When it comes to eating disorders, bulimia and anorexia are the best-known conditions which affect people of both sexes and of all ages. However, there is another eating disorder which receives a lot less attention from the media and which has barely been heard of by the general public, but which is no less important – rumination disorder.

Rumination – An Overview

Rumination disorder is a medical condition which causes people to unintentionally and repeatedly regurgitate partially digested or undigested food from their stomach, chew it again and then either spit it out or re-swallow it. Since the food isn’t digested, it tastes normal rather than acidic like vomit. Usually, rumination takes place every time the sufferer eats, almost immediately after eating.

It can cause ongoing problems such as dental decay or even malnutrition if allowed to continue, and it can also cause a lot of social problems which cause sufferers to become isolated, resulting in mental health issues. To be classified as a disorder, the patient must repeatedly regurgitate food on a regular basis for a minimum of a month.

Who Suffers From Rumination Disorder?

At present, it isn’t known exactly how many people suffer from rumination. Most frequently it occurs in young children aged between 3 – 12 months and may occur less often in girls than boys. However, the studies are limited so the evidence to support this is slim. Older children and teenagers can suffer from this disorder too, but many are very secretive about their suffering. So can adults. Due to the embarrassment and shame that they feel about their problem they often refuse to seek help from a professional to combat their disorder. This means that there is no way of knowing for sure just how widespread the condition really is.

However, there are treatments available including medications and behavioral therapy which can prove to be highly beneficial as long as the symptoms are recognized and action is taken to address them.

What Are The Symptoms Of Rumination?

There are several symptoms associated with rumination disorder. These include:

• Effortlessly regurgitating food, usually within ten minutes of consuming it without any obvious physical health condition to cause the behavior
• Rechewing then swallowing food which they’ve regurgitated or spitting the chewed food out
• Hiding their eating behavior by covering their mouth or coughing
• Stomach pressure or pain which can be alleviated by regurgitation
• Avoiding eating if going out
• Feeling full
• Nausea
• Bad breath
• Malnutrition
• Unintentionally losing weight
• Indigestion
• Chapped, sore lips
• Hunger between meals and irritability

Other Signs And Symptoms

Although the above symptoms are linked specifically with rumination disorder, there are a number of other signs and symptoms to look out for which are associated with all forms of eating disorders. These include both physical and emotional symptoms. Some of these include:

• Behaviors which suggest that controlling food, dieting and weight loss are prime concerns
• Being preoccupied with food, weight, fat, carbohydrates, dieting and calories
• Refusing to eat specific foods or restricting whole food categories like carbohydrates or fats
• Appearing uncomfortable when eating around other people
• Developing rituals surrounding earing such as only eating a specific food, chewing excessively or refusing to allow different foods to touch each other
• Skipping meals
• Only taking small food portions at meals
• Adopting fad diets
• Withdrawing from usual activities and friends
• Dieting frequently
• Having a high level of concern about shape, size and bodyweight
• Frequently checking in mirrors for flaws in their appearance
• Having violent mood swings

• Noticeable weight fluctuations
• Suffering from stomach cramps
• Gastrointestinal problems like acid reflux and constipation
• Irregular periods
• Difficulty in concentrating or focusing
• Abnormal lab test results such as low potassium or thyroid levels, low red and white blood cell counts or anemia
• Fainting or dizziness
• Feeling excessively cold
• Problems with sleeping
• Calluses or cuts on the finger joints
• Dental decay, tooth sensitivity or enamel erosion
• Dry hair and skin
• Brittle nails
• Swelling in the salivary gland area
• Fine hair growth on the body
• Discolored teeth
• Weak muscles
• Mottled, cold feet and hands
• Swelling feet
• Slow healing of wounds
• Impaired immune system

How Can Rumination Disorder Be Diagnosed?

If the symptoms of rumination disorder are spotted, a doctor can then officially diagnose the condition by carrying out a physical exam and obtaining a full medical history of the individual. There are several tests including blood tests and imaging studies which can rule out any physical cause for the regurgitation and these tests can also help doctors to evaluate the ways in which the disorder has impacted on the body by spotting signs of malnutrition or dehydration. Usually, expensive tests like an endoscopy aren’t required, since doctors can usually diagnose this condition after analysing the symptoms and eating behaviors.

What Causes Rumination Disorder?

It isn’t yet clear what causes rumination syndrome however it may result from increased abdominal pressure. This condition is often mistaken for other problems like bulimia, gastroparesis or GERD (gastroesophageal reflux disease). There are some people who suffer from rumination disorder which is also linked with rectal evacuation disorder. This involves poorly coordinated pelvic floor muscles which result in chronic constipation.

Although at one time rumination was only associated with people suffering from developmental disabilities and infants, it is now known by medical professionals that this condition isn’t linked to age since it occurs in children, adults and teenagers alike. It is, however, more common in people suffering from depression, anxiety and psychiatric disorders. In some patients a severe illness or considerably mental stress have been linked to developing the condition.

