Rumination disorder, which is also referred to as rumination syndrome, is a chronic, rare disorder. This disorder can be found in infants, children, and adults, and can have life-threatening side effects. The primary indicator of Rumination disorder is the regurgitation of food after nearly every meal, if not after every meal. This regurgitation is not involuntarily expelled or vomited from the mouth. The base word of this disorder, ruminate, refers to when someone literally or figuratively chews something over and over again. In the figurative sense, rumination occurs when someone is deeply pondering something, but the rumination associated with this disorder occurs when patients regurgitate their meals. Ruminate is also associated with the way cows eat because they chew the cud over and over again.
Many children diagnosed with Rumination disorder outgrow the regurgitation of food, and older patients (teens and adults) who suffer from Rumination disorder tend to hide their disorder out of embarrassment and fear of judgement from their peers – because of these factors, it is very difficult to pinpoint an exact number of people who suffer from this uncommon disorder worldwide. The disorder, however, is generally considered uncommon and members of the psychiatric community theorize the disorder occurs more often in boys than girls, but there are few studies of the disorder.
Because there is a lack of scientific studies and data on Rumination disorder, the exact cause of the disorder is unknown. There are, however, many factors that may impact the development of Rumination disorder, such as severe stress, chronic physical illness, or a way for children to gain attention. Another factor that can influence the likelihood of Rumination disorder is an abnormal relationship between a child and caregiver, or situations of neglect. The act of chewing and re-chewing food may be comforting to children in these situations. Although regurgitation is an unintentional act, the process of regurgitation can be learned – children who suffer from Rumination disorder may have never learned how to relax their abdominal muscles.
The primary symptom associated with this disorder is the regurgitation of undigested food – this regurgitation is repeated and occurs between a half hour to two hours after eating. People who suffer from Rumination disorder tend to regurgitate every day and after almost every meal. Other symptoms that may occur with Rumination disorder are bad breath, dry mouth, stomach pain, toothaches and tooth decay, and weight loss. One difference between adults and children who suffer from rumination syndrome, however, is adults tend to spit out regurgitated food, while children are more likely to chew their food again and re-swallow it.
The DSM-5, a tool used by mental health professionals to classify mental illnesses, states:
“Rumination is characterized by both voluntary or involuntary regurgitation and re-chewing of the partially digested food that is then re-swallowed or spat out. The regurgitation process is sometimes preceded by a belching sensation, but the individual does not typically throw-up nor experience nausea. Furthermore, regurgitant in rumination does not have a sour or a bitter taste…Evaluate the following to identify the feeding and eating disorder correctly:
The symptoms associated with Rumination disorder are much different from acid reflux or gastrointestinal reflux disease (GERD.) In acid reflux disease, the acid that is found in all of our stomachs that breaks down food rises into the esophagus. This causes a “burning” feeling in the stomach and can also leave a sour, unpleasant taste in the mouth from the rising stomach acid. With acid reflux disease, food can occasionally be regurgitated, but it tastes sour or bitter – this is not the case with food regurgitated in Rumination disorder. In addition to the prevalence of regurgitation, the time of day also differs from Rumination disorder and acid reflux. Many adults experience acid reflux when laying down or at night time because stomach acid can travel up the esophagus easily when someone is laying down. This is different from Rumination disorder because regurgitation occurs after nearly every meal.
Although Rumination disorder has been linked to eating disorders such as Bulimia and Anorexia, there is a lack of scientific evidence that shows the strength of the link between Rumination disorder and eating disorders. Children and adults alike who have suffered from an eating disorder in the past may have a higher likelihood of suffering from Rumination disorder, and patients and their families should be aware of signs and symptoms of eating disorders and Rumination disorder. Anorexia and Bulimia differ from Rumination disorder, however, in the way symptoms present themselves. As opposed to starving or binging/purging, Rumination disorder deals with the repeated regurgitation of food following meals.
Because psychiatrists and the mental health community is still unsure what causes Rumination disorder, conditions related to this disorder are not exactly known, but it is widely accepted that childhood neglect, eating disorders, and other mental illnesses can all be risk factors that may influence the onset of Rumination disorder.
Although Rumination disorder is found in children and many children outgrow regurgitating their food, many adults suffer from Rumination disorder as well. Even though adults also suffer from Rumination disorder, the exact number is unknown because many adults may not share their symptoms out of embarrassment. When children suffer from Rumination disorder, a number of tests can be administered to track contractions of the stomach and small intestine. These tests include Barium Swallow, an x-ray test used to examine the upper digestive tract. Because internal organs such as the small intestine are not visible in x-rays, swallowing liquid barium causes a temporary lining to form and allow physicians to examine contractions in the gastrointestinal system. Another test that can be administered is an upper endoscopy, in which a small tube containing a camera is inserted into the esophagus; this test can look for abnormalities that may contribute to rumination in patients.
