Psychologists Explain What You Need to Know About Rumination Disorder

For the most part, food that you eat takes a very specific route once it enters your body—from your mouth to your esophagus, stomach, small intestine, large intestine, then out through your rectum and anus.

But for some people with a condition known as rumination syndrome or disorder, food doesn't always follow that path—instead, when individuals with rumination disorder swallow their food, they regurgitate that food back up through their mouth, Andrea Vazzana, PhD, a child and adolescent psychologist and the clinical co-director of the Eating Disorders service at the Child Study Center, a division of NYU Langone Health's Hassenfeld Children's Hospital, tells Health.

The regurgitation that happens with rumination disorder is different than vomiting, Vazzana says. Overall, regurgitation is essentially the "ejection of the contents of the esophagus" before they get to the stomach, whereas vomiting is a more forceful ejection of food that's already been broken down in the stomach. Regurgitated food might still resemble food that's recently been chewed, whereas vomited food wouldn't, since the acid in the stomach will have mixed with it, Vazzana says.

Rumination disorder is technically known as a feeding and eating disorder, or a behavioral disorder, and it often presents during infancy or childhood and is more prevalent in those populations. (About 5% of children meet the criteria for rumination disorder, while only about eight or nine adults per every thousand meet diagnosis requirements, Vazzana says.)

Symptoms of Rumination Disorder

People with rumination disorder regurgitate their food—voluntarily or involuntarily—usually within 10 minutes of finishing a meal. Patients may regurgitate, re-chew, and re-swallow food multiple times, Kasey Goodpaster, PhD, a psychologist, and director of behavioral services for the Bariatric & Metabolic Institute at Cleveland Clinic, tells Health. These repeated regurgitations could last for up to two hours, Vazzana explains.

According to the National Eating Disorders Association (NEDA), people must meet the following criteria to be diagnosed with rumination disorder, per the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5):

• There's been at least one month of repeated regurgitation of food.
• The repeated regurgitation is not due to a medical condition.
• The regurgitation is not linked to anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.
• If it occurs in addition to a developmental disorder, it's severe enough to warrant separate attention.

Causes

Unfortunately, not a lot is known about rumination disorder, Vazzana says. And according to MedlinePlus, a resource of the US National Library of Medicine, the exact causes of the disorder are also unknown.

That said, certain risk factors have been linked to the disorder. Among these are neglect and lack of stimulation during infancy, as well as "high-stress family situations," according to MedlinePlus.

Goodpaster adds that individuals with developmental disabilities are more likely to suffer from rumination disorder. Associated conditions include anxiety, obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), depression, and Post-Traumatic Stress Disorder (PTSD), Vazzana says.

Individuals can also develop rumination disorder after contracting a viral illness, according to the Genetic and Rare Diseases Information Center (GARD), a division of the National Institutes of Health (NIH). While the causes of rumination disorder are unknown, Vazzana says that one theory as to why neglected or under-stimulated children begin regurgitating, rechewing, then re-swallowing might be to self-stimulate or self-soothe.

Rumination disorder may, too, be a reaction to a physical injury, according to GARD, which states: "It is theorized that while the initial stressor improves, an altered sensation in the abdomen persists." This causes the bottom of the esophagus to relax, which might cause discomfort. In order to relieve that pressure, individuals regurgitate their food. "Over time the person unconsciously adopts this learned behavior," per GARD.

Treatment

Many different experts can help treat individuals with rumination disorder, according to the GARD. Among these are gastroenterologists, psychologists, recreational therapists, and massage therapists.

Patients with rumination disorder are encouraged to self-monitor after having a meal to figure out their triggers, Goodpaster explains. This can mean recording how often regurgitation happens, but it also entails keeping tabs on one's emotions. Goodpaster says that any factors associated with the regurgitation—like the thoughts and feelings that might lead to it—can be useful in helping a psychologist figure out patterns that lead to regurgitation, which can, of course, help them make recommendations on how to stop it.

Oftentimes, when treating rumination disorder, specialists are working to undo a habit of regurgitation that a child or adult has gotten into, Goodpaster explains. As with other habit reversal techniques, distraction after mealtimes is often suggested, she adds, as are relaxation techniques.

Diaphragmatic breathing exercises are also part of the first line of defense when treating rumination disorder, Vazzana adds. These exercises teach patients to breathe from their diaphragm, she explains, and they might be as simple as having a patient place one hand on their chest and one on their lower abdomen, then having them breathe in such a way that only their lower hand—the one on their abdomen—moves when they inhale and exhale.

As far as medical interventions go, "there are some limited suggestions that there could be pharmacological strategies, [but] those are really more secondary," Vazzana says. According to GARD, if behavioral treatments fail, a pain medication called baclofen might be prescribed. The medicine belongs to a class of drugs known as skeletal muscle relaxants and helps treat spasticity (muscle tightness and stiffness) for individuals with multiple sclerosis. While "limited data" on the effectiveness of baclofen for rumination disorder exist, "success with baclofen has been reported," according to the GARD.