewed-and-spit bite at the table, though sometimes I would bring a piece to the bathroom when I had to pee.

The only visible signs of my behaviour at that point were the hundreds, maybe even thousands, of dollars that disappeared as I’d buy more and more food to chew and spit, and the loaves of bread and boxes of cereal that would vanish from my parents’ kitchen.

The only evident side-effects were my frequent cavities and acute jaw pain. Whether it was stomach acid or simply the excessive amounts of chewing I was doing (or the possible dregs of sugar left in my teeth), I don’t know. But chewing and spitting felt almost as bad for my body as it did for my mind.

The Stress Factor

Things got better in college—somewhat miraculously. Though my chewing and spitting episodes persisted during freshman year (an unsurprisingly anxious time), my busier schedule and less-private living situation cut the frequency down to just a few times a week. On stressful evenings after spending hours at the library, I’d buy a couple of Chocolate Chip Clif bars and a few bags of honey-wheat pretzels from the vending machine in my dorm basement. There was a bathroom down there that people rarely used—perfect for my purposes. These episodes coexisted with my actual diet of beer, pizza, gross dining hall food, and other freshman-15-inducing foods. I started to become skeptical of chewing and spitting as my pants grew progressively tighter.

Over the next two years, my chewing and spitting habit receded. Sophomore year saw me settling into my routines and making connections with mentors, friends, and activities that gave my life meaning beyond chewed-up food. I only ever found myself chewing and spitting on especially stressful days—never in the same compulsive and addictive way that had plagued me those first three years.
Junior year was characterised by a different trauma—an addiction to the amphetamine-based stimulant Adderall, which I abused in response to academic pressure. As a result, chewing and spitting found itself in the metaphorical backseat of my psychiatric issues. Since Adderall decimated my appetite (an added bonus, I felt at the time), I simply never wanted to chew and spit. So I didn’t, and the habit came to a halt without my thinking about it. I stopped using the Adderall after my junior year, and it felt like I’d just fallen out of the habit of using CHSP as a tool for myself. 

Since then, I haven’t chewed and spit. I’ve thought about doing it, but the distance I now have from the habit gives me the space I need to remind myself of how awful it was. As for on-and-off anorexia, I finally came clean to myself, my family, my friends—and my shrink—about my history of starving myself. I have begun opening up about my self-esteem issues in therapy, which has helped me get to the “root cause” of my struggles with eating.

In 2015, I landed on the right medication for my diagnosed anxiety and have continued to explore new ways of trying to be kinder to myself with hobbies like yoga, meditation, and writing poetry. Since then, my obsession with thinness and hyper-restrictive ways of eating has ebbed. Yet with all that said, feeling fat and out of control is still my Achilles heel. When I face a tough moment—be it a fight with a friend or work stress—body insecurity is the first place my mind goes. Luckily, today my eating habits don’t change accordingly. On the surface, I eat a pretty normal, healthy-but-not-too-healthy, diet.

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Diagnosis Or Symptom?

Unfortunately, you never really hear about chewing and spitting as an eating disorder behavior quite like you hear about restricting, binge eating, vomiting, or laxative abuse.

Recent changes in the Diagnostics and Statistical Manual of Mental Disorders (DSM) have even brought about confusion regarding where to “place” chewing and spitting on the eating disorder spectrum. In the DSM-4, published in 1994, chewing and spitting was listed as an example disorder of the EDNOS diagnosis—Eating Disorder Not Otherwise Specified. Curiously, in the DSM-5, released in 2013, the EDNOS acronym was changed to OSFED (Otherwise Specified Feeding or Eating Disorder), and chewing and spitting was no longer listed as a common “otherwise specified” disorder.

Several studies, however, including one from Johns Hopkins University, have identified it as a common behaviour in individuals with anorexia, bulimia, and/or other eating disorders, and have suggested it may be a marker of disorder severity.
What still remains unclear to clinicians is pinning down what diagnosis exactly corresponds with chewing and spitting. Is it a sign of anorexia? Bulimia? Something entirely different? There’s a bit of controversy.

