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Embarassed to Tell Therapist About Chewing and Spitting

By December 17, 2012

Chewing and spitting became my activity of choice as my eating disorder spun out of control last fall. My weight has fluctuated while I’ve alternated between anorexia and binge eating. I’ve been able to tell my friends and therapist about the issues that surround this fluctuation, but I’ve never been able to tell anyone about the behavior that I engage in when I’m at my most hopeless and depressed – chewing and spitting. I’m so embarrassed by it, but I don’t think I can make any headway in therapy without admitting to what I consider to be the worst manifestation of my problem. Is there any way that I can be honest with my therapist about my desperation without telling her about this extremely humiliating behavior? Is it absolutely necessary for me to tell someone about my chewing and spitting in order to recover from my eating disorder? Thank you all so much for your wonderful website. It has been such a comfort in my struggle.- Naomi

Dear Naomi,

Sometimes a behavior becomes shameful to us when we think, “I am the only one who does this.” In reality, chewing and spitting — in the context of an eating disorder — is not that uncommon. One study found that 22% of individuals with eating disorders engage in regular chewing and spitting. Chewing and spitting occurs more with anorexia, probably because anorexics are more frightened of swallowing food than bulimics; although bulimics also engage in chewing and spitting. Even if chewing and spitting was a rare event – it is not a reason to be ashamed. It is also an example of the Eating Disorder, Not Otherwise Specified (EDNOS) diagnosis giving in the manual that psychologists/psychiatrists use to diagnose.

If your therapist is knowledgeable about eating disorders, s/he is very likely to be familiar with this ED behavior. I cannot imagine that s/he would think negatively of you because of this. It is not uncommon for therapists to come across this behavior in the patients we serve. Professionals see chewing and spitting as just another manifestation of the eating disorder. As with any ED behavior it is simply the person trying to deal with the overwhelming anxiety, wounds, and other issues that fuel the ED.

I do believe it is very important to talk to your therapist about the chewing and spitting. First, you obviously need help in dealing with this problem from a therapist who understands how to help you. She cannot help you if she doesn’t know. The second part is that, in order for therapy to be the most effective – there has to be a high level of trust between the client and the therapist. Even State governments recognized this need for trust – which is why they have laws to make therapy a very special place where a client can talk about her issues with the confidence that the discussion will stay in the client-therapist relationship (except in a few cases involving danger to self or others).

Just telling your therapist about the chewing and spitting is very likely to help, even if that’s all you did. Shame loves darkness. When you tell her, you put light on the shame and it begins to shrink, although it may grow briefly until the two of you can talk through it. Her reaction and continued acceptance of you will begin to deflate the shame about this issue.

I am not sure how much you know about the concept called “projection” – but let me briefly explain. Without going into details, with projection, I may feel badly about myself and believe people don’t like me. If I am with someone and she looks at me, I may project my bad feelings about myself on to her – and believe that she doesn’t like me. We are most likely to project when the other person isn’t giving us any clues as to what s/he is thinking. When you are sitting in a therapy session – you know about the chewing and spitting – but your therapist doesn’t. This will create tension for you — and you are very likely to project your feelings on to her – and believe that she would be shocked or turned off if she knew. If this feeling builds up, it can begin to impact other parts of your therapy, as issues of trust and your projections start to get in the way of genuine communication.

I pray that you will see your chewing and spiting for what it is – a symptom of the pain, anxiety and other issues that have caused the eating disorder in the first place. People, in the general public, who are ignorant concerning ED issues, may not understand, but even some of them will. Remember 22% of people with an ED practice chewing and spitting as well.

Love your neighbor as you love yourself. Love your neighbor in the same way as you love yourself. Now let me turn that statement around: Love yourself in the same way as you love your neighbor.

“Love is patient, kind, gentle, doesn’t keep track of wrongs done….” You don’t have to feel love to have love. You can love yourself in how you talk to yourself – just talk to yourself about this behavior in the same way as you would a person you love dearly – with patience and kindness and gentleness. It will make it all that much easier to move past it.

Sincerely,

David Wall, PhD