What is Rumination Disorder?

Rumination Disorder is a rare disorder that occurs mostly in infants and young children but has also been seen in older children and adults with intellectual disabilities.  Because there is not much research being done on this disorder, there seem to be more questions than answers.  This article will take a look at the definition, possible causes, what to look for and treatment for Rumination Disorder.

Rumination Disorder What Does It Mean?

Rumination Disorder is an eating disorder where a person eats their food and regurgitates it back up, often times chewing it again, regurgitating again and spitting it out. Regurgitation will occur within 30 minutes of eating, and usually within 10-20 minutes.  Sometimes will regurgitate and not chew it again.  One thing is clear, however, that this disorder is done without thinking about it or doing anything.  Persons with Rumination Disorder don’t consciously regurgitate their food and its unknown what causes it.

Ruminate Definition

The Merriam-Webster dictionary defines Ruminate as:  to chew again what has been chewed slightly and swallowed.  An example is how cows have to chew their food twice.  They cannot digest it without chewing twice, so, therefore, they chew once, swallow, regurgitate and chew again.  The word “ruminate” comes from the part of the cow called “rumen muscles” that sends the cud back up to a cow’s mouth where they then re-chew and swallow it.

Stats: How Many Suffer from this Disorder?

Rumination Disorder is very uncommon, however, it is not known how many people suffer from this disorder due to possible under-reporting.  This disorder typically occurs in infants between the ages of 3-12 months and is rarer in adults.  Most children that have this disorder outgrow it by adulthood and adults with this disorder tend to have intellectual disorders or do not seek treatment.  It is thought that slightly more boys than girls have this disorder.

What Causes Rumination Disorder?

The cause of Rumination Disorder is unknown.  Some doctors have said that it is a feeding or eating disorder, however, most medical professionals don’t believe it has anything to do with that.  Stress is thought to exasperate the disorder and it is thought that many times the behavior is learned.  Many doctors believe that often times persons with Rumination Disorder didn’t learn how to relax their abdominal muscles and instead constrict them which causes them to regurgitate the food.

Signs and Symptoms of Rumination Disorder

The signs and symptoms of Rumination Disorder are regurgitating food after eating it.  It appears to be more common in infants and young children but should be considered a possible diagnosis when it happens with older children or adults with developmental disabilities.  Many times the person will chew the food again and swallow the food after they have regurgitated it.

What are the Common Behaviors/Characteristics?

Rumination Disorder tends to happen mostly in infants and children, however, it also affects some adults.  Typically it is seen in infants, children and adults with intellectual disabilities.  Some medical professionals think that when a patient is unable to express that they don’t want food, they may develop Rumination Disorder. This, however, is not always the case.  It is not completely known why they develop this disorder, but it appears that it may either be learned behavior or brought on by stress.

Testing: What are the Diagnostic Criteria Per the DSM 5?

Rumination Disorder is often diagnosed after a complete medical examination and often times by observing the patient’s behavior during eating.  It is important to rule out any medical conditions before diagnosing someone with this disorder.

Some doctors may use a test called single-photon emission computerized tomography (SPECT) of the stomach to see how the stomach is functioning.  It can also help the doctors to determine if a medication to relax the stomach muscles can be used.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) identifies the following diagnostic criteria for rumination disorder:

  • Recurrent regurgitation of food for at least a one-month period. Regurgitated food may be spit out, rechewed, or reswallowed.
  • Regurgitation isn’t caused by a medical condition, such as a gastrointestinal disorder.
  • Regurgitation doesn’t always occur in relation to another eating disorder, such as anorexia nervosa, binge-eating disorder, or bulimia nervosa.
  • When regurgitation occurs alongside another intellectual or developmental disorder, symptoms are severe enough to require medical assistance.

This disorder is classified under “eating disorder in infancy” in the DSM 5.

Rumination Disorder and Other Conditions

Rumination Disorder is very different than any other disorder or condition, however, the conditions listed below should be ruled out before a diagnosis of Rumination Disorder is made.

Rumination Disorder vs GERD

In GERD, the acid that is used to break down food in the stomach rises into the esophagus which causes acid reflux, or GERD.  With GERD, food is not often regurgitated and when it is, it has an acidic taste which is not the case with Rumination Disorder. Treatment for GERD also does not help persons with Rumination Disorder.  GERD is usually treated with medication and diet.

Rumination Disorder vs Bulimia or Anorexia

Bulimia is characterized by binge eating then forcing yourself to vomit so that you don’t absorb the calories.  This is very different than Rumination Disorder because the vomiting is self-induced and intentional.  Bulimia is very severe and can be life threatening.  Persons with this disorder are not absorbing vitamins and nutrition and tend to have other problems associated with self induced vomiting.

Anorexia is characterized by a person that purposely restricts their calories in an effort to lose weight or to not gain weight. Persons with this disorder tend to exercise compulsively, self induce vomiting and may even take laxatives to try to get rid of food.  They often have a distorted view of their body image and may see themselves as being fat when they are, at times, underweight.  Again, this disorder is different from Rumination Disorder in that the actions are intentional.  A person with Rumination Disorder does not intentionally vomit or regurgitate their food.