However, this doesn’t mean that chewing and spitting has been forgotten in the clinical landscape. Jennifer J. Thomas, Ph.D, co-director of the Eating Disorders Clinical Research Program at Massachusetts General Hospital and Associate Professor of Psychology at Harvard Medical School, clarifies a possible meaning for the change: “Chewing and spitting is very rarely a stand-alone syndrome. I think dropping chewing and spitting from DSM-4 to DSM-5 was not meant to diminish its importance, but to recognise it as a symptom rather than as a stand-alone disorder.”
In my case, chewing and spitting was one of many symptoms involved in years of on-and-off anorexia. I did it because I wanted the pleasure of a carbohydrate in my mouth without the risk of gaining weight. Others may do it amidst bulimia—as a gentler alternative to vomiting.
Experts, too, feel that information is too scarce to make formal statements about how, why, and when chewing and spitting occurs in eating disorder patients. Evelyn Attia, M.D., Director of the Centre for Eating Disorders at New York Presbyterian Hospital and Professor of Psychiatry at Columbia University Medical Centre and Weill Cornell Medicine, explains, “We don’t know enough about how many people engage in chewing and spitting, and whether the behaviour always, sometimes, rarely, or never exists together with other symptoms of a given disorder.” One thing is clear: Chewing and spitting still exists in the shadows.

This article originally appeared on Women’s Health.

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‘After 3 Miscarriages, This is How I Processed the Trauma’

With October marking International Pregnancy Loss Awareness Month, we spoke to survivor of multiple miscarriages and women's health lobbyist Samantha Payne, CEO and Co-Founder of Pink Elephants - Australia’s only national support service dedicated solely to miscarriage and early pregnancy loss.

Here's her story.

What is your experience with miscarriage?

I have lost 3 babies to miscarriage, my first was a missed miscarriage - I walked into a scan expecting to show my then-toddler her baby sibling on the screen only to be met with 'I'm sorry there is no heartbeat.' I had to endure a weekend with that baby dead inside of me before I could be fitted in for a D&C.

My next miscarriage happened 6 months later - I started to bleed on holiday with friends, I told no one, I was deeply ashamed. I passed that baby alone in the shower at 3am, forever traumatised as I had to flush the remains down the toilet.

My final loss was just last year another miscarriage I started to spot and I just knew, the Doctor that saw me this time asked if we could see a flicker on the screen she thought there was a heartbeat, astounded we asked for a second opinion, where it was confirmed my baby had died.

How did you process the trauma?

With my first two losses, I didn't cope. I poured everything into Pink Elephants and having another baby. I had another pregnancy but was completely terrified the whole time, I didn't bond with this baby, no names, no gender reveal, wearing a brave face every day pretending I was grateful. When Johnny was 4 months old it all caught up with me: I had postpartum anxiety and post-traumatic stress as a result of my losses and not processing the trauma. With counselling and medication, I began to heal and process my losses. My loss last year was different: I took bereavement leave, I gave myself permission to grieve our baby girl and mourn my future with her. I spoke with others in our community, I went back to counselling, and I took the time I needed to start to heal.

How did you get the courage to launch Pink Elephants?

I don't think it was courage, in the beginning, I think it was my anger at the lack of support and validation that I chose to channel into something positive.

I never want my daughter to go through what I did in the way I did. Women deserve so much more than what we currently get.

Last year took courage to come back and work in this space again after bereavement leave - the physical and emotional pain was real, the triggers of other women's stories are real but they are also cathartic. As is the change we create, I feel like my work is meaningful and makes a difference that's what carries me on, I know we can do so much more with the right support alongside us.

I want to next see more targeted action from our government - in particular the Department of Health - in addressing this issue. It's no longer ok to turn a blind eye to the death of our babies, our trauma, and our poor mental health because of the system failing us.

How can we support a friend that has been through loss like this?

You can be there for her, you can validate her loss, don't reduce it to 'at least' comments. You can't take away her pain but you can provide a safe space for her to share and feel listened to, empathised with, and supported. Like any other bereavement send flowers, we have collaborated on a LVLY nurture flower posy as a way to do this. Remember there is no timeline to grief and it's ok for her to still be upset for many months after, remember her due date, acknowledge it at the time, support her through other friends' baby showers.

How can women experiencing miscarriage access support?

They can head to www.pinkelephants.org.au to access our circle of support, which includes online peer support communities to connect with others through miscarriage, trying to conceive again, and pregnancy after loss. Specialised emotional support content, as well as shared stories and journeys, can be accessed through our website too.