Rumination disorder is an uncommon disorder of infants and young children in which the child repeatedly spits up food without effort. He may spit out the food, but in some cases, he will rechew and reswallow it. If you are familiar with a cow's ability to chew its cud, you have a fairly accurate image of rumination disorder in human beings.
Three formal criteria must be met to qualify for a diagnosis of rumination disorder. Note that although these criteria are only defined for infants and young children (no criteria have yet been adopted for older children and adults), the symptoms exist in other people as well:- Repetitive regurgitation and rechewing of food is present. This must occur for at least one month.
- Regurgitation and rechewing is not caused by another gastrointestinal condition or by some other general medical condition.
- These behaviors do not occur only when anorexia nervosa or bulimia nervosa is present. For those who qualify for a diagnosis of mental retardation or another pervasive developmental disorder, rumination disorder is only diagnosed if the symptoms are severe enough to treat independently.
Who is Likely to Have Symptoms of Rumination Disorder?
Accurate data on the frequency of rumination disorder is not currently available. But the symptoms appears most often in infants between the ages of 3 to 12 months. This would seem to make sense simply from watching an infant "spit up" after feeding. It's clear that babies aren't distressed by spitting up, and this is normal for anyone diagnosed with rumination disorder as well: Regurgitating food is effortless, and it does not produce any discomfort or disgust at all. But there is a difference. Even in infants, the regurgitation in rumination disorder is intentional, and their rechewing (or re-sucking) is observable.
Rumination disorder appears more commonly among the mentally retarded than those of normal intelligence, though it is diagnosed in both groups. Also, among older children and adults, females experience rumination disorder more than males.
A Disorder That Differs With Age
For whatever reason, it appears that children and adolescents with rumination disorder are far less likely to rechew their food: In one study, only 4% did so. It is clear that the criteria for rumination disorder should be modified for other ages. Some researchers have begun to propose new criteria for both older children and adults.
A notable contrast in rumination disorder between infants and those who are older is that nausea, heartburn, and other gastrointestinal discomforts do occur with rumination disorder in children and adults. Nausea, however, does not cause the phenomenon, because it only occurs after regurgitation.
Problems Associated With Rumination Disorder
Rumination disorder by itself is relatively benign. But it does have some physical complications, and it can cause other circumstances that have significant impact:
- Bad breath
- Weight loss (when regurgitated food is spit out)
- Dental erosion
- Electrolyte imbalances (which, when severe, can be quite dangerous)
- Alienation due to the disgust of caregivers (this is of particular note when the person is developmentally disabled and more reliant on the care of others)
- Time and money lost (missing school or work, for example) due misdiagnosis and inappropriate treatment. One treatment center reported that incoming patients had suffered with rumination disorder for an average of 2.75 years before receiving a correct diagnosis. Incorrect diagnoses include gastroesophageal reflux disease (GERD) and gastroparesis.
Origins
There is no consensus regarding the origins of rumination disorder, but there are theories:
- Physical causes may include unusual muscle contractions in the digestive tract.
- Psychosocial factors may include situations in which a child uses rumination as a means to "self-soothe" in response to too little or too much stimulation from the living environment or the relationship with the child's mother. In other words, rumination in these cases may be a means to regulate uncomfortable emotions.
Relation to Other Eating Disorders
Studies searching for connections between rumination disorder and other eating disorders are not common. However, one small study of eight persons with rumination disorder found that five of them qualified for a current or prior eating disorder diagnosis. While this information is not conclusive, it does suggest that those with eating disorders should be asked about rumination behavior and vice versa.
Prognosis and Treatment
For many infants, the disorder simply resolves by itself. For children and adults, a brief course of behavioral training can teach breathing techniques that can counteract the regurgitation of food. In many cases, one session is sufficient to address rumination. Other treatment options that can be added to this training are biofeedback, relaxation training, and cognitive-behavioral therapy.
Sources:
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association; 1994.
Chial, Heather J.; Camilleri, Michael; Williams, Donald E.; Litzinger, Kristi; and Perrault, Jean. Rumination syndrome in children and adolescents: Diagnosis, treatment, and prognosis. Pediatrics 111 (2003): 158-162.
Eckern, M. and Stevens, W. The relationship between rumination and eating disorders. International Journal of Eating Disorders 26 (1999): 414-419.
minddisorders.com. Accessed 26 October 2007.
Papadopoulos, V. and Mimidis, K. The rumination syndrome in adults: A review of the pathophysiology, diagnosis and treatment. Journal of Postgraduate Medicine 53 (2007): 203-206.
