Rumination Disorder

When discussing eating disorders, most people are familiar with common ones such as bulimia or anorexia. However, there is a distinct category known as Other Feeding and Eating Disorders that encompasses rare and lesser-known conditions that don’t align with the criteria of more widely recognised disorders. One example is rumination disorder, where people regurgitate food and then re-eat it. While this behaviour may appear uncommon, it is a valid eating disorder that affects many people globally.

What is rumination disorder?

Rumination disorder is an eating disorder presentation that is found under the classification of OFED. It’s characterised by the repeated regurgitation of food that is then re-chewed, re-swallowed or spit out. This behaviour typically occurs within the first 30 minutes after a meal and is not related to a medical condition. The disorder is usually found in infants but has been reported in adults with intellectual disabilities.

Is rumination disorder rare?

The exact number of people with rumination syndrome is uncertain because different criteria are used for diagnosis in different medical settings. Many cases likely go undiagnosed because of this. Patients often take a long time to get the right diagnosis, seeing multiple doctors, which can result in limited and possibly inaccurate data. Also, the symptoms reported by patients, like vomiting and abdominal pain, can overlap with other disorders, making it challenging to diagnose rumination syndrome accurately.

How is rumination disorder diagnosed?

According to the DSM-5, rumination disorder is diagnosed through the following criteria and features:

  • Food that was previously eaten and might be partially digested is brought back up into the mouth without feeling sick or disgusted. This can happen regularly, at least a few times a week.
  • The repetitive regurgitation is not linked to any underlying gastrointestinal or medical conditions like gastroesophageal reflux or pyloric stenosis.
  • The eating disturbance is not exclusive to anorexia nervosa, bulimia nervosa, binge-eating disorder or avoidant/restrictive food intake disorder.
  • If the symptoms occur alongside another mental disorder (e.g., intellectual disability or neurodevelopmental disorder), they must be severe enough to warrant additional clinical attention.

The clinician can directly witness those exhibiting the symptoms of rumination disorder to diagnose. In some cases, a diagnosis can be determined through self-report or information provided by parents or caregivers. People might explain the behaviour as a habit or something they can’t control.

Is rumination disorder dangerous?

While rumination disorder itself may not be inherently dangerous, it can have potential health consequences.

Some potential risks and complications associated with rumination disorder include:

  • Nutritional deficiencies: The regurgitated food may result in a loss of nutrients, leading to nutritional deficiencies and related health problems.
  • Weight loss and failure to thrive: If the behaviour persists, it may lead to weight loss and a failure to thrive, particularly in infants and young children.
  • Dental issues: Frequent exposure of the teeth to stomach acid from regurgitated food may contribute to dental problems, such as tooth decay.
  • Social and emotional impact: Rumination disorder can have social and emotional consequences, leading to isolation, embarrassment and a negative impact on overall well-being.

What are the causes of rumination disorder?

The exact causes of rumination disorder are not fully understood, and it likely involves a combination of biological, psychological and environmental factors. Some potential contributors to the development of rumination disorder include:

  • Early learning and conditioning: Rumination disorder often begins in infancy or early childhood. Some people may develop the behaviour as a learned response to stress or discomfort, possibly as a way to self-soothe. The act of regurgitating and re-chewing may have initially provided relief from distress.
  • Environmental factors: Stressful or adverse environmental conditions during infancy or childhood may contribute to the development of rumination disorder. Factors such as neglect, trauma or disruptions in caregiving may play a role.
  • Psychological factors: people with rumination disorder may have underlying psychological factors, such as anxiety, depression or other emotional challenges. The regurgitation behaviour may serve as a coping mechanism for emotional distress.
  • No enjoyment in eating: One study found that those with rumination disorder showed high levels of the following: Forgetting to eat/difficulty making time to eat, lacking enjoyment in food or eating and feeling full, and stopping eating early. This lack of interest in food, the making of food or the eating of food could be one of the causes of rumination disorder.
  • Lack of awareness or control: In some cases, people with rumination disorder may be unaware of their behaviour or have difficulty controlling it.
  • Learning difficulties: Rumination disorder is typically observed in infants but can also manifest in older people, especially those who concurrently experience an intellectual disability.

