Rumination disorder is a rare health disorder , and is included in the DSM 5 chapter on Eating and eating disorders (APA, 2013). The focus of the problem with this disorder is regurgitation, which is caused by a contraction of the stomach.

The term “rumination” comes from the Latin word ruminare, which means “to chew the alimentary bolus”. It was mentioned in antiquity in the writings of Aristotle, and was first documented clinically in the 17th century by the Italian anatomist Fabricus ab Aquapendende.

The name of this disorder is due to the analogous regurgitation of herbivorous animals, “rumination”. In this article, we will address its symptoms and prevalence, as well as the causes of this disorder and its treatment.

Symptoms of rumination disorder

Rumination disorder consists of the repeated regurgitation of feed over a period of at least one month . In addition, this regurgitated food can be re-chewed, swallowed, or spit out by the person with it, without showing symptoms of disgust, repulsion, or nausea.

In addition, rumination disorder does not occur only in the course of anorexia nervosa, bulimia nervosa, binge eating disorder or avoidance/restriction of food intake disorder.

Regurgitation should be frequent, occurring at least several times per week, typically on a daily basis. Unlike the involuntary vomiting that any person may experience (uncontrollable), regurgitation may be voluntary. Adults who suffer from it claim that they have no control over this disorder and that they cannot stop it.

The characteristic body position of children who suffer from it is to keep their back taut and arched with their head backwards, making sucking movements with their tongue. They can give the impression of getting satisfaction from the activity of regurgitation. As a result of the activity, children may be irritable and hungry between episodes of rumination .

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On the other hand, symptoms of malnutrition and weight loss may appear in adolescents and adults, especially when regurgitation is accompanied by voluntary restriction of food intake due to social anxiety that causes them to be seen by others (for example, they avoid breakfast at school for fear of vomiting and being seen).

It should be noted that repeated regurgitation cannot be attributed to an associated gastrointestinal or other medical condition , such as gastroesophageal reflux.

Prevalence

Although the data on prevalence are inconclusive, it seems that occurs more frequently in infants, children and people with intellectual functional diversity .

The age of onset of rumination disorder in children is usually around 3-12 months. This feeding problem can produce severe symptoms of malnutrition in children, becoming potentially fatal.

Causes of rumination disorder

Rumination syndrome is a little-known phenomenon, and there are several speculations about the causes of regurgitation.

The most widely documented organic mechanism is that food intake generates gastric distension, which is followed by abdominal compression and subsequent relaxation of the lower esophageal sphincter (LES). A cavity is created between the stomach and the oropharynx that leads to the return of partially digested material to the mouth.

People with this disorder have a sudden relaxation of the LES. While this relaxation may be voluntary (and learned, as in Bulimia), rumination itself is usually still involuntary. Patients often describe a sensation similar to the appearance of a burp that precedes rumination.

The most important causes of rumination disorder are mostly of psychosocial origin . Some of the most common causes are: having lived in a cognitively unstimulating psychosocial environment, having received negligent care by the main attachment figures (and even situations of abandonment), experiencing highly stressful events in their lives (such as the death of a loved one, changes of city, separation from parents…) and traumatic situations (child sexual abuse).

In addition, difficulties in parent-child bonding are considered one of the most important predisposing factors in the development of this disorder in children and adolescents.

In both children and adults with intellectual deficits or other neurodevelopmental disorders, regurgitation behaviors appear to have a self-stimulating and calming function, similar to the function that repetitive motor behaviors such as rocking may have.

Treatment

The treatment will be different depending on the age and intellectual capacity of the individual presenting it.

In adults and adolescents, biofeedback and relaxation techniques or diaphragmatic breathing after ingestion or when regurgitation occurs have been shown to be helpful.

In children and in people with intellectual deficits the techniques of behaviour modification , including treatments that use operative techniques, are those that have shown the most efficacy.

Some examples are: withdrawing attention from the child while performing the behavior we want to reduce and giving him/her primary or unconditional reinforcements (affection and attention) or materials (a trinket) when he/she does not regurgitate. Other authors bet on putting an unpleasant taste (bitter or sour) on the tongue when it is starting the typical rumination movements.

In the case of children, it is important that the family understands the disorder and learns some patterns of action in the face of problematic behaviour, and as is usually advised in these cases, to have a lot of patience. If the relationship between the parents and the child is not good, it is necessary to work on the emotional difficulties that may be maintaining the problem.