How Rumination Disorder Is Diagnosed

Rumination disorder, or rumination syndrome, occurs when a person regurgitates food (which they either spit out or rechew and swallow).

The regurgitation is believed to be an unintentional but learned behavior. When a person with the condition regurgitates food, they usually do not feel upset by it. In some cases, it can even be self-soothing.

Before making a diagnosis of rumination disorder, a doctor must rule out other conditions that can have similar symptoms, including feeding and eating disorders and gastrointestinal diseases. They may run tests that are not typically used to diagnose other eating disorders, such as esophageal manometry, gastric emptying studies, and esophagogastroduodenoscopy.

Anyone can have rumination disorder, but it is most frequently diagnosed in children and adults with intellectual disabilities. The experience of being diagnosed will be similar for everyone, but there are some key elements that a person being assessed for the condition or their caretakers should understand.

Diagnostic Criteria

There are two different sets of diagnostic criteria for rumination disorder because it is classified as a mental health condition and a gastroduodenal condition. The criteria that need to be met for each diagnosis are a little different; for example, how long a person has had symptoms.

If you or a loved one might have rumination disorder, here's what you can expect from the process of getting diagnosed.

DSM-5 Criteria for Rumination Disorder

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) is the handbook that mental health professionals use to diagnose mental health conditions, including rumination disorder.

The DSM-5 diagnostic criteria for rumination disorder include:

• Repeated regurgitation of food for one month or longer; the person may spit out, rechew, and/or re-swallow the regurgitated food.
• The regurgitation is not being caused by a medical condition (such as a gastrointestinal disease).
• The repeated regurgitation is not due to anorexia nervosa, bulimia nervosa, binge eating disorder, or avoidant restrictive food intake disorder (ARFID).
• If another mental disorder is present—such as an intellectual or developmental disorder—the repeated regurgitation is severe enough to require independent clinical attention.

ROME IV Criteria for Rumination Disorder

ROME IV is the document that guides gastroenterologists in diagnosing functional gastrointestinal disorders.

According to the ROME IV, a person with rumination disorder must have started having symptoms at least six months previously. Additionally, two symptoms must have started happening regularly in the past three months:

• Persistent or recurrent regurgitation of recently ingested food into the mouth, with subsequent spitting or remastication and swallowing.
• Regurgitation is not preceded by retching.

Professional Screenings

If you or a loved one is being assessed for rumination disorder, you will talk with your doctor about different aspects of your health, lifestyle, and medical history. They will ask questions about your diet, diseases or conditions that run in your family, and any other symptoms you might have.

Your doctor will also have you explain what happens when you regurgitate—for example, does it happen only at certain times or after eating specific foods?

Doctors can use specific interview styles or screening tools that have been standardized through research to help them diagnose conditions like rumination disorder.

PARDI

The Pica, ARFID, and Rumination Disorder Interview (PARDI) is a relatively new semi-structured interview that was developed to diagnose feeding and eating disorders. It is administered by a medical professional and takes, on average, about 39 minutes to complete.

Preliminary evidence indicates that the PARDI is reliable and valid, but more research with larger sample sizes is needed to determine how useful it is for diagnosing rumination disorder.

The types of questions that might be asked during the PARDI include:

• Has the material come back up into your mouth during or after eating in a way that felt different from being sick or throwing up (vomiting)?
• How did it feel different from being sick or throwing up (vomiting)?
• Do you experience retching when the material comes back up?
• How long after eating does the material first come back up?
• How many times does the material come back up once it starts?
• What does the material taste like?
• Do you experience a sensation that tells you the material is about to come back up?
• Have you rechewed it, re-swallowed it, or spat it out?

ROME IV Questionnaire

The ROME IV includes criteria to diagnose functional gastrointestinal disorders, including rumination disorder.

Some clinicians, primarily gastroenterologists, use the questionnaire associated with the ROME IV to gather a clinical history and screen a patient for rumination disorder.

Behavioral Observation

If you or someone that you care for is being evaluated for rumination disorder, your doctor might ask you to come to the office so they can watch you eat. If you have identified specific foods that seem to be associated with regurgitation, your doctor will want you to eat those foods.

