Understanding Rumination Disorder

Navigating the Intricacies of Rumination Disorder

Defining the Disorder
Rumination disorder is a disorder characterized by an individual’s uncontrollable and frequent regurgitation of food. The food that is regurgitated is either re-chewed and swallowed, or spit out.

It’s most common to see a diagnosis of rumination disorder in infants, young children, and individuals with intellectual disabilities. However, as more awareness about rumination disorder is available adolescents and adults are now more frequently diagnosed. It is not considered a commonly diagnosed disorder.

Rumination disorder, also referred to as rumination syndrome, is considered a psychiatric disorder, classified under feeding and eating disorders in the "Diagnostic and Statistical Manual of Mental Disorders, Edition 5" (DSM 5), but a gastroenterologist and other specialists are typically involved in diagnosis—particularly to eliminate medical causes for regurgitation.
What Is Rumination Disorder?
Rumination disorder can be differentiated from other types of eating disorders, like bulimia nervosa, as concerns about weight gain and body image are not central. In rumination disorder, the food is effortlessly regurgitated and not actively retched. Individuals with rumination disorder will often eat a meal, and then regurgitate the food within 30 minutes, eliminating the typical acidic or bitter taste of digested food that is vomited. With rumination disorder, an individual may belch or burp after a meal, leading to the regurgitation.
Rumination Disorder Vs. Bulimia
Rumination disorder should not be confused with bulimia nervosa. Despite the fact that they are both classified as feeding and eating disorders, rumination disorder differs from bulimia in a few ways. This includes:

In people with rumination disorder, the regurgitation is effortless and unforced.
While people with bulimia nervosa are often attempting to achieve a specific type of body, this is not usually the case with rumination disorder.

The frequency and severity of rumination disorder varies from person to person, but typically a person will regurgitate food within a half-hour of eating a meal. Food that is regurgitated has not mixed with stomach acid and does not taste unpleasant, so it may be rechewed and swallowed or spit out

Other symptoms may include:

  • Regurgitation that is not forced and not preceded by retching
  • Belching or burping prior to regurgitation
  • Abdominal discomfort, relieved once food has been regurgitated
  • Halitosis (chronic bad breath)
  • Weight loss, though not typically planned or intended
  • Chapped lips

Rumination disorder can also create psychological distress and embarrassment, especially because of the lack of control over the regurgitation. Over time the following symptoms can be found:

  • Tooth erosion or decay
  • Depression
  • Anxiety
  • Malnutrition
  • Skipping social events or social eating

Diagnosing rumination disorder can be a complicated process, especially because other medical conditions must first be ruled out by medical specialists, such as gastroenterologists. Costly procedures and testing with long wait lists may also slow down the process.

Symptoms that may suggest rumination disorder:

  • Absence of gagging, retching, or acid reflux
  • Lack of sour or bile taste when food is regurgitated
  • The timing of the regurgitation

Testing will be done to rule out gastrointestinal causes of the symptoms, including achalasia (a motility disorder of the esophagus), gastroparesis (in which the stomach takes too long to empty its contents), and gastroesophageal reflux disease (GERD), in which stomach acid enters the esophagus.

Some of the tests include:

  • Endoscopy
  • Esophageal manometry
  • Gastric emptying scan
  • Scintigraphy

Once the doctor eliminates physical causes of the regurgitation and related symptoms, a mental health professional, such as a psychologist or psychiatrist, can diagnose rumination disorder. The diagnosis is made based on the criteria discussed in the DSM-5:

  • Food is regurgitated for a minimum of one month, with or without rechewing and swallowing.
  • The regurgitation is not attributed to any physical medical condition
  • The regurgitation, or related symptoms, are not linked to any other eating disorders, including bulimia nervosa, anorexia nervosa, or binge-eating disorder.
  • If the regurgitation occurs alongside another mental health disorder, such as anxiety, or a neurodevelopmental disorder, the symptoms must be severe enough for a separate investigation and diagnosis.

Studies suggest that people with rumination disorder visit an average of five doctors over 2.7 to 4.9 years before a correct diagnosis is reached.

Currently, there is no known cause for rumination disorder. For infants and younger children, there is some speculation that being over or under-stimulated at home can contribute to rumination disorder. Regurgitation may also be a way to deal with emotional distress, and can then become a habit that is difficult to break.

Treatment for rumination disorder may be different depending on the severity, age of the patient, and underlying mental health conditions. A behavioral psychologist will often work with a patient to unlearn habits, whether conscious or unconscious, that lead to the regurgitation.

These practices may involve:

  • Deep breathing exercises, particularly after meals.
  • Habit-reversal training
  • Relaxation techniques
  • Aversion therapy

Sometimes a gastroenterologist is part of the treatment team, in which case some medications may be prescribed to help with recovery. Some medications that might be prescribed include Nexium (esomeprazole) or Prilosec (omeprazole) if there is damage to the esophagus from frequent regurgitation.

Article Sources

1. Cleveland Clinic. Rumination syndrome. Updated August 9, 2019.
2. Murray HB, Juarascio AS, Di Lorenzo C, Drossman DA, Thomas JJ. Diagnosis and treatment of rumination syndrome: A critical review. Am J Gastroenterol. 2019;114(4):562-578. doi:10.14309/ajg.0000000000000060
3. Mousa HM, Montgomery M, Alioto A. Adolescent rumination syndrome. Curr Gastroenterol Rep. 2014;16(8):398. doi:10.1007/s11894-014-0398-9
4. Nationwide Children's. Providing intensive treatment of rumination syndrome in adolescents.