Alex, a four-year-old boy who lives at home with his mother, has been losing weight recently. When his mother kisses him goodnight, there is also a foul stench in his mouth even after he brushes his teeth. After nearly every meal, Alex’s mother also notices that he seems to be “eating” something a half hour after every meal, even though the food has been cleared from the table. Alex’s mother confronts him, and he admits to regurgitating his food – he has been doing this for about two months. Because of the weight loss, foul breath, and regurgitation of food lasting longer than one month, these criteria are consistent with DSM-5 diagnostics for Rumination disorder.
Dealing with rumination syndrome can seem impossible – but with the help of friends, family, and physicians/mental health professionals, managing symptoms can become much easier. Being up-front about symptoms, primarily the regurgitation of food, can help you and your family choose to seek help for dealing with Rumination disorder.
Risk factors for Rumination disorder include a history of eating disorders such as Anorexia/Bulimia and a family history of Rumination disorder. Risk factors that may not be as obvious are neglect/abuse in the household and undergoing stressful experiences – extreme stress or abuse can trigger Rumination disorder, but the exact cause of the disorder is still unknown.
There are a number of medications that can help with Rumination disorder, including protein pump inhibitors. When this medication is prescribed, it helps protect the lining of the esophagus until therapy such as behavioral therapy lessens the frequency and severity of regurgitation. If Rumination disorder is tied to depression or other mental illnesses, antidepressants such as SSRI’s can help diminish depression.
Mindfulness exercises and diaphragmatic breathing can help patients cope with potential stressors such as abuse that contributed to the onset of Rumination disorder. When patients undergo behavioral or behavioral cognitive therapy, therapists will often give patients exercises to complete at home to help lessen the frequency of regurgitation. Even though it can be easy to “blow off” these exercises, completing them in the exact way your therapist suggested can greatly reduce the learned behavior of regurgitation. In addition to mindfulness and behavioral training, talking with your family and loved ones can help you make a “game plan” for dealing with the symptoms of Rumination disorder.
Living with this disorder can be challenging, especially when the person suffering is your child. Although living with any mental illness is difficult, a mixture of medication, therapy, and home remedies can significantly assist symptoms of Rumination disorder. Being up-front and honest with family members can help establish a support system in case the symptoms of Rumination disorder reoccur. As with any illness – whether it be physical or mental – taking medication as directed and listening to mental health professionals and physicians will greatly increase your treatment.
Mental health coverage for patients varies greatly from person to person and policy to policy. Although some insurance providers may not offer coverage for services such as behavioral therapy, medication is often partially or fully covered by insurance providers. In order to see what coverage is provided by your insurance provider, have a conversation with your insurance agent about mental health coverage. If you cannot afford your medication or therapy, there are state-funded programs to help people pay for mental health services such as behavioral therapy, which can be a crucial factor in the treatment of mental illnesses such as Rumination disorder.
There are many factors to consider when selecting a mental health professional to help you manage Rumination disorder. Different therapists operate under different psychological principles (which psychological “perspective” they adhere to,) and this will determine the type of therapy that is administered, and how long therapy lasts. For Rumination disorder, behavioral therapy has proven to be a sound method for dealing with the disorder, because the repeated act of regurgitation is a learned behavior.
When searching for someone to help you manage Rumination disorder, see if your licensed mental health professional if they have experience dealing with patients with Rumination disorder. Also, see what ages the therapist or psychiatrist specializes in. Some therapists primarily deal with children, teens/young adults, and adult patients.
When consulting with a mental health professional, ask them what psychological perspective they adhere to. How does their therapy work, and how often will you be having sessions with them? Also be sure to ask if they prefer a method of therapy only, or if a mixture of therapy and medication are used at their place of practice. Establishing a rapport with your mental health professional can help you feel more comfortable when discussing symptoms and a treatment plan with them.
Resources for Rumination disorder include NAMI, or the National Alliance on Mental Illness, your friends and family members, and mental health professionals/physicians. NAMI also offers a helpline to discuss treatment options and symptoms. Call 1-800-950-NAMI Monday through Friday, 10 a.m.– 6 p.m. ET and a mental health worker will discuss Rumination disorder and other mental health concerns with you.
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