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.

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.

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.

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.

FAQ’s