title: Chewing and spitting: a marker of psychopathology and behavioral severity in inpatients with an eating disorder.
abstract: Chewing and spitting out food is a frequent behavior in hospitalized patients with eating disorders (ED). Personality characteristics of those who frequently chew-spit (CHSP), the amount of food consumed during CHSP episodes, associated sense of loss of control overeating (LOC), and clinical response to hospital-based treatment have not been examined and were the focus of this study. Participants (N=324) were inpatients on a behavioral ED specialty unit. A third of the sample (n=107) reported engaging in CHSP in the 8weeks prior to admission with 21% (n=69) reporting CHSP at least once per week. Those who engaged in the behavior at least weekly (CHSP+) were compared to those with less frequent or no CHSP (CHSP-) on demographic and clinical indices and on the EDI, BDI, and the NEO-FFI. Participants were also asked if their CHSP behavior involved a binge-like amount of food (≥1000kcal) or was associated with LOC. The CHSP+ group was more likely to have purging diagnoses. After controlling for purging diagnosis, CHSP+ were found to engage in more restricting, diet pill and laxative use, and excessive exercise, and endorsed greater drive for thinness, body dissatisfaction, depression, and neuroticism than CHSP-. Among all CHSP+ participants, LOC was present in 70% and a minority (n=10, 18%) endorsed recent CHSP on binge-like amounts of food. This behavior should be assessed routinely in all patients, as it appears associated with increased eating behavior severity and increased psychiatric comorbidity at hospital admission.
authors.affiliation: University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA. Electronic address: saniha1@umbc.edu.
authors.forename: Saniha H
authors.initials: SH
authors.lastname: Makhzoumi
authors.affiliation: The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, MD 21287, USA.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Guarda
authors.affiliation: The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, MD 21287, USA.
authors.forename: Colleen C
authors.initials: CC
authors.lastname: Schreyer
authors.affiliation: The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, MD 21287, USA.
authors.forename: Shauna P
authors.initials: SP
authors.lastname: Reinblatt
authors.affiliation: The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, MD 21287, USA.
authors.forename: Graham W
authors.initials: GW
authors.lastname: Redgrave
authors.affiliation: The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, MD 21287, USA.
authors.forename: Janelle W
authors.initials: JW
authors.lastname: Coughlin
mesh_terms: D000293:Adolescent; D000328:Adult; D002149:Energy Intake; D001068:Feeding and Eating Disorders / Q000523:psychology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D008409:Mastication; D011599:Psychopathology; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Anorexia nervosa; Binge; Bulimia; Chewing and spitting; Eating disorders; Loss of control