What is rumination disorder?

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What is rumination disorder?

Rumination disorder, also referred to as rumination syndrome, is a rare and chronic condition that is characterized by an individual’s uncontrollable regurgitation after most meals. (1) While rumination disorder tends to occur less frequently in the general population, research suggests that its prevalence may be as high as eight percent in those with eating disorders. (2) 

In rumination disorder, the food is effortlessly regurgitated, without actively retching. The regurgitated food is either re-chewed and swallowed, or spit out. This usually occurs within 30 minutes of eating, before stomach acid can break down the food, thus eliminating the acidic taste of digested food. (3)

While it’s more commonly diagnosed in infants, children, and those with developmental delays, rumination disorder can affect people of all ages.

Diagnosing rumination disorder

Diagnosing rumination disorder can be a complicated and lengthy process, as there is currently no test for rumination disorder. And healthcare specialists–such as gastroenterologists– first must rule out other medical conditions, such as gastroparesis and gastroesophageal reflux disease. (3)

Once other physical causes of regurgitation have been ruled out, a mental health professional can talk to a patient about their symptoms. If certain criteria are met, rumination disorder can be diagnosed. The criteria for a rumination diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) include: (4)

  • Regurgitating food for at least one month, with or without rechewing and swallowing.
  • Regurgitation is not the result of a physical medical condition.
  • Regurgitation and other related symptoms are not linked to another eating disorder, such as bulimia nervosa or binge eating disorder.
  • The symptoms of regurgitation must be severe enough for a separate diagnosis if it occurs alongside another mental health disorder.

To diagnose rumination disorder in children, it may be necessary for a medical professional to review their eating habits by observing them during and after feeding.

Signs and symptoms of rumination disorder

The severity and frequency of rumination disorder vary between individuals. Identifying the signs and symptoms of the condition is an important part of getting a quick diagnosis. 

Swift treatment can address malnutrition and reduced immune function, which can be common in cases of rumination disorder, helping people recover completely. Here are some warning signs that could indicate a rumination disorder: (2,3,5)

  • Regurgitation that is not preceded by retching or forced, 30 to 120 minutes after eating
  • Burping before regurgitation
  • Abdominal pain, which is relieved following regurgitation
  • Indigestion
  • Unplanned or unintentional weight loss
  • Halitosis (chronic bad breath)
  • Chapped lips and/or dry lips
  • Tooth decay
  • Depression and/or anxiety
  • Malnutrition
  • Avoiding social events or eating with others
  • Hunger and irritability between regurgitation episodes

Effects of rumination disorder

Short-term effects

The short-term effects of rumination disorder are fairly subtle and can often be mistaken for something else, such as poor oral hygiene or even poor table manners, particularly when in young children. Common short-term effects of rumination disorder include: (5)

  • Unintentional weight loss
  • Dehydration
  • Bad breath
  • Tooth decay or erosion
  • Choking

Long-term effects

If left untreated, the long-term effects of rumination disorder can be serious and life-limiting. Medically, long-term regurgitation can result in significant weight loss, which may lead to developmental delays in children. Malnutrition can also occur, with the associated nutritional deficiencies potentially resulting in a weakened immune system.

Rumination disorder can also have psychological and social effects. Sufferers often avoid social situations and develop mental health disorders, such as anxiety and depression.

Some long-term consequences of rumination disorder are: (6)

  • Malnutrition and nutritional deficiencies
  • Reduced resistance to infections and diseases
  • Stomach issues, such as ulcers
  • Failure to grow and thrive, in children
  • Aspiration pneumonia or other respiratory issues, from vomit inhaled into the lungs
  • Death

Related disorders

In many cases, rumination disorder does not occur independently. Rumination syndrome is associated with several co-occurring disorders, which include: (2)

  • Anxiety disorder
  • Depression
  • Post-traumatic stress disorder
  • Obsessive-compulsive disorder
  • Attention deficit-hyperactivity disorder

Treatment of rumination disorder

Treatment for rumination disorder is the same for children and adults and usually consists of behavioral therapy. (7)

Other healthcare professionals, such as massage therapists, recreational therapists, psychologists, nutritionists, and nurse practitioners, may also be involved in the care of people with rumination disorder. This ensures the patient is receiving adequate nutrition, as well as managing other symptoms, such as anxiety and stomach discomfort.

Therapies for rumination disorder

Behavioral therapy focuses on changing the learned behaviors responsible for regurgitation. A behavioral psychologist or gastroenterologist will work with a patient to unlearn habits–whether unconscious or conscious–that lead to regurgitation. Approaches used will be tailored to a patient’s individual needs, abilities, and age. (4)

The primary treatment approach for rumination disorder is diaphragmatic breathing. Patients are taught to breathe deeply from their diaphragm rather than their chest. This helps relax the diaphragm and change pressure in the esophagus, which prevents regurgitation after eating.

