Rumination disorder is a type of eating disorder that is somewhat rare in the United States. Sometimes called rumination syndrome, this condition involves regurgitating food and is common among infants. Fortunately, treatment options exist for rumination eating disorder, and the condition can be managed successfully.

What Is Rumination Disorder?

Rumination disorder, or rumination eating disorder, is characterized by the regurgitation of food, possibly re-chewing it, and then re-swallowing the food. For the person who has this condition, rumination disorder is relatively effortless, unlike vomiting which requires forceful abdominal muscle contractions. In an infant who has this condition, they may roll their tongue and arch their back during the episode.

Also known as rumination syndrome, this condition is thought to represent a motility disorder with involuntary relaxation of the muscles that control the opening and closing of the esophagus.

inforgraphic explaining what rumination disorder is

Who Is Affected by Rumination Disorder?

Infants are most commonly affected by rumination disorder, and the age of onset is usually between three and 12 months. Infants tend to outgrow the syndrome, but some people carry these behaviors into adulthood. It is quite uncommon, but the exact incidence is unknown because adolescents and adults may hide the behavior out of embarrassment.

inforgraphic stating the age of those affected by rumination disorder

Signs and Symptoms of Rumination Disorder

Rumination disorder signs and symptoms may include:

  • Regurgitation
  • Spitting out food
  • Malnutrition
  • Weight loss or failure to thrive
  • Putting hands to mouth before regurgitation
  • Gagging
  • Tooth decay
  • Bad breath
  • Choking
  • Chapped lips

infographic listing the signs and symptoms of rumination disorder

Effects of Rumination Disorder

Many effects of rumination disorder result from food and acid returning to the mouth. These effects and other rumination disorder health risks may include:

  • Bad breath
  • Tooth decay
  • Malnutrition
  • Weight loss
  • Chapped lips
  • Loose esophageal sphincter
  • Acid reflux

Causes of Rumination Disorder

The causes of rumination disorder cannot always be determined. There may be multiple underlying reasons, such as a weakened esophageal sphincter that readily permits food contents from the stomach to return to the mouth.

Cultural, socioeconomic and psychological factors are the most commonly cited causes of rumination disorder. Specifically, the bond between mother and infant may be impaired from maternal neglect or from an overstimulated, chaotic environment.

Other theories surrounding the cause for rumination disorder are based on negative or positive reinforcement. Increased attention from other people as a response to the regurgitation, or to cure boredom may be other causes. Psychiatric disorders such as depression and anxiety might be other causes of rumination disorder.

Physical conditions may predispose a person to rumination disorder. Some of these conditions include:

  • Gastroesophageal reflux (GER)
  • Belching or heartburn
  • Over- or under-active muscles of the gastrointestinal tract (spasms)
  • Abnormal tongue movements
  • Low stomach acid
  • Poor chewing
  • Swallowing air
  • Hand or finger sucking

Venn diagram inforgraphic of the causes of rumination disorder

Diagnosing Rumination Disorder

Rumination disorder diagnosis is based on blood tests to check for anemia or electrolyte abnormalities. Anemia may occur due to damage to the stomach or esophageal walls. Imaging studies are done to diagnose rumination disorder or other predisposing conditions. A barium swallow can show a hiatal hernia, narrowing of the esophagus and abnormal motility of the esophagus or stomach.

An upper gastrointestinal (GI) series and small bowel follow-through test can diagnose an ulcer or other mechanical or physical problems of the intestines. Other lab tests that may be helpful are cultures for Heliobacter pylori (which is a bacteria that causes ulcers), studies to measure the rate of stomach emptying, motility, pH testing and X-rays.

Rumination diagnosis is based upon ruling out other gastrointestinal conditions, and the condition must be present for one month.