There are some physical conditions that may also potentially lead someone to develop rumination disorder. These conditions may include:

• Heartburn
• Gastroesophageal reflux
• Under or over-active gastrointestinal tract muscles
• Abnormal movements of the tongue
• Poor chewing technique
• Low levels of stomach acid
• Swallowing air

Spotting The Difference Between Rumination Disorder And Other Conditions

It can be difficult in some cases to spot the difference between rumination syndrome and some other health conditions with similar symptoms. One condition that is sometimes confused with rumination disorder is GERD (gastrointestinal reflux disease). When someone has acid reflux, the acid which is in the human stomach to break down food begins to rise up into the sufferer’s esophagus. This results in a burning sensation in the stomach as well as an unpleasant sour taste inside the mouth due to the rising stomach acid. When someone has acid reflux they may occasionally regurgitate food, however the taste is bitter or sour. This isn’t the case with food which is regurgitated due to rumination disorder. Also, there is a difference between the time of the day at which acid reflux occurs and the occurrence of rumination. Most people experience a problem with acid reflux at night or when they are lying down since this prone position allows the stomach acid to easily travel up their esophagus. In someone with rumination disorder, however, regurgitation with occur after almost every meal.

While rumination disorder is a form of eating disorder it is very different from conditions like bulimia and anorexia. Adults and children who have previously suffered from one of these eating disorders may increase their chances of developing rumination disorder but the way in which the symptoms occur are very different between the conditions. Instead of the sufferer starving themselves or binge eating then purging, people who have rumination disorder will eat food and then almost immediately regurgitate it before re-swallowing it or spitting it out. There is, however, a possible link between bulimia and rumination syndrome. Around a fifth of people who have bulimia are also found to have rumination disorder.

Does Rumination Disorder Have Any Co-Occurring Conditions?

Many eating disorders co-exist with other medical or mental health conditions. Rumination disorder is no exception. One co-occurring condition which has been linked with rumination syndrome is pica. This condition involves the individual eating non-nutritive or non-food items. Although pica isn’t believed to cause rumination, it’s possible for rumination to occur after pica.

As mentioned above, rumination and bulimia are believed to be co-occurring conditions. Bulimia involves deliberately overeating then purging by using enemas, laxatives or self-induced vomiting in order to avoid gaining weight. Rumination involves involuntarily regurgitation of food. While in younger sufferers, the food is usually re-swallowed in older sufferers, the food is more commonly spat out, and this may explain why 20% of bulimia sufferers also have rumination disorder.

One further co-occurring condition linked with rumination disorder is substance abuse. This is especially likely to be the case if someone is suffering from rumination due to underlying anxiety or depressive disorders for which the sufferer is self-medicating with drugs or alcohol. Some people with rumination disorder feel so ashamed and embarrassed about their eating behavior that they begin to abuse substances to cope with their emotions.

What Complications Arise From Rumination?

If left untreated in the long term, rumination may damage the esophagus. It may also result in dental erosion, malnutrition, an unhealthy amount of weight loss, social isolation, embarrassment and bad breath. Stomach ulcers can also occur as a result of untreated rumination syndrome and there are even more serious issues which may occur such as aspiration pneumonia which can be caused when vomit is inhaled into the lungs. Some sufferers even choke and could die as a result of their excessive and ongoing rumination.

How Is Rumination Disorder Treated?

There are several ways in which rumination syndrome can be treated. The methods chosen will depend on whether the sufferer has any other co-existing disorders as well as on their cognitive ability and age.

People who have no developmental disabilities but suffer from rumination disorder usually benefit from receiving habit reversal behavioral therapy. During this treatment, the patient learns how to recognize when rumination is occurring and to use their abdominal muscles to breathe out and in (this is called diaphragmatic breathing) when they notice it happening. This works because it stops the abdominal muscles contracting and this, in turn, prevents regurgitation. As part of this type of therapy, biofeedback is also used. This involves imaging to help the patient to learn how to use their diaphragmatic breathing to prevent regurgitation.

There are also mild aversive and non-aversive techniques which can help people with rumination disorder. These include:

• Only taking small bites when eating food
• Making sure that each mouthful has been chewed completely before it is swallowed
• Eating food which is thick
• Using relaxation techniques
• Hypnosis
• Counseling for any psychological triggers or issues

In patients who already have a damaged esophagus because of their rumination, medications like omeprazole or esomeprazole (both of these are forms of proton pump inhibitor) can be prescribed. This protects the esophagus lining until the patient is able to reduce the severity and frequency of their regurgitation thanks to the behavioral therapy they are receiving. Sometimes, an additional medication which relaxes the stomach after eating can also help to relieve rumination syndrome.

It can be hard to live with rumination disorder, even when receiving treatment. However, with the right medication and therapy, it’s possible to alleviate the symptoms associated with this condition. By being honest and upfront with other people, it’s possible to get a support system in place to help sufferers to cope and to overcome the challenges that this eating disorder can present.

Spotting The Signs Of Rumination Disorder

The prevalence of rumination disorder in the widespread population is currently unknown. However, there are effective treatments available to address the problem as long as the signs and symptoms are recognized and the sufferer gets appropriate medical help.

Rumination disorder can be an embarrassing and damaging problem, both mentally and physically, so getting the right support is very important at as early a stage as possible. By gaining a better understanding of how to spot this eating disorder, it’s possible to take action quickly and to make sure that sufferers have the best chance of a good outcome for their treatment so that they can return to normal eating patterns and enjoy a better quality of life in the long term.