For children with rumination disorder, several additional approaches may be used to stop regurgitation, including: (6)

  • Changing a child’s position during and after eating
  • Distracting a child when they start ruminating
  • Increasing interaction between the caregiver and child during meal times
  • Using techniques to make mealtime a more relaxing and pleasurable experience
  • Aversive conditioning, which involves placing something unpleasant tasting in the mouth

Medications for rumination disorder

There are currently no FDA-approved medications to treat rumination disorder. However, Baclofen is a medication that has shown promise. (8) It’s believed to reduce regurgitation following a meal by increasing the resting pressure of the esophagus, potentially reducing the relaxation that leads to effortless regurgitation. 

Currently, Baclofen is only prescribed in cases where patients don’t improve with behavioral interventions, due to its side effects, which include dizziness, weakness, constipation, and headaches.

Understanding rumination disorder

People with rumination disorder often report their primary symptom as vomiting. Due to limited understanding of rumination, this can lead to the disorder being confused with other conditions, such as bulimia nervosa or gastroparesis, in which the stomach cannot empty normally. (8)

There is a misconception that rumination disorder only affects infants and children, and primarily those with a developmental delay. So patients are often misdiagnosed. Research suggests it can take from two to six years to get a correct diagnosis. (9)

Living with rumination disorder

Rumination disorder is a complicated health issue that can result in embarrassment and frustration. It’s not unusual for people living with rumination disorder to avoid social occasions, preferring to eat alone, as they fear judgment from other people.

But rumination disorder is nothing to be ashamed of. It’s a medical condition that requires treatment, just like any other. Living with such a complex disorder can lead to isolation and loneliness, so it’s important to reach out for support and know there is help out there for you.

Recovery from rumination disorder is possible. The team at Within Health can guide you toward the right help and  provide a strong support network. 

History of rumination disorder

  • Rumination disorder was first clinically described in 1618 by Fabricius ab Aquapendente, an Italian anatomist, who identified the symptoms in one of his patients. (10)
  • Among the first recorded cases of rumination disorder was of the physician, Charles-Eduoard Brown-Sequard, who acquired the condition by stimulating regurgitation on himself repeatedly for experiments. Eventually, he regurgitated his meals habitually.

How to help someone with rumination disorder

Getting help early for rumination disorder can save you or your loved one from prolonged distress or further complications, like malnutrition. The first step toward recovery is finding a trustworthy and compassionate health care provider who can support you throughout treatment

The multidisciplinary team of medical professionals at Within Health has the highly specialized expertise in eating disorders that’s essential in providing the services and support needed for a full recovery. Contact us today to learn more.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Vandergriendt, C. (2018, September 18). Rumination disorder: Treatment in children vs. adults, and more. Healthline. 
  2. Halland, M. (2020, July 18). Rumination Disorder. UpToDate. 
  3. Bell, B. (2021, February 7). Is rumination disorder a medical or psychological condition? Verywell Health. 
  4. Mousa, H.M., Montgomery M., Alioto, A. Adolescent rumination syndrome. Curr Gastroenterol Rep. 2014;16(8):398.
  5. Rumination disorder (2019, Oct). Beat. (n.d.). 
  6. WebMD. (n.d.). Mental health: Rumination disorder. WebMD. 
  7. U.S. Department of Health and Human Services. (n.d.). Rumination disorder. Genetic and Rare Diseases Information Center. 
  8. Vasant, D., and Disney, B.  How to recognise and manage rumination syndrome.  (2021, November 16) The British Society of Gastroenterology.
  9. Rumination disorder  Psychology Today. (n.d.). 
  10. Olden, Kevin W. (2001), Rumination. Current Treatment Options in Gastroenterology, 4 (4): 351–358.
  11. Kanner, L (February 1936), Historical notes on rumination in man. Medical Life, 43 (2): 27–60.

FAQs

Is rumination syndrome an eating disorder?

Yes, rumination is an eating disorder, in which undigested food comes back up from a person’s stomach into their mouth to be spit out or re-swallowed, shortly after eating. There is no medical reason–such as gastroparesis–for the regurgitation. And, unlike bulimia, the regurgitation is effortless and often uncontrollable.

What causes rumination disorder?

The causes of rumination disorder are not currently clear, but researchers believe the action to regurgitate–such as contracting the diaphragm muscles–is learned. But certain factors may increase the risk of developing rumination disorder, including:

  • Having an acute illness
  • Experiencing a mental illness or psychiatric disturbance
  • Undergoing major surgery
  • Undergoing a stressful life event

When should you get help for rumination disorder?

Rumination disorder can lead to weight loss, malnutrition, electrolyte disturbances, and dental issues if left untreated. (5) So it’s important to seek professional help as soon as possible, if you’re worried about yourself or a loved one.


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