Rumination disorder, also called rumination syndrome, is a rare eating disorder that causes a person to regurgitate their food — normally within 15 minutes after their meal is finished.
Here, we’re going to take a closer look at what rumination is, the possible causes, and how rumination disorder can be treated.
What Is Rumination Disorder?
Rumination disorder is a rare behavioral problem where someone regurgitates their food. This is a reflex rather than a conscious action and tends to happen within 15 minutes of finishing a meal.
One of the important things to note about rumination disorder is that people dealing with this condition don’t tend to appear stressed, upset, or disgusted when they regurgitate, nor do they appear to be making any effort to perform forceful contractions of the abdominal muscles. It’s unconscious, making it different from other eating disorders such as anorexia, bulimia, binge-eating disorder, and avoidant/restrictive food intake disorder (ARFID).
Melissa Galica, a Grow Therapy Licensed Professional Counselor, elaborates: “The main difference between rumination disorder and other eating disorders is that rumination disorder is considered an unconscious behavior that is an attempt to provide some sort of relief, whereas bulimia nervosa, the eating disorder that it’s commonly confused with, is purposeful control of binging and purging related to weight loss and/or body image.”
As a byproduct of rumination disorder, individuals may try to limit how much or how often they eat to avoid regurgitation, which results in unduly weight loss and the development of nutritional deficiencies.
Symptoms of Rumination Disorder
Another key thing to remember about rumination disorder is that the accompanying regurgitation differs from vomiting. Vomiting is a forceful action that might involve gagging and retching, and people aren’t often able to keep the vomitus in their mouths. Regurgitating is usually effortless without gagging or retching, and a person can keep the undigested food in their mouth.
Because people think that the effortless regurgitation taking place is vomiting, and vomiting is much more common, rumination disorder tends to be mistaken for other medical conditions, such as digestive problems.
Common symptoms, as reported by patients with rumination disorder, are dyspepsia (pain or an uncomfortable feeling in the upper middle of your stomach area) and abdominal pain.
Galica advises that some psychological symptoms can coexist with rumination disorder, such as “anxiety, depression, social isolation, low self-esteem, feelings of guilt or shame, irritability, trouble concentrating, and trouble sleeping. These symptoms can range from mild to severe,” she adds.
Diagnosis of Rumination Disorder
According to the National Eating Disorders Association, for rumination disorder to be diagnosed, a doctor will follow this Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria:
- Repeated regurgitation of food for a period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out
- The repeated regurgitation is not because of a medical condition (e.g., functional gastrointestinal disorders)
- The behavior does not occur exclusively during anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder (ARFID)
- If it occurs in the presence of another mental disorder (e.g., an intellectual developmental disorder), it’s severe enough to warrant independent clinical attention
If a medical health provider suspects an individual has a rumination disorder, they’ll evaluate the patient’s nutritional status to check for weight loss and nutritional deficiencies. They can also perform an esophageal manometry, a test to show whether someone’s esophagus is working correctly.
To differentiate between regurgitation and vomiting, a medical health provider must take a detailed history from the patient. Particulars, such as rumination disorder, not usually accompanied by nausea and regurgitated food being undigested and recognizable, are helpful for a clinician to rule various conditions in or out.
If a clinician wants to solidify their diagnosis further, they can perform a behavioral observation whereby a patient consumes the foods they associate with regurgitation with the clinician present.
Causes of Rumination Disorder
Rumination syndrome is believed to be unintentionally acquired. According to a paper published in the National Library of Medicine, the risk factors for someone developing rumination disorder might include:
- Emotional neglect (in infants)
- Emotional stress
- Presence of mental health diagnoses such as obsessive-compulsive disorder, anxiety, depression, adjustment disorder, post-traumatic stress disorder, and attention deficit-hyperactivity disorder (ADHD)
- Developmental delay
- Fibromyalgia (a chronic disorder that causes pain and tenderness throughout the body, as well as fatigue and trouble sleeping)
While experts believe that rumination disorder is unconscious, they also think that the voluntary muscle relation of the diaphragm becomes a learned habit — similar to a typical belching (burping) reflex.
