Similarly, CHSP can also become a compulsion for an individual suffering from OCD. Dr Kimberley Quinlan, a licensed California-based therapist who specialises in co-existing eating and anxiety disorders, notes how to tell to the difference. “The content of the obsessions is the most clinically correct way to differentiate between the two,” she told me over email. “If someone is compulsively chewing and spitting to control or reduce a fear related to body weight or body image, it is almost always an eating disorder.” She goes on to say that for those with OCD, chewing and spitting is unrelated to body size, but is instead done for a variety of reasons such as an attempt to neutralise intrusive thoughts or a fear of food making them unwell. “The behaviours might look very similar, but the fear behind them is very different,” she says. Addiction and compulsion aren’t the only harmful side effects of CHSP. Most of the women I talked to “figured out” chewing and spitting on their own (one got the idea from the MTV comedy show Girl Code and another from an episode of Sex and the City) because they erroneously assumed that it would allow them to taste and enjoy food without any 'negative' consequences – calorific or otherwise. Distressingly for sufferers, however, chewing and spitting often causes more weight gain than they originally thought. This is because saliva contains enzymes that start the digestion process, meaning many more calories are absorbed than you’d first assume. Additionally, because sufferers tend to chew and spit large amounts of food in a session (like a bulimic’s binge), they often swallow more than they imagine. Hannah admits she tried to avoid this by chewing with her head facing down, often over a bin in the kitchen. She also says that CHSP sessions made her vision “go white” and her body feel weak and lightheaded. Other side effects reported by those I talked to include stomach and mouth ulcers, swelling of the jaw from the repeated chewing motion, and a build up of gas.