How to Spot the Signs of Rumination
Rumination disorder or rumination syndrome is widely misunderstood. Because rumination disorder is quite rare, many people do not understand its symptoms. Rumination syndrome is a type of feeding and eating disorder. Rumination disorder is a familiar condition in babies and individuals with developmental disabilities. However, it can occur in anyone, regardless of age. Signs and symptoms of rumination syndrome are also common in youth and adults experiencing high stress or anxiety levels. Rumination syndrome frequently goes undiagnosed or misdiagnosed as it is easily confused with other eating disorders or medical conditions such as GERD and bulimia nervosa.
What is Rumination Disorder?
Rumination disorder (sometimes called rumination syndrome or merycism) occurs when people repeatedly and unintentionally regurgitate (spit up) partially digested or undigested food from their stomach. Someone with rumination disorder will eat meals normally. However, within a few hours of eating, they will regurgitate food into their mouths. In some cases, they will reach you and then re-swallow their food. In others, they will split the food out. Rumination typically occurs after every meal shortly following eating. Because rumination disorder is
relatively rare, it is unclear how many Americans struggle with this mental health condition.
Data on the prevalence of rumination disorder is limited. This is because, to date, researchers have yet to conduct any large-scale studies on the illness. These studies are essential to determine a reliable, consistent prevalence rate for any disease. There have been a handful of smaller studies that may provide a suggested baseline.
One of the more extensive studies on rumination syndrome (conducted in 2012) surveyed more than 2000 youth between the ages of ten and sixteen. Data from the survey showed approximately 5% of youth (regardless of gender) reported rumination disorder symptoms. Of those, around 8% reported experiencing symptoms daily, with 74% re-swallowing their food. Other data from the same survey indicated the most common side effects of rumination disorder were stomach pains (19%), bloating (17%), and weight loss (12%).
Little data is available regarding the prevalence of rumination disorder in adults. However, medical experts believe the rates could be as high as 10% in adults with developmental disabilities who live in institutional settings.
What are the Signs and Symptoms of Rumination Syndrome?
It is important to note that, unlike other eating disorders that involve regurgitation or vomiting, rumination disorder is not associated with retching or self-induced regurgitation activities. Someone with rumination disorder unknowingly and effortlessly regurgitates their food. Individuals with this disorder report that pressure in the abdomen or pain in the stomach resulting from eating is relieved by regurgitation. Other symptoms of rumination disorder include bad breath, nausea, unintentional weight loss, and a feeling of being “full.” Other symptoms of rumination disorder may consist of digestive problems, tooth decay, and chapped lips.
What Causes Rumination Disorder?
Research has yet to uncover a specific cause of rumination disorder. Many medical experts believe rumination disorder is an unconscious disorder meaning those who struggle with its symptoms have little or no control over when or if it occurs. Studies suggest that voluntary muscle relaxation in the diaphragm that allows for regurgitation becomes a learned habit, and therefore, frequent, consistent regurgitation of undigested food occurs without necessarily trying.
Another potential cause of rumination syndrome is increased pressure in the stomach. Some researchers suggest that children or adults with rumination syndrome experience increased abdominal pressure, leading to the desire to burp or relieve gas. However, instead of the normal belching reflex that leads to a burp, relaxed muscles in the diaphragm cause food to come up rather than air.
It is important to mention that rumination disorder is frequently confused with other disorders that involve regurgitation, such as bulimia nervosa, gastroesophageal reflux disease (GERD), and gastroparesis. The primary difference between rumination disorder and these other conditions is that regurgitation for those with rumination disorder is involuntary.
Diagnosing Rumination Syndrome
Medical and mental health professionals generally diagnose rumination syndrome based on a comprehensive exam and learning about your medical history. For most patients, specific symptoms surrounding regurgitation and rumination are examined. Specifically, if you have been regurgitating, chewing, and swallowing food for a period of at least three months (but not vomiting as with purging disorders), your symptoms likely meet the diagnostic criteria for rumination disorder.
In addition to a medical evaluation, providers look to the Diagnostic and Statistical Manual for Mental Disorders when assessing someone for rumination syndrome. The manual lists four specific diagnostic criteria that a person must meet to be diagnosed with rumination disorder. First, they must regurgitate food repeatedly for a period of at least 30 days. Regurgitated food must be spit out or re-chewed and re-swallowed.
