What Is Rumination Disorder?

A Disorder Characterized by Habitual Regurgitation

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Rumination disorder is a disorder characterized by an individual’s uncontrollable and frequent regurgitation of food. The food that is regurgitated is either re-chewed and swallowed, or spit out.

It’s most common to see a diagnosis of rumination disorder in infants, young children, and individuals with intellectual disabilities. However, as more awareness about rumination disorder is available adolescents and adults are now more frequently diagnosed. It is not considered a commonly diagnosed disorder.

Parent assists child who has spit up

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Rumination disorder, also referred to as rumination syndrome, is considered a psychological disorder, classified under feeding and eating disorders in the "Diagnostic and Statistical Manual of Mental Disorders, Edition 5" (DSM 5), but a gastroenterologist and other specialists are typically involved in diagnosis—particularly to eliminate medical causes for regurgitation.

Due to the limited research and knowledge around rumination disorder, there is often conflicting information presented by academic journals and scholarly articles, including some characterizing rumination disorder as a functional gastrointestinal disorder.

What is Rumination Disorder?

Rumination disorder can be differentiated from other types of eating disorders, like bulimia nervosa, because the food is effortlessly regurgitated and not actively retched. Individuals with rumination disorder will often eat a meal, and then regurgitate the food within 30 minutes, eliminating the typical acidic or bitter taste of digested food that is vomited. With rumination disorder, an individual may belch or burp after a meal, leading to the regurgitation.

Rumination Disorder vs. Bulimia

Rumination disorder should not be confused with bulimia nervosa. Despite the fact that they are both classified as feeding disorders, rumination disorder differs from bulimia in a few ways. This includes:

  • People with rumination disorder are aware of the negative impact that regurgitation has on their health, but they cannot control the regurgitation reflex.
  • While people with bulimia nervosa are often attempting to achieve a specific type of body, this is not usually the case with rumination disorder. 

Symptoms

The frequency and severity of rumination disorder varies from person to person, but typically a person will regurgitate food within a half-hour of eating a meal. Food that is regurgitated has not mixed with stomach acid and does not taste unpleasant, so it may be rechewed and swallowed or spit out

Other symptoms may include:

  • Regurgitation that is not forced and not preceded by retching
  • Belching or burping prior to regurgitation
  • Abdominal discomfort, relieved once food has been regurgitated
  • Halitosis (chronic bad breath)
  • Weight loss, though not typically planned or intended
  • Chapped lips

Rumination disorder can also create psychological distress and embarrassment, especially because of the lack of control over the regurgitation. Over time the following symptoms can be found:

Diagnosis

Diagnosing rumination disorder can be a complicated process, especially because other medical conditions must first be ruled out by medical specialists, such as gastroenterologists. Costly procedures and testing with long wait lists may also slow down the process.

Symptoms that may suggest rumination disorder: 

  • Absence of gagging, retching, or acid reflux
  • Lack of sour or bile taste when food is regurgitated
  • The timing of the regurgitation

Testing will be done to rule out gastrointestinal causes of the symptoms, including achalasia (a motility disorder of the esophagus), gastroparesis (in which the stomach takes too long to empty its contents), and gastroesophageal reflux disease (GERD), in which stomach acid enters the esophagus.

Some of the tests include:

Once the doctor eliminates physical causes of the regurgitation and related symptoms, a mental health professional, such as a psychologist or psychiatrist, can diagnose rumination disorder. The diagnosis is made based on the criteria discussed in the DSM-5:

  • Food is regurgitated for a minimum of one month, with or without rechewing and swallowing. 
  • The regurgitation is not attributed to any physical medical condition
  • The regurgitation, or related symptoms, are not linked to any other eating disorders, including bulimia nervosa, anorexia nervosa, or binge-eating disorder. 
  • If the regurgitation occurs alongside another mental health disorder, such as anxiety, or a neurodevelopmental disorder, the symptoms must be severe enough for a separate investigation and diagnosis.

Studies suggest that people with rumination disorder visit an average of five doctors over 2.7 to 4.9 years before a correct diagnosis is reached.

Causes

Currently, there is no known cause for rumination disorder. For infants and younger children, there is some speculation that being over or under-stimulated at home can contribute to rumination disorder. Regurgitation may also be a way to deal with emotional distress, and can then become a habit that is difficult to break. 

Treatment

Treatment for rumination disorder may be different depending on the severity, age of the patient, and underlying mental health conditions. A behavioral psychologist will often work with a patient to unlearn habits, whether conscious or unconscious, that lead to the regurgitation. 

These practices may involve:

  • Deep breathing exercises, particularly after meals.
  • Habit-reversal training
  • Relaxation techniques
  • Aversion therapy

Sometimes a gastroenterologist is part of the treatment team, in which case some medications may be prescribed to help with recovery. Some medications that might be prescribed include Nexium (esomeprazole) or Prilosec (omeprazole) if there is damage to the esophagus from frequent regurgitation. 

Coping

Rumination disorder is a complicated health challenge that can lead to frustration and embarrassment. If you have rumination syndrome there is nothing to be ashamed of. Being diagnosed with rumination disorder does not mean that there’s something “wrong” with you.

Having a disorder that is unfamiliar and complex can lead to loneliness and isolation, but it’s important to reach out and find support, and to know that there is help and therapy to support your recovery. 

  • Find an in-person or online support group. Contact your care team, or an eating disorder helpline for suggestions, such as Eating Disorder Hope at 1-855-783-2519. 
  • Attend therapy or counseling
  • Find something that reduces stress, like yoga or hiking
  • Journal or log how you’re feeling
  • Talk to your doctor if you’re feeling anxious or depressed
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Article Sources
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