How can I spot the signs of rumination disorder in my child?

If you suspect rumination disorder in your child, there are some telltale signs that your child may have the disorder. According to the DSM-5, infants affected by rumination disorder typically exhibit a distinctive posture, straining and arching the back while extending the head backwards. They also engage in sucking movements with their tongue, conveying a sense of gratification from this behaviour. These infants may experience irritability and hunger in the intervals between episodes of regurgitation.

How can I spot the signs of rumination disorder in my older loved one?

Malnutrition can occur in older children and adults, especially when regurgitation is coupled with a reduction in the intake of food. Adolescents and adults may try to conceal the regurgitation behaviour by covering their mouth with a hand or coughing to mask the regurgitation sounds. Some people may avoid eating in the presence of others due to the recognised social stigma associated with the behaviour. This aversion can extend to skipping meals before social events, like work or school, to prevent potential regurgitation. An example of this would be voiding breakfast to mitigate the risk.

How is rumination disorder treated?

Overcoming rumination disorder is a transformative journey, and there are various treatment options available to address the complex nature of this condition. It’s important to note that specialised rehab treatments for rumination disorder are offered by various facilities worldwide.

Behavioural Therapies

Rumination disorder often has underlying causes related to stress or trauma. Effective treatment involves addressing these root issues. Various behavioural therapies are employed to uncover the reasons behind the disorder and help people modify their behavioural responses. Some common therapies include:

  • Cognitive Behavioural Therapy (CBT): CBT is a widely used therapeutic approach that helps people identify and change negative thought patterns and behaviours. In the context of rumination disorder, it can be instrumental in addressing the triggers and responses associated with the condition.
  • Dialectical Behaviour Therapy (DBT): DBT combines cognitive-behavioural techniques with strategies to improve mindfulness and interpersonal effectiveness. It is beneficial for people struggling with emotional regulation, which may be a component of rumination disorder.
  • Mindfulness and meditation: These practices are integrated to enhance self-awareness, reduce stress and promote a healthier relationship with thoughts and emotions. Mindfulness can play a crucial role in breaking the cycle of rumination.
  • Art therapy: Expressive therapies like art therapy provide a non-verbal outlet for people to explore and communicate their emotions. This can be particularly helpful for those who find it challenging to express themselves verbally.
  • Sound therapy: Using sound as a therapeutic tool can have calming and grounding effects, contributing to the overall well-being of people with rumination disorder.

Individualised approach

Many treatment centres recognise that every person is unique. Therefore, a variety of therapies are offered to allow clients to discover what works best for them. This individualised approach ensures that the treatment plan is tailored to the specific needs and preferences of each person seeking help for rumination disorder.

Professional guidance

Skilled therapists play a crucial role in guiding people through the recovery process. Their expertise helps clients navigate the complexities of rumination disorder and develop coping mechanisms to find joy and balance in their relationship with food.

What are the next steps?

If you or someone you care about is experiencing rumination disorder, it’s crucial to seek help for treatment. In today’s modern era, effective treatment plans and options are available to facilitate recovery from rumination disorder. If you suspect that your infant child may be displaying signs of the disorder, it’s essential to seek help promptly to address the eating disorder efficiently. Taking swift action and choosing a reputable rehab centre can empower you and your loved ones to overcome rumination disorder and live a life free from the challenges of an eating disorder.

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Is rumination disorder a mental illness?
Rumination disorder is a mental health condition, meaning it’s a psychological issue. It falls under the category of feeding and eating disorders in the DSM-5. Seeking professional help is important for proper diagnosis and treatment if someone is experiencing symptoms of rumination disorder.
Who can be affected by rumination disorder?
Rumination has traditionally been associated with infants and individuals with developmental disabilities. However, recent understanding reveals that age is not a determining factor, as it can occur in children, teenagers, and adults alike.
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