The second diagnostic criteria state that regurgitation activities must not be linked to another medical condition or gastrointestinal disorder that could better explain regurgitation and stomach problems. Similarly, symptoms of rumination disorder must not co-occur only in the presence of another eating disorder. In other words, rumination behaviors must occur outside of symptoms also connected to bulimia nervosa, binge eating disorder, anorexia nervosa, or avoidant/restrictive food intake disorder.
The last diagnostic criteria listed by the Diagnostic and Statistical Manual for Mental Disorders speaks to symptom severity. The fourth criteria states that should rumination disorder co-occur with another mental health diagnosis, the symptoms explicitly connected to rumination syndrome must be “severe enough and be the main reason for seeking medical care.”
A medical provider may also use a series of diagnostic tests to rule out other conditions. Common examples of these tests include a gastric emptying test, x -rays, and upper endoscopy tests. A gastric emptying test measures the time required for food to move from your stomach to the small intestine. It can help determine if you have a blockage or another digestive disorder that may limit your ability to pass food all the way through your digestive system. An upper endoscopy or upper GI looks at the upper portion of your digestive system, specifically your esophagus and stomach. Like a gastric emptying test, an upper endoscopy examines the health of your esophagus and stomach to see if another medical concern may cause regurgitation behaviors.
Rumination Disorder Causes and Risk Factors
Because rumination disorder is quite rare, it is also frequently misunderstood. Also, the statistics around rumination syndrome may be quite inaccurate as the illness might be underdiagnosed in many situations. Currently, health care providers are learning more about the disorder. They can better separate rumination disorder from other feeding and eating disorders such as bulimia or binge eating disorder.
To be clear, rumination disorder is not necessarily occurring with greater frequency; however, providers are learning more about it and can better provide an accurate diagnosis; therefore, reports of the illness have increased in recent years. There is no known cause for rumination disorder. Medical professionals believe the symptoms (namely regurgitation) are unconscious; therefore, the individual does not know they occur.
Treatments Options for Rumination Disorder
Treatments for rumination syndrome vary depending on several factors. The best course of treatment for you or a loved one who struggles with this disorder will be decided after close consultation with a health care provider. Factors including age, overall health, and the severity of the illness’s impact on your physical and mental health are all valuable considerations in developing a treatment plan.
The primary treatment method for rumination syndrome is behavioral therapy. The goal of behavioral therapy is to help stop regurgitation and other behaviors connected to rumination disorder. The most effective behavioral therapy is diaphragmatic breathing. Your diaphragm is a large, powerful muscle located at the base of your lungs. The purpose of practicing diaphragmatic breathing is to help you relax the diaphragm, strengthen it, and use it correctly while breathing.
Practicing diaphragmatic breathing may also help to control regurgitation that characterizes rumination disorder. If you struggle with this illness, your provider will teach you how to practice breathing exercises properly. Diaphragmatic breathing is done while lying flat on your back on a flat surface with your knees bent and your head adequately supported. It is essential to place your hand on your chest to feel your diaphragm move as you breathe. The goal is to breathe in slowly through your nose so that your stomach moves out against your hand and your chest remains as still as possible.
Other treatments for rumination syndrome include removing distractions during meals, changing posture during and immediately after eating and reducing stress during meals.
The most effective therapy for rumination syndrome is cognitive-behavioral therapy or CBT. The goal of CBT for rumination disorders is to help you recognize the urge or feelings that lead to regurgitation and rumination. By bringing something that is ordinarily unconscious (involuntary) to the forefront of your mind through therapy, you can develop control over the behavior.
As part of psychotherapy sessions, cognitive-behavioral therapy can help you develop and practice skills and techniques that are beneficial for behavioral changes. In the case of rumination disorder, you will learn more about specific techniques you can use to change behaviors once believed involuntary.
It is important to remember that severe cases of rumination disorder can lead to potentially harmful medical problems such as malnutrition. As mentioned above, rumination disorder can co-occur with other eating disorders, increasing your risk of significant medical and emotional challenges. If you struggle with a co-occurring rumination disorder and another eating disorder, seeking treatment at a specialized treatment center like The Meadowglade is essential for a safe and healthy recovery.
At The Meadowglade, our team of treatment specialists will work with you to develop a treatment plan that focuses on your unique needs as you enter treatment. In general, rumination disorder does not lead to significant medical or mental health challenges, although they are a possible side effect of any untreated behavioral condition. However, the potential for severe effects related to co-occurring eating disorders or other mental health challenges points to the need for carefully designed, comprehensive treatment that focuses on whole-person healing. To learn more about our programs at The Meadowglade, contact a member of our admissions team today.