Related Conditions

Rumination Disorder is considered an eating disorder that is unrelated to any other eating disorder.  It is believed that the regurgitation is unintentional, however, it can also be a learned behavior.

Rumination Disorder In Adults/Children

Rumination Disorder can occur in children and adults, however, it typically occurs in infants and young children.  There are cases of Rumination Disorder in older children and adults with intellectual disabilities, and is thought to be the cause of learned behavior or possibly a lack of desire to eat and they are unable to express this.  Its more likely that when Rumination Disorder occurs in infants and young children it is due to stress or tightening of stomach muscles.

Example Case of Rumination Disorder

A 11 year old male patient with complaints of vomiting, for the past 10-15 days.  Mom reports her son regurgitates his food within 15 minutes of swallowing it and sometimes chews it and swallows it again.  Patient has moderate mental retardation and this behavior appears to be new as the mother has never seen him do this before now.  Mom takes her son to a gastroentrologist who performs a variety of tests including looking at the lining of the patient’s stomach.  The doctor determines that the patient has no medical reason to be regurgitating his food and suggests the patient may have Rumination Disorder.  Patient is monitored in the hospital while tests are being completed.  The patient was discharged after five days of admission and was given a psychological consultation. Mother was counseled regarding the feeding techniques and given the name of some licensed therapists that can assist in cognitive behavior therapy to address the behavior aspect of the disorder.  After several months of treatment, the patient no longer exhibits symptoms of Rumination Disorder.

Rumination Disorder

How to Deal/Coping With Rumination Disorder

Rumination can be a difficult disorder to deal with due to the frustration it may cause the caretaker of someone with this disorder.  Often times, care takers don’t understand why the person is regurgitating food and may even feel that they can control it.

Look out for These Complications/Risk Factors

Some of the potential complications associated with Rumination Disorder when it is untreated are:

  • Malnutrition
  • Lowered resistance to infections and diseases
  • Failure to grow and thrive
  • Weight loss
  • Stomach diseases such as ulcers
  • Dehydration
  • Bad breath and tooth decay
  • Aspiration pneumonia and other respiratory problems caused by vomit that is breathed through the lungs
  • Choking
  • Death

Rumination Disorder Treatment

Treatment of rumination disorder focuses on changing the behavior. Several techniques are used, including:

  • Changing the persons posture during eating and right after eating.
  • In children, encouraging more interactions between a child and their mother during feeding; which in turn, gives the child more attention.
  • Reducing outside distractions during feeding.
  • Making the feeding time more relaxing and pleasant.
  • Distracting the person whenever he or she begins the rumination behavior.
  • Placing something sour or bad-tasting on the persons tongue when he or she begins to regurgitate food which is known as aversive training.

One of the most common treatments for Rumination Disorder is diaphragmatic breathing treatment.  During this treatment, the patient is taught how to do deep breathing and relax while eating.  Relaxing the diaphragm makes it impossible for someone to vomit while eating.

Possible Medications for Rumination Disorder

There are no medications to treat Rumination Disorder but they are medications that can treat the various symptoms and sometimes doctors will use medications to relax the stomach muscles if they determine that is the cause of the Rumination Disorder.

Home Remedies to help Rumination Disorder

There are no known home remedies for Rumination Disorder.

Living with Rumination Disorder

important to seek help from a medical professional if you know someone who may possible have Rumination Disorder. Without treatment, people with this disorder can damage their esophagus or cause weight loss that is unwanted.  Most infants and young children with this disorder will outgrow it, however, older children and adults may take longer and need more treatment for these symptoms to go away.

Insurance Coverage for Rumination Disorder

Most insurances will cover the diagnosis and treatment of Rumination Disorder.  To find out more, contact your treating physician or call the number on the back of your insurance card.

How to Find a Therapist

If you suspect you or someone you love has signs of Rumination Disorder, you can find a therapist at www.psychologytoday.com . There you will search for a therapist that specializes in eating disorders and cognitive behavior therapy.  Its important to seek medical attention first to rule out the possibilities of any underlying medical condition.

What Should I be Looking for in an LMHP?

To find a therapist that would have knowledge in working with persons with Rumination Disorder, you will want to make sure the therapist has knowledge of eating disorders and also of cognitive behavior therapy.  This therapy is often used to teach new behaviors.

Questions to Ask a Potential Therapist

Questions you should ask a potential therapist are:

  1. Are you knowledgeable of Rumination Disorder?
  2. Have you ever treated someone with Rumination Disorder and if so, how many people?
  3. What is your preferred treatment of Rumination Disorder?
  4. What is your success rate?

Rumination Disorder Resources and Support Helpline

National Eating Disorders website offers resources as well as a helpline number.  The website is www.nationaleatingdisorders.org.  The number to the helpline is: 800-931-2237.  Their website provides screening tools, support and information on eating disorders including Rumination Disorder.

Although Rumination Disorder is an uncommon disorder, it is highly treatable and the outcome for those who are diagnosed is very favorable.  Getting the diagnosis may be confusing at first, but with the right treatment and support, persons with this disorder can make a 100 percent recovery.  It’s important to gather all your facts and information and seek medical attention first to rule out any medical issues.   Support is out there and getting a good therapist will be helpful in learning how to cope with this disorder.