For 17 years I have had severely restricting Anorexia and a lot of chewing and spitting (CHSP), with resultant major dental problems…but no purging. It’s funny how these little terms, like CHSP, come along, isn’t it … an attempt to encompass such heavy, emotionally-laden, guilty, secretive behaviors into tiny acronyms that sound really clinical and matter-of-fact.
Dentists want to help people who have eating disorders. We have a chance to tell them what it feels like when our eating disorder starts to ‘eat’ and destroy our teeth. On April 5, I will co-present with Prof. Susan Paxton at the 35th Australian Dental Congress in Melbourne. Our presentation is listed on the main scientific program. Our topic is: Reflux and related diseases. Share your experience to help dentists help others. Your details remain confidential. Email: email@example.com
“A”, age 30, shares her experience:
As a kid I was very affectionate and obsessive, perfectionist and ritualistic. I always felt worried. I was 13, in high school, when a standard class in health and nutrition sparked my eating disorder. I started learning about healthy foods and not healthy foods. Suddenly I began to become very aware of what food I was eating. I went from eating normally to certain foods only. I started to get perfectionist about this, cutting out oils and butter, eliminating meat, saying ‘no’ to bread. Then I began on the vegetables thinking maybe I should not eat potato, and soon I was eating no vegetables; then I started on the fruit, and within weeks of all this starting I was eating only one strawberry a day.
My obsessive compulsive behaviors seemed to morph into an aggressive form of AN.
Before that I had a normal kid’s life – I enjoyed birthday parties, chocolates and lollies. I had no hang-ups with food. I was always of a slight build but now my weight was spiraling downward.
In class at school I also learnt about exercise – and started on this too. Being a perfectionist, I made myself walk to school each day. It took 45 minutes each way and I wore a heavy backpack. Also I did a lot of running. Sometimes four hours a day, from 1am to 5am. I would sneak out my bedroom window so that my parents did not know. I was 14 years’ old.
Because these changes happened rapidly, within weeks, Mum noticed and said ‘you are not eating’ and talked me into having a check up with the doctor.
The doctor said ‘you may have an ED’.
For my parents, this was like a bolt out of the blue.
Because my blood pressure was down and I had lost a lot of weight, the doctor said: You will have to start eating or go to hospital.
I ended up in hospital on a nasal gastric tube for several weeks. Unhappy, I started to eat food, thinking: I will eat my way out of here.
Which is what I did.
For a few months I was okay but then the eating disorder behaviors took over again and this has been story of my life. I have always been a restrictor. This means I don’t binge and starve or purge – I tried to purge and could not do it.
I have mostly avoided hospital but eat just enough to survive. I am the same size in weight and height as I was at age 13.
Chewing and spitting
At 15, I began to chew food and spit it out. Just did it. It just happened. It was a way to get food without getting food and putting on weight. I don’t believe this was a way to cope with my emotions but rather to solve my craving for food – it was a physical need.
First I started craving sweet foods – like chocolate bars, cake and whatever I could get my hands on. The type of food was not important – I ate any food that I liked. I was more concerned that I must not swallow it. You see, you crave more because you are starving.
I would take the food to somewhere private, usually my bedroom. I was always hungry but the chewing and spitting alleviated the craving that went with feeling hungry. This way I could taste the food but not swallow it and could restrict more.
I had beautiful straight perfect teeth until age 15, and in some ways they are still okay. I don’t have false ones.
But two years after I developed AN, I started to get some get gaps in my teeth. My teeth started to get sensitive and develop cavities and my gums were sore. A few teeth rotted and the dentist pulled them out.
At age 16, a big piece chipped off one of my two front teeth. This was a wake up call.
My dentist asked if I was eating sugary things, and would say ‘try this toothpaste’, or he would ask ‘are you drinking too much soft drink?’ General questions. He never asked if I had an eating disorder. I did not tell him or anyone about the chewing and spitting.
