OVERVIEW

What is Rumination Disorder?

Rumination disorder, also known as rumination syndrome, is a type of eating disorder characterized by the repeated regurgitation of recently ingested food back into the mouth without any underlying organic disease. The food is then re-chewed and either swallowed again or spit out.

It may present as episodic or persist until effective treatment is received.

Rumination disorder may require professional psychological intervention or medication to improve. If you are diagnosed with rumination disorder, please adjust your mental state and actively participate in treatment. If a friend or family member is diagnosed, offer them care and support, and maintain open communication to aid their psychological recovery.

Is Rumination Disorder Common?

There is limited research on the exact prevalence of rumination disorder, but it may be more common in certain groups, such as individuals with intellectual disabilities.

Additionally, psychosocial factors like lack of stimulation, neglect, stressful life situations, and parent-child relationship issues may contribute to the development of rumination disorder in infants and young children.

SYMPTOMS

What are the manifestations of rumination disorder?

• Typical characteristics during episodes: The patient regurgitates recently ingested food from the stomach back into the mouth, re-chews it, and then swallows or spits it out.

• The symptom occurs effortlessly, often without abdominal discomfort, nausea, retching, or aversion, which clearly distinguishes it from vomiting. Some infants may exhibit behaviors like head-shaking or turning during episodes.

• Rumination usually occurs within 15 minutes after a meal and can last for several hours. It stops when the regurgitated food becomes sour. Episodes generally do not occur during nighttime sleep.

• Rumination is a voluntary process accompanied by a sense of pleasure. However, patients may feel embarrassed if observed and attempt to conceal the symptoms. To avoid embarrassment, they may escalate to avoiding eating or social situations involving food, such as skipping breakfast to prevent being seen ruminating, thereby avoiding workplaces or schools.

• If rumination persists for an extended period, it may affect the child's growth and development. Excessive regurgitation of stomach contents can lead to dehydration, loss of stomach acid, and electrolyte imbalances. Children with intellectual disabilities are more likely to experience delays in multiple aspects of mental development.

What is the prognosis for rumination disorder?

Rumination disorder can occur in infants, children, adolescents, or adults. The onset in infants typically occurs between 3 and 12 months of age. In most cases, infants recover spontaneously, but if the condition persists, it may lead to malnutrition, growth retardation, and, in severe cases, even life-threatening risks.

CAUSES

What Causes Rumination Disorder?

The exact cause of rumination syndrome remains unknown. However, studies have linked potential etiological factors to patients' medical histories.

In infants, young children, and individuals with cognitive impairments, the disorder is often attributed to either excessive or insufficient stimulation from parents or caregivers, leading the individual to seek self-satisfaction and self-stimulation due to a lack or excess of external stimuli.

The condition is also frequently triggered by a recent illness, periods of stress, or changes in medication.

DIAGNOSIS

How is rumination disorder diagnosed?

• Repeated regurgitation of food for at least 1 month. The regurgitated food may be re-chewed, re-swallowed, or spit out;

• Regurgitation is not caused by gastrointestinal or other medical conditions (e.g., gastroesophageal reflux, pyloric stenosis), nor is it a manifestation of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder;

• If rumination occurs in the context of another mental disorder (e.g., intellectual disability or other neurodevelopmental disorders), it must be severe enough to warrant additional clinical attention to justify a diagnosis of rumination disorder.

Often, individuals with rumination disorder may avoid seeking medical help due to stigma. In reality, struggling with emotional difficulties is not your fault—you have the right to seek support.

What conditions should rumination disorder be distinguished from?

• Gastrointestinal disorders: Rumination must be differentiated from gastroesophageal reflux and other medical conditions that may cause regurgitation or vomiting.

• Some individuals with anorexia nervosa or bulimia nervosa may also regurgitate or spit out food. However, this behavior stems from concerns about weight gain and should not be diagnosed as rumination disorder.

TREATMENT

How to Treat Rumination Disorder?

• In infants and young children, rumination is often closely related to a distant mother-infant relationship. Treatment focuses on fostering a good parent-child relationship, maintaining close contact with the child, diverting the infant's attention, and strengthening parents' confidence in correcting the rumination behavior.

  Alternatively, aversion therapy or punishment therapy can be attempted. For example, when rumination occurs, a sour or bitter substance can be applied in the mouth to create an aversive conditioned reflex, thereby reducing rumination. Behavioral interventions may yield longer-lasting effects. Gastrointestinal motility drugs like cisapride may also be tried.

• For individuals with intellectual disabilities, drug therapy (such as antiemetics), dietary adjustments, or nutritional therapy can be attempted, though the effects may be limited.

• For intellectually normal adult patients with rumination disorder, cognitive interventions such as education and explanation are the primary approaches. These can be combined with aversion therapy, punishment therapy, or biofeedback to help patients learn and establish self-control.

The prognosis for rumination disorder is generally good, and the behavior tends to diminish with age.

Being diagnosed with rumination disorder may be difficult to accept, but regardless, it is important to follow medical advice and actively pursue treatment, as the condition can improve.

How to Care for Rumination Disorder?

There are currently no known specific therapies for rumination.

For infants and individuals with intellectual disabilities, mild behavioral aversion training can be used. For intellectually normal patients, diaphragmatic breathing techniques can be trained to suppress rumination urges.

DIET & LIFESTYLE

What should be paid attention to in daily life for rumination disorder?

Rumination disorder may be related to growth retardation, so attention should be paid to nutrition intake and supplementation.

Older individuals with rumination disorder may restrict food intake to avoid regurgitation in social situations, leading to impaired social functioning. Therefore, certain attention should be given to interpersonal relationships and other social aspects.

PREVENTION

How to prevent rumination disorder?

Rumination disorder may be caused by psychosocial factors such as lack of stimulation, neglect, stressful life situations, and parent-child relationship issues.

Therefore, prevention measures include providing adequate stimulation, timely attention to individuals with rumination disorder, reducing exposure to stressful stimuli, and maintaining a close and comfortable parent-child relationship through effective communication.