Risk Factors for Rumination Disorder

The main risk factor for rumination disorder is being institutionalized due to profound intellectual disability. People of average intelligence can develop rumination disorder, but due to the secretive nature of the disorder in adults, the true incidence and risk factors are presently unknown. More research is needed to determine a comprehensive list of risk factors and rumination disorder health risks.

Rumination Disorder Statistics

Statistics on rumination disorder are difficult to find due to the lack of existing studies. Current rumination disorder statistics include:

  • Amongst institutionalized people, the incidence of rumination disorder is 8-10 percent
  • There is a slightly higher incidence of rumination disorder among female gender than among males
  • Up to 20 percent of people who have bulimia also struggle with rumination

Rumination Disorder and Co-Occurring Conditions

Pica and rumination disorder are two separate conditions that may be associated with each other. Pica is the eating of non-food or non-nutritive substances. While it may be possible that rumination occurs after pica, pica does not cause rumination.

In one German study, the prevalence rates of recurring pica behavior were significantly elevated if recurring rumination disorder was present.

Additionally, bulimia and rumination disorder are two different conditions that people may think co-occur. Bulimia is a behavioral disorder that is the result of deliberate eating and purging with self-induced vomiting, use of laxatives or enemas. The purpose of these behaviors is to prevent weight gain in a person who has unrealistic body expectations. In contrast, rumination disorder is a medical condition that is involuntary regurgitation of food that is re-swallowed.

Rumination disorder and substance abuse may be related if the rumination is due to an underlying depressive or anxiety disorder where the person self-medicates with alcohol or drugs. Substance abuse could also be associated with rumination directly because of the shame or embarrassment that the ruminator experiences.  

Inforgraphic with various statistics about rumination disorder

Treatment for Rumination Disorder

Rumination disorder treatment consists of non-aversive and mild aversive techniques that are supportive and psychodynamic. If the rumination is to self-stimulate, the treatment results tend to be temporary. If it is socially motivated, then treatment can eliminate the symptoms. Some non-aversive techniques include:

  • Small bites of food
  • Chewing completely before swallowing
  • Eating thick food
  • Feeding techniques
  • Habit reversal with relaxation
  • Diaphragmatic breathing
  • Hypnosis
  • Biofeedback
  • Guided imagery
  • Weight reduction
  • Addressing psychological issues or triggers
  • Medications, if significant acid damage exists

If you or a loved one struggle with a drug or alcohol addiction and co-occurring rumination disorder, The Recovery Village can help. The Recovery Village facilities offer addiction treatment options as well as counseling for co-occurring mental health disorders. Reach out to a representative to learn more.

    

Papadopoulos V, Mimidis K. “The rumination syndrome in adults: A review of the pathophysiology, diagnosis and treatment.” ResearchGate, 2007. Accessed March 2019.

Chial HJ, Camilleri M, Williams DE, et al. “Rumination syndrome in children and adolescents: diagnosis, treatment, andprognosis.” American Academy of Pediatrics, 2003. Accessed March 2019.

Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P. “Functional gastroduodenal disorders.” PubMed.gov, 2006. Accessed March 2019.

Idaira Y, et al. “Factors affecting the oral condition of patients with severe motor and intellectual disabilities.” PubMed.gov, 2008. Accessed March 2019.  

Green AD, Alioto A, Mousa H, Di Lorenzo C. “Severe pediatric rumination syndrome: successful interdisciplinary inpatient management.” Northwestern University, 2011. Accessed March 2019.

Hartmann A, et al. “Prevalence of pica and rumination behaviors in German children aged 7–14 and their associations with feeding, eating, and general psychopathology: a population-based study.” European Child & Adolescent Psychiatry, August 2018. Accessed March 2019.

Black, Rosemary. “Rumination disorder: The Eating Disorder You Never Heard of.” Psycom, 2018. Accessed March 2019.

The Mayo Clinic. “Rumination syndrome.” Updated September 2018. Accessed March 2019.

Lumen. “Rumination Syndrome (307.53).” (n.d.) Accessed March 2019.

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