Rumination disorder, or rumination syndrome, is a condition in which someone regularly regurgitates their food after eating it. The food is re-chewed and then either re-swallowed or spat out.
The core symptom of rumination disorder is regurgitating one’s food, after which the food may be swallowed again or spat out. In rumination disorder, regurgitation is not due to throwing up involuntarily, and the person doesn’t view the behavior with disgust. It’s sometimes described as habitual or uncontrollable, according to the DSM-5.
Regurgitating food several times a week, for a period of a month or longer, would lead to a diagnosis of rumination disorder. A diagnosis would not be given if the behavior was due to another eating disorder, mental health condition, or medical condition.
Rumination can lead to psychological distress, because people may struggle with embarrassment and isolation, potentially avoiding settings where they would need to eat with other people such as at school or work. The disorder can sometimes lead to medical complications as well, through weight loss, electrolyte imbalances, and dental problems. Therefore, seeking treatment early on is key.
Adults with rumination disorder may try to hide their regurgitation by coughing into their hand or their napkin while eating. They may also avoid eating with other people. Babies with rumination disorder may make sucking movements with their tongue, display hunger and irritability between regurgitation sessions, and struggle to gain weight, according to the DSM-5.
Rumination disorder is diagnosed based on a medical exam and the behavior of regurgitating food after eating. This may be reported by the patient or their family members, or the doctor may observe it directly during an appointment. Patients with rumination disorder often report vomiting as their main symptom, which can lead rumination to be confused with other diseases. Many patients are often misdiagnosed, and most wait between two and six years for a correct diagnosis, research suggests.
The regurgitation that takes place in rumination disorder is distinct from vomiting because it happens effortlessly, doesn’t involve feeling nauseous, and the food remains undigested and therefore tastes the same as when it was first eaten. It’s distinct from acid reflux because the taste is not acidic and regurgitation doesn’t occur specifically after sleep or fasting.
The roots of rumination disorder are still mysterious, but the disorder involves contracting the muscles in the esophagus and diaphragm, which may then lead regurgitation to become a reflex, similar to burping.
A few environmental factors raise the risk of developing the disorder, including lack of stimulation, stressful events, and a problematic parent-child relationship, according to the DSM-5.
Rumination disorder is particularly high among those with developmental disabilities and other neurodevelopmental disorders. In those cases, regurgitation may be a tool for self-soothing or self-stimulation.
Very little research has assessed the prevalence of rumination disorder, and it’s thought to be relatively rare. Current estimates place the prevalence around 1 percent. (Estimates in specific populations, such as those with other eating disorders, are higher.) One study of 2,163 children in Sri Lanka found that just over 5 percent met the criteria for rumination disorder, although this data relied on self-reports.
Rumination can occur throughout one’s lifetime. It often emerges in childhood, but it can begin in adulthood as well. In infancy, the disorder most commonly appears between 3 and 12 months, according to the DSM-5.
Treatment for rumination disorder may involve working with gastroenterologists, general or nurse practitioners, and therapists.
The primary treatment approach is diaphragmatic breathing, in which patients learn to breathe deeply from their diaphragm rather than their chest. This will help relax the diaphragm, adjust pressure in the esophagus, and consequently prevent regurgitations after eating. A therapist can help the patient learn this skill and integrate it into their mealtime routine.