There may have been a particular priming episode of psychological stress or gastrointestinal (GI) upset (such as gastroenteritis) before any symptoms of rumination disorder were noticed. This episode or event might have been small and quickly forgotten, but it’s thought that this prompts patients to tense their abdominal walls to relieve discomfort. This reaction is then maintained and reinforced, resulting in patients continuously tensing their abdomens after eating.
The National Library of Medicine published research in 2019 that stated rumination can help alleviate psychological distress (such as anxiety) or provide a soothing/pleasant sensation (for example, in infants and individuals with developmental disabilities and those who seek out foods or times to ruminate).
Rumination disorder is often a primary condition, but it’s been recognized that it can occasionally be a secondary response to GERD episodes and is a maladaptive response to the discomfort caused by them.
Health Risks of Rumination Disorder
Various health risks can affect people with rumination disorder, especially those with severe symptoms.
When regurgitation occurs, and the individual does not intend to re-chew the food but spits it out, or if they eat less because they want to avoid regurgitation, this can lead to malnutrition and dehydration. These can result in electrolyte imbalances and a condition called refeeding syndrome when medical complications occur from increased nutrition after a long period of starvation.
Additional possible health risks in both adults and children with rumination disorder are a failure to grow and develop normally, dental erosions, the likelihood of aspiration (when food or liquid enters a person’s airway and then the lungs by accident), halitosis (bad breath), and stigma because of the rumination or its connected complications.
Treatment Options for Rumination Disorder
If you think you have a rumination disorder, seek medical intervention sooner rather than later. Here are treatment steps you can take:
Visit a Healthcare Provider
If you or a loved one appears to be dealing with rumination disorder, it’s important to visit a healthcare provider so that they can deliver an accurate diagnosis.
Gastroenterologists (doctors specializing in gastroenterology, studying the function of the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts, and liver) can diagnose and treat gastrointestinal issues. Book an appointment with a gastroenterologist — as referred by your GP — to rule out gastric-specific concerns.
There aren’t yet any medications that can directly treat rumination disorder. The best way to stop the condition is for the patient to relearn how to eat and digest food correctly — often requiring diaphragmatic breathing training. “Studies have shown that diaphragmatic breathing can effectively treat rumination disorder. In one study, people with rumination disorder who were taught diaphragmatic breathing showed a significant reduction in the frequency of their rumination episodes,” Galica says.
Diaphragmatic breathing techniques, which can also be called deep breathing or belly breathing, are often taught to help the body relax. Instead of the stomach moving with each breath, diaphragmatic breathing encourages the stomach to expand while inhaling and contract while exhaling.
Diaphragmatic breathing can also offer a number of gastrointestinal-related benefits, such as reducing abdominal pain and bloating. This is because activating the diaphragm creates a gentle massaging action felt by the intestines and stomach.
Behavioral Therapy
Because rumination disorder is a behavioral problem, behavioral therapy is a plausible treatment option. JohnNeiska Williams, a Grow Therapy Licensed Professional Counselor, concurs: “Behaviors are learned and can be changed through several positive forms of reinforcement. Behavior therapy can help as it uses biofeedback. They [behavioral therapists] teach individuals how to understand breathing and recognize symptoms more easily. The biofeedback imaging (when someone is connected to electrical pads to help them get information about their body) shows patients how they can improve and how to make it [breathing] more effective.”
Other Therapies Used to Treat Rumination Disorder
Galica adds, “Other behavioral therapies, such as habit reversal therapy, exposure therapy, and CBT, may also be effective in treating rumination disorder.”
Get Help for Rumination Disorder
Like with all eating disorders, it can take time, patience, and consistency to reach the ultimate goal of getting to a place where someone lives a happier life. The most important thing anyone can do when they have an eating disorder or mental health condition is to give themselves grace — recognizing there’s a problem is already part of the journey completed.
Grow Therapy is home to many excellent, qualified therapists specializing in eating disorders and behavioral therapy. Simply filter by the specialty and insurance type you’re looking for, and find the right therapist for you or your loved ones.
