What Is Rumination Disorder?

Rumination disorder involves bringing previously chewed or previously swallowed food back up to the mouth, to either spit out or re-swallow. It's also sometimes called regurgitation disorder.

In babies, rumination disorder usually ends without any medical intervention. But the condition also can last into later years. Most people who are treated for rumination disorder are children and adults with intellectual disabilities and/or developmental delays.

For these people, regurgitation and rumination seem to be soothing.

Rumination disorder differs from self-induced vomiting more commonly found in anorexia nervosa and bulimia nervosa because, in rumination disorder the regurgitation is usually automatic and not usually intended to influence shape or weight.

It is important to remember that because these rumination behaviors are often done in secret and there is a fear of how others will react to it, it is assumed that many people who are struggling with this disorder do not seek treatment. Unfortunately, the true prevalence of rumination disorder is unknown.

Diagnosing Rumination Disorder

In order to meet the criteria for a diagnosis of rumination disorder, someone must meet all of the criteria for the condition outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the guide that mental health professionals use to diagnose mental conditions.

These criteria include:

• Repeated regurgitation of food for at least one month.  This food may be re-chewed, re-swallowed, or spit-out.  The regurgitation occurs without any sort of nausea or retching.

• There is no medical condition causing the person to regurgitate their food (for example, someone with bad heartburn might regurgitate food unintentionally).

• This problem does not occur exclusively when the person is suffering from another feeding or eating disorder such as anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.

• If the symptoms are occurring alongside another mental disorder, the symptoms are severe enough to warrant attention by themselves.

Rumination disorder is relatively rare among adults receiving treatment for eating disorders. One recent study assessed 149 consecutive females entering residential treatment for an eating disorder and found that 4 patients met criteria for rumination disorder, but were ineligible for a formal diagnosis because they met criteria for one of the other eating disorders.  

Complications of Rumination Disorder

People who have rumination disorder can suffer from malnutrition, and that can lead to a host of other medical complications. Malnutrition may occur because rather than eating more food, the person is continuously eating and re-chewing the same food over and over again.

Older children and adults may also restrict what they are eating in order to avoid negative social reactions to their rumination. Less extreme complications of rumination disorder are bad breath, tooth decay, and ulcers on the esophagus.

Treatment

Unfortunately, there is very little research on the treatment of rumination disorder.  However, the treatment of these symptoms must be individualized to each person, based on whether or not there is another co-occurring disorder such as anorexia nervosa or bulimia nervosa, or if the person is intellectually delayed. 

If the person with rumination disorder also is suffering from another eating disorder, then treatment goals will focus on that problem, with the goal of reducing all symptoms related to the eating disorder.

 For a young child or someone who has an intellectual disability or delay, treatment will likely include some type of behavioral therapy and may include goals such as changing the way(s) the person is able to soothe themselves.

Behavioral strategies such as diaphragmatic breathing training, which teaches individuals to breathe using their diaphragm muscles are often effective because diaphragmatic breathing is incompatible with regurgitation. Self-monitoring of the behavior can also be beneficial by drawing greater awareness to the behavior.

_Sources:

_{American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.}

_{Clouse, R.E., Richter, J.E., Heading, R.C., Janssens, J., & Wilson, J.A. (1999). Functional esophageal disorders. Gut, 45. 1131-1136.}

Delaney, Charlotte B., Kamryn T. Eddy, Andrea S. Hartmann, Anne E. Becker, Helen B. Murray, and Jennifer J. Thomas. 2015. “Pica and Rumination Behavior among Individuals Seeking Treatment for Eating Disorders or Obesity.” International Journal of Eating Disorders 48 (2): 238–48. doi:10.1002/eat.22279.

_{Hartmann, A.S., Becker, A.E., Hampton, C., & Bryant-Waugh, R. (2012). Pica and rumination disorder in the DSM-5. Psychiatric Annals, 42(11). 426-430.}

_{Papadopoulos, V. & Mimidis, K. (2007). The rumination syndrome in adults: A review of the pathophysiology, diagnosis, and treatment. Journal of Postgraduate Medicine, 53(3). 203-206.}

Thomas, Jennifer J., and Helen B. Murray. 2016. “Cognitive-Behavioral Treatment of Adult Rumination Behavior in the Setting of Disordered Eating: A Single Case Experimental Design.” International Journal of Eating Disorders 49 (10): 967–72. doi:10.1002/eat.22566.