Rumination Disorder

Most of the symptoms associated with rumination syndrome have to do with the physical actions and characteristics that accompany the condition and cause disturbance. 

• A tendency to regurgitate partially digested food
• A habit of re-chewing, re-swallowing, or spitting out the regurgitated food
• Chapped lips
• Stomach aches
• Indigestion 
• Nausea
• Secretive behavior around eating
• Bad breath

Symptoms associated with the regurgitation of food and rumination syndrome can occur instantly, after every bite, or up to an hour after a person is done eating. Regurgitation often occurs with every meal, but may occur less often. To be diagnosed, a person must engage in regurgitation for at least a month. Babies with rumination disorder may constantly arch their backs, strain, hold their head back, or make sucking noises while they are trying to regurgitate their food.

Related complications

Ultimately, rumination syndrome can result in weight loss, gastroesophageal reflux, dehydration, malnutrition, and electrolyte imbalance, especially if the individual chooses to spit out the regurgitated food. It can also cause damage to a person’s teeth and gums. Aspiration, choking, and pneumonia are additional potential complications. In infants, symptoms of rumination syndrome can lead to failure to thrive and lower a baby’s resistance to disease. 

The constant regurgitation associated with rumination disorder may cause mental and physical stress, resulting in a negative impact on a person’s quality of life. Individuals with rumination syndrome often develop mental disorders, such as depression, anxiety, and somatization. They may choose to avoid social situations, especially those that involve eating or drinking.

Experts are still researching exactly what causes symptoms of rumination disorder. It’s something that individuals pick up unintentionally, possibly related to the belch reflex. People with the disorder often experience an unperceived increase in their intra-abdominal pressure and negative intrathoracic pressure. Together, these can create increased intragastric pressure and cause the regurgitation of food back into a person’s mouth. 

Research into patients’ medical histories have revealed that symptoms are often initiated by a triggering event, such as an infection or a stressful life event that causes vomiting. Eventually, the initial event is resolved, but the regurgitative behavior remains. The body has learned to contract the abdominal muscles when food or drink enters the stomach, resulting in the person’s food continually being regurgitated.

Studies also suggest that people with rumination disorder are more likely to have anxiety, depression, or somatic disorders. Some problems, including a lack of stimulation, high-stress family relationships, and emotional neglect have been linked to rumination disorder in infants.  Children may experience the condition during times of extreme stress.

Although a number of factors have been linked to the development of rumination disorder, the majority of cases have no clear cause. The disorder is different from several other eating disorders in that it is rarely used to help a person control their body weight.

Common treatments of rumination disorder include diaphragmatic breathing and biofeedback. However, before treatment of rumination disorder can begin, doctors may have to perform tests and exams to rule out physical causes, such as gastrointestinal system abnormalities, pyloric stenosis, and hiatal hernia. For example, an upper endoscopy may be performed to examine the patient’s esophagus and stomach. Once it has been confirmed that a patient has the disorder, additional tests may be performed to determine if they have malnutrition. The physician may perform a blood test to check for anemia and assess the patient’s endocrine hormone functions. 

Medication

Medication is typically only considered a treatment option for people who don’t respond to behavioral therapy and are still experiencing symptoms. Baclofen is one of the most utilized medications. It counteracts the relaxation that happens in the lower esophageal sphincter (LES) by increasing the basal pressure in the LES. It has been shown to improve self-reported symptoms in patients. However, baclofen may be accompanied by side effects, especially drowsiness. 

Consult with your doctor or other healthcare professional before starting, stopping, or changing medication.

Other treatment options

Biofeedback is another popular treatment option for rumination disorder. During biofeedback, a practitioner attaches sensors to a person’s body, often to their forehead, to gain computerized information about their body, including their muscle tension, temperature, and hand moisture levels. Gaining biofeedback via high-resolution esophageal manometry or electromyography is often successful in helping patients relax the muscles of their abdominal wall and decrease the frequency of their regurgitation. It may also help patients better visualize their diaphragmatic breathing. 

If rumination is a result of infant abuse or neglect, the condition may be treated through improvement of the environment or support for the parents so that they can implement necessary changes.

If you suspect you have rumination disorder, it may be beneficial to talk to a mental health professional about how the disorder has impacted your life. A therapist can help you navigate the recovery⁴ process. If you don’t feel comfortable discussing rumination disorder in traditional in-office therapy, you might consider online therapy with an online platform such as BetterHelp, which allows you to complete therapy sessions from wherever you feel most comfortable via audio, video, or live chat.

Also, the National Eating Disorders Association (NEDA) is a large nonprofit that provides information about eating disorders as well as treatment options. You can use NEDA’s website to find treatment providers in your area. 

Another organization that may be helpful is the National Association of Anorexia Nervosa and Associated Disorders (ANAD), which provides services to people with eating disorders as well as their families. 

• ANAD’s treatment directory can help patients connect with professionals in their area. 
• ANAD also offers support groups for people who are recovering from eating disorders, as well as caregivers and siblings of those in recovery. These support groups typically meet once a week on Zoom and are led by trained volunteers who have experience recovering from an eating disorder. 
• The ANAD eating disorders helpline is available toll-free at 1 (888) 375-7767. Here you can find support and encouragement, ask questions about eating disorders, or seek treatment referrals.

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

Rumination disorder isn’t always easily recognized, and doctors and health care professionals may not understand it as well as they do other eating disorders. While diaphragmatic breathing is most commonly used, researchers in one study wanted to determine if it was the best course of action to treat patients. After analyzing 12 studies that involved over 250 patients, researchers in Singapore concluded that the data supports diaphragmatic breathing as the most efficient treatment, with the medication baclofen also proving to be beneficial. They suggest that both treatments should be considered, depending on their availability.

Research is also looking into the manifestation of rumination disorder in pediatric patients. In one case study of a nine-year-old with the condition, the child had been regurgitating his food about half an hour after each meal for the previous three months. After examining the child’s physical and medical history, researchers concluded that a previous GERD episode and psychosocial factors were at the root of this disorder. They believe that this case highlights the importance of early diagnosis to avoid future medical and psychiatric comorbidities.⁵

Below are some key statistics on rumination disorder:

• Rumination disorder is not very common in adults, affecting less than 1% of the adult population.
• It can be difficult to diagnose the condition because it can look like other gastrointestinal illnesses. On average, diagnosis takes anywhere from 21 to 77 months.
• In a study of more than 2,000 children and teens with rumination disorder, 8% of participants reported experiencing daily symptoms, and 63% reported monthly symptoms. 
• Certain factors increase a person’s likelihood of developing rumination disorder. 20% of people with eating disorders have the condition, and 8% of people with fibromyalgia develop rumination disorder.