My front tooth was capped and I started to floss and brush all the time. That is, I became obsessive, and would floss and brush four or five times a day. The trouble was, this heavy brushing and cleaning wore away the enamel on my teeth and hurt my gums. Every time some food went passed my lips, I would brush and floss my teeth.
My chewing and spitting behaviors continued throughout university and into my early 20s, but at age 26 and 27 a relapse occurred and I was ordered back to hospital, this time for three-and-a-half months.
I’d finished a degree and got a job for a while. The relapse began before I started to study honors and spiraled within a few weeks. I took study very seriously, but feared I might not pass; I might fail. Restricting food intake was a way to cope. It still is.
Nurses had not heard of chewing and spitting behavior
While in hospital, the nurses found the plastic bags I would spit into and accused me of purging. I would say ‘I don’t purge, I just don’t swallow it in the first place’. I did not want them to think I was vomiting. I did not like being accused of a behavior I did not do. The nurses took several weeks to convince.
They had not heard of this chewing and spitting behavior and this was the first time I had told anyone. Not even my mother had known.
I still chew and spit occasionally, maybe three times a week, usually early morning or in the evening, whenever a craving for food occurs. The behavior of chewing and spitting is very comforting.
Mostly I go for sweet foods; but anything chewable is okay, like potato crisps and Cheezels, and take-away food like noodles or fish and chips. But not icecream or fluids – they are too risky and could dribble down my throat.
Sometimes I eat just one bowl of cereal, or three bowls. I dampen the cereal ensuring there is no liquid. This way I can pig out without swallowing.
Financially, chewing and spitting is costly, as I’m buying food but not consuming it. Afterwards I floss and brush my teeth and feel okay; I don’t feel guilty, because I know I haven’t taken in any calories.
Impact on teeth
But my teeth have suffered a lot. I have had more teethed capped, three or four abscesses, four teeth taken out at the back, and have eroded enamel and gum lines. Most of my teeth are white but have dark edges and they look gappy. My front teeth are worn away and I must have a filling on every tooth.
I still have my teeth but you can see a bit of darkness that would normally be covered by gum tissue; this occurs particularly on the bottom gum.
Looking at the damage makes me feel sad and sorry.
I have never felt worried about visiting my dentist – he is a nice quiet man and is very supportive. He may have suspected the eating disorder or chewing and spitting behavior but has never said anything directly, not even today. When the eating disorder developed I may have felt very ashamed if he had said: ‘Do you have an eating disorder?’ Now I am quite open about my illness, but as a kid I kept the secret to myself. If the dentist had said anything back then I probably would not have gone back to him.
The dentist knows my family and I feel sure he has known about my illness but I am grateful that he has not said anything to me.
My message to dentists
Be careful what you say. It is good to have it (the eating disorder) out in the open but try not to embarrass your patient. They feel very ashamed. Whether you say anything or not, don’t be judgmental.
I would have felt relieved to share and talk about my eating disorder, knowing that I would not be judged.
Clues on how to take care of teeth are very helpful – my dentist would ask: ‘Have you tried this flossing technique?’ and ‘Have you tried this tooth paste?’ I was able to say: ‘My teeth are very sensitive and my gums are sore.’ But the underlying reason was never discussed.
Prior knowledge could not have stopped the development of my eating disorder but I believe that if information and awareness about the damage that could occur to my teeth would have helped me try harder to resist developing the harmful behavior of chewing and spitting. Then I would not have had the erosion, the recessed gum line or sensitivity.
The impact on my teeth has been great.
I don’t smile with my mouth in photos because of my teeth.
Many things affect my self-esteem but teeth are right up there at the top as the biggest damage caused by ED. Looking in a mirror is hard. Makes me cry.
You can hide other effects of ED, but you can’t hide your teeth because the dentist can see them.
I know the chewing and spitting behavior seems gross. I want dentists to know it is a physical craving, like a drug. This is how the ED manifested for me.
So far, no one has been able to help me.