Rumination syndrome, or disorder, is a condition where there is a backward flow of undigested food from the stomach to the mouth. The regurgitated food is then re-chewed, re-swallowed, or spit out. This condition is believed to have a behavioral origin and its development stems from emotional distress, physical injury, viral illnesses, or other traumatic events. Rumination syndrome is an eating disorder that has been linked to other types of eating disorders.
By: Erin Duffy
Rumination syndrome is a rare and chronic disorder where undigested food is automatically regurgitated back into the esophagus, throat, and mouth after eating.[1,2] The regurgitated food is then re-chewed and swallowed or spit out. Rumination syndrome differs from vomiting because the action is involuntary and it occurs without nausea, gagging, retching, or forceful expulsion.[3] This disorder’s symptoms can become more frequent, worsen over time, and can appear in all populations.[4]
Rumination syndrome is not life-threatening, but it does have medical and psychological consequences. The predominant concern of this condition is the uncontrolled, frequent regurgitation of food as it can lead to embarrassment, social isolation, and increase the risk of medical consequences. Individuals with rumination syndrome may emit food after meals daily or as frequently as after every meal.
Common signs and symptoms include: [2]
- Frequent regurgitation/re-chewing of food
- Stomach aches/indigestion
- Oral problems such as tooth decay/bad breath
- Headaches
- Dizziness
Significant consequences that can occur: [2,8]
- Significant weight loss
- Malnutrition
- Dehydration
- Aspiration
- Nutritional deficiencies
- Electrolyte imbalance
It is believed that rumination syndrome develops as an involuntary learned behavior where the diaphragm muscle relaxes voluntarily.[1] This mechanism is similar to a belching reflex, but instead of gas, undigested food comes up.[6] The true nature of what causes this condition is unclear but is speculated to develop after a traumatic event.[2,4] One study found that viral illness, emotional stress, or physical injury can cause the onset of rumination syndrome.[5]
One hypothesis on how regurgitation becomes a learned behavior starts with the identification of an alternative sensation present in the abdomen, usually co-occurring with stress. To alleviate the discomfort that is associated with this sensation, an individual uses their abdominal wall muscles to dislodge and expel the food. Over time, this way of relieving the alternative sensations associated with stress is unconsciously adapted by those who have rumination syndrome.[2] Physiologically speaking, another explanation is that food expands in the stomach which increases abdominal pressure and opens the lower esophageal sphincter to allow for the passage of food to be regurgitated.[7]
Rumination syndrome has diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) to differentiate it from other vomiting syndromes and gastroesophageal reflux disease (GERD).[1]
DSM-V Diagnostic Criteria for Rumination Syndrome: [7]
- Repeated regurgitation of food for a period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
- The repeated regurgitation is not due to a medication condition (e.g., gastrointestinal condition).
- The behavior does not occur exclusively in the course of anorexia nervosa, bulimia nervosa, BED, or avoidant/restrictive food intake disorder.
- If occurring in the presence of another mental disorder (e.g., intellectual developmental disorder), it is severe enough to warrant independent clinical attention.
Rumination syndrome is considered an eating disorder. To establish if symptoms are related to rumination syndrome and not another eating disorder with vomiting characteristics, a detailed history and explanation of symptoms are required in addition to the DSM-V diagnostic criterion.[1] There is very little research on how to treat rumination syndrome.[10] Treatment typically involves a combination of behavioral therapy, diaphragmatic breathing exercises, and the learning of skills to help with habit reversal.[7,8]
At BALANCE eating disorder treatment center, our compassionate, highly skilled team of clinicians is trained in diagnosing and treating the spectrum of eating disorders, including anorexia, bulimia, binge eating disorder, compulsive overeating, and other disordered eating behaviors and body image issues. We offer a variety of programs and services targeted at helping clients overcome fear foods and develop a healthy relationship with food. We offer nutrition counseling with a licensed dietitian, meal support, a Food & Mood Group, and a variety of other groups and resources to help those seeking help for food concerns.
Our admissions team would be happy to answer any questions you may have about our programs and services. Book a free consultation call with our admissions team below or read more about our philosophy here.
This post was written by BALANCE Dietetic Intern, Erin Duffy (she/her).
Erin has been a nutrition student throughout her academic career at Hunter College, first with an undergraduate degree in Nutrition and Food Science, followed by a graduate degree in Nutritional Science and now as a dietetic intern. Erin was first interested in working with individuals with eating disorders after a familial experience. Through this impactful experience, Erin learned a different side of nutrition that aligned with her beliefs. Since interning at BALANCE, Erin has been a strong advocate of intuitive eating, the Health at Every Size movement, and the All Foods Fit approach. She hopes to work as an anti-diet registered dietitian that helps dismantle destructive diet culture norms and creates space for people to heal wholly.
References
1. Talley, Nicholas J. “Rumination Syndrome.” Gastroenterology & Hepatology, vol. 7, no. 2, Feb. 2011, pp. 117–18.
2. Rumination Disorder | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program. https://rarediseases.info.nih.gov/diseases/7594/rumination-disorder. Accessed 22 Feb. 2021.
3. “Rumination Disorder: Treatment in Children vs. Adults, and More.” Healthline, 11 Dec. 2017, https://www.healthline.com/health/rumination-disorder.
4. Rumination Syndrome. https://www.nationwidechildrens.org/conditions/rumination-syndrome. Accessed 22 Feb. 2021.
5. Mousa, Hayat M., et al. “Adolescent Rumination Syndrome.” Current Gastroenterology Reports, vol. 16, no. 8, Aug. 2014, p. 398. PubMed, doi:10.1007/s11894-014-0398-9.
6. “Articles.” Cedars-Sinai, https://www.cedars-sinai.org/health-library/articles.html. Accessed 22 Feb. 2021.
7. “Rumination Disorder.” National Eating Disorders Association, 26 Feb. 2017, https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/rumination-disorder.
8. “Rumination Syndrome: Causes, Signs & Symptoms, Treatment.” Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17981-rumination-syndrome. Accessed 22 Feb. 2021.
9. Michalska, Aneta, et al. “Nonspecific Eating Disorders – a Subjective Review.” Psychiatria Polska, vol. 50, no. 3, 2016, pp. 497–507. DOI.org (Crossref), doi:10.12740/PP/59217.
10. “Rumination Disorder Mainly Impacts the Disabled.” Verywell Mind, https://www.verywellmind.com/rumination-disorder-1138199. Accessed 22 Feb. 2021.
