• Catherine Lott

What is Rumination Disorder?



woman trying not to be sick

So What Is Rumination Disorder?

According to the DSM-5 criteria, to be diagnosed as having Rumination Disorder a person must display:

  • 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 due to a medication condition (e.g. gastrointestinal condition).

  • The behaviour does not occur exclusively in the course of Anorexia Nervosa, Bulimia Nervosa, BED, or Avoidant/Restrictive Food Intake disorder.

  • If occurring in the presence of another mental disorder (e.g. intellectual developmental disorder), it is severe enough to warrant independent clinical attention.

Rumination has been described as a symptom in association with eating disorders, but also as a separate disorder.

Studies (such as Eckern, James and Mitchell (1999)[i]) have found a high incidence of rumination in association with Eating Disorders and have underlined the importance of screening for rumination among Eating Disorders among individuals who ruminate and for screening for rumination among Eating Disorder clients.

Pathophysiology

While the pathophysiology (physiological process by which the abnormal condition develops and progresses) of rumination remains largely unclear, one way it might happen is that gastric distention with food is followed by abdominal compression and relaxation of the lower oesophageal sphincter, allowing the stomach contents to be regurgitated and rechewed and then swallowed or expelled.

Possible causes for this relaxation of the lower oesophageal sphincter:

  1. Learned voluntary relaxation

  2. Simultaneous relaxation with increased intra-abdominal pressure

  3. Adaptation of the belch reflex

Symptoms of rumination can include the following:

  • Weight loss

  • Halitosis

  • Indigestion

  • Chronically raw and chapped lips

Vomit may be noted on the individual's chin, neck, and upper garments.

Regurgitation typically begins within minutes of a meal and may last for several hours. Regurgitation occurs almost every day following most meals.

Regurgitation is generally described as effortless and is rarely associated with forceful abdominal contractions or retching.

Physical findings in patients with rumination may include the following:

  • Regurgitation

  • Vomiting not visible to others

  • Unexplained weight loss, growth failure

  • Symptoms of malnutrition

  • Antecedent behaviours including postural changes, putting hands into mouth, and gentle gagging motion of the neck region

  • The patient may appear to derive satisfaction and sensory pleasure from mouthing the vomit rather than considering vomitus in the mouth disgusting

  • Tooth decay and erosion

  • Aspiration that may cause recurrent bronchitis or pneumonia, reflex laryngospasm, bronchospasm, and/or asthma

  • Premalignant changes of the lining of the oesophagus with chronic rumination

Rumination is a potentially a very serious disorder.

Possible effects may be

  • Halitosis

  • Malnutrition

  • Weight loss

  • Growth failure

  • Electrolyte imbalance

  • Dehydration

  • Gastric disorders

  • Upper respiratory tract distress

  • Dental Problems

  • Aspiration

  • Choking

  • Pneumonia

  • Death

What actually causes rumination disorder?

Although the aetiology of rumination is unknown, multiple theories have been advanced to explain the disorder. These theories range from psychosocial factors to organic origins. Cultural, socioeconomic, organic, psychodynamic and psychiatric (e.g. depression and anxiety) factors have been implicated. In terms of heredity, occurrences in families have been reported, as of yet, no genetic association has been established.

Some possible physical causes of rumination include the following:

  • Dilatation of the lower end of the oesophagus or of the stomach

  • Overaction of the sphincter muscles in the upper portions of the alimentary canal

  • Cardiospasm

  • Pylorospasm (spasm of pyloric sphincter)

  • Gastric hyperacidity

  • Achlorhydria (absence of hydrochloric acid in gastric secretions)

  • Movements of the tongue

  • Insufficient mastication

  • Pathologic conditioned reflex

  • Air Swallowing

  • Finger or hand sucking

When rumination is associated with Eating Disorders symptoms should be addressed simultaneously. The treatment of adult rumination syndrome consists of reassurance, behaviour therapy, psychotherapy and relaxation therapies.

[i] Eckern, James and Mitchell, Int J Eat Disord 26: 414–419, 1999

#rumination #anorexia #bulimia #regurgitation #BED