When you want the taste of food but none of the calories, it might seem like a harmless compromise to chew it up and spit it out, but new findings show otherwise. Chewing and spitting is common among patients receiving inpatient treatment for eating disorders, and previous research has linked the practice with greater illness severity. A study published last year in Eating Behaviors confirmed those results and was the first to investigate co-occurring symptoms and personality traits. A third of the 324 inpatients studied reported that they had engaged in chewing and spitting during the eight weeks before admission to the hospital, and 21 percent did so at least once a week. When compared with patients who did not engage in this behavior or did so less than once a week, the higher-frequency group had a more troubling list of symptoms: they restricted food intake more often, exercised more excessively, had increased use of diet pills and laxatives, and had higher levels of depression, neuroticism and body dissatisfaction.

The findings suggest that chewing and spitting could be a marker of severity for eating disorders. “It may be an ‘add-on’ behavior that is more likely to develop over time as an individual's illness becomes more severe, and the person's repertoire of disordered eating behaviors increases,” says Saniha Makhzoumi, now a predoctoral intern in clinical psychology at Lucile Packard Children's Hospital at Stanford University, who co-authored the study with eating-disorder researchers at the Johns Hopkins University School of Medicine. Despite the greater pathology found among such patients, their short-term response to treatment was similar to that of other patients. The bottom line: watch out for this behavior as an indicator of worsening illness, but remember that treatment can help.