Doctors typically use observation when a patient's history has not given them enough information to be confident of a diagnosis of rumination disorder, or in cases where the patient is a child or person with intellectual disabilities who may not be able to discuss their symptoms.

Labs and Tests

There is no single biomarker or test that can be used to diagnose rumination disorder. However, the diagnosis process typically involves some medical tests.

If you are regurgitating often, you might first be referred to a gastroenterologist before seeing a mental health professional. Different tests can help doctors figure out the cause of regurgitation, and the results can also help them rule out specific gastrointestinal conditions.

High-Resolution Esophageal Manometry With Impedance

High-resolution esophageal manometry with impedance assesses the pressure and movement of fluid within a person's esophagus and lower esophageal sphincter (LES).

The test is one of just a few that have been studied and shown to potentially help doctors detect rumination disorder. A 2017 study found that the test could tell the difference between rumination disorder and gastroesophageal reflux disease (GERD) when abdominal pressure increased >25 mm Hg.

While high-resolution esophageal manometry has the potential to be an important part of the diagnosis of rumination disorder, experts say more research is needed to be confident in its use as a diagnostic tool.

Differential Diagnosis

Differential diagnosis is a process that doctors can use to reduce the chance of misdiagnosing a patient. The process helps doctors evaluate a patient for all possible diagnoses, rule out conditions one at a time, and ultimately reach the correct diagnosis.

Ruling Out Other Conditions

As both a feeding and eating disorder and a functional gastroduodenal disorder, the symptoms of rumination disorder can overlap with other conditions. This can make diagnosis challenging.

While there are some elements to the diagnostic process that are the same for nearly every patient, each person will need to be evaluated individually.

Gastrointestinal conditions that doctors need to rule out before diagnosing rumination disorder include:

• Gastroesophageal reflux disease (GERD)
• Gastroparesis
• Eosinophilic esophagitis (EoE)
• Cyclic vomiting syndrome
• Achalasia
• Congenital anatomical defects

Your doctor also needs to consider mental health conditions that could explain a patient's symptoms, such as:

• Anorexia nervosa
• Bulimia nervosa
• Binge eating disorder (BED)
• Avoidant restrictive food intake disorder (ARFID)

Medical tests such as gastric emptying and esophagogastroduodenoscopy can be used to rule out some gastrointestinal conditions.

Your doctor may give you self-report questionnaires or ask you questions to see whether your symptoms fit better with another gastrointestinal, mental health, or eating disorder.

The Roles of Different Doctors in Diagnosis

The process of being diagnosed with rumination disorder can also be different depending on what type of medical professional is involved.

Gastroenterologists often believe that rumination disorder can be diagnosed using screening tools and by gathering a clinical history without the need for more invasive medical tests.

On the other hand, mental health clinicians that follow the DSM-5 criteria believe that medical tests need to be completed to rule out possible gastrointestinal causes before a mental health condition can be diagnosed.

Some researchers believe that a patient's clinical history alone is enough to diagnose rumination disorder—unless the patient also has clear symptoms of another gastrointestinal disorder that could be causing the regurgitation.

Summary

A person with rumination disorder regurgitates the food they have recently eaten. While the regurgitation is unintentional, it is often a learned behavior and is sometimes self-soothing. A person is usually not upset by the regurgitation and may either spit out the food or rechew and swallow it.

Children and adults with intellectual disabilities are most often diagnosed with regurgitation disorder, but any person can develop it. If a person has symptoms that suggest the condition, they will need to be evaluated by different types of doctors.

Gastroenterologists and mental health professionals are usually involved in the diagnosis of rumination disorder because it is considered both a mental health condition and a functional gastrointestinal disorder.

A Word From Verywell

If you or someone that you care for is regurgitating food, it's important to talk to your doctor about the symptoms.

There are different types of tests clinicians can use to rule out other possible causes for regurgitation, and it is important that they are certain there is no other explanation for the symptoms before diagnosing regurgitation disorder.

While there can be many causes for your regurgitation, most—including regurgitation disorder—can be treated as long as the correct diagnosis is reached.