Rumination Disorder
Primer
Rumination Disorder is a feeding and eating disorder characterized by repeated regurgitation of food occurring after feeding or eating over a period of at least one month.
Epidemiology
The prevalence is not well understood, but is most common in those with intellectual disability.
The disorder may be diagnosed across the life span.
The age at onset in infants is usually between ages 3 to 12 months.
It may be more common in males.
Prognosis
In infants, the disorder frequently remits spontaneously
In older children, adolescents, and adults, social functioning is likely to be adversely affected.
Comorbidity
Risk Factors
Psychosocial factors such as low stimulation, neglect, life stressors, and difficulties in the parent-child relationship may increase the risk in infants and young children.
DSM-5 Diagnostic Criteria
Criterion A
Repeated regurgitation of food over a period of at least 1
month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
Criterion B
The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g. - gastroesophageal reflux, pyloric stenosis).
Criterion C
Criterion D
If the symptoms occur in the context of another mental disorder (e.g. - intellectual developmental disorder or another neurodevelopmental disorder), they are sufficiently severe to warrant additional clinical attention.
Specifiers
Signs and Symptoms
Infants with rumination disorder display a classic position of straining and arching the back with the head held back, making sucking movements with their tongue. They may give the impression of gaining satisfaction from the activity, but will be irritable and hungry between episodes of regurgitation.
Children and adults with rumination can also have malnutrition, especially when the regurgitation is accompanied by restriction of intake. The behaviours may be disguised by placing a hand over the mouth or coughing. Some may avoid eating with others because they are aware of the social undesirability of their behaviours (e.g. - avoiding breakfast because it may be followed by regurgitation).
Screening and Rating Scales
See also:
Bryant‐Waugh, R., Micali, N., Cooke, L., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2019). Development of the Pica, ARFID, and Rumination Disorder Interview, a multi‐informant, semi‐structured interview of feeding disorders across the lifespan: A pilot study for ages 10–22. International Journal of Eating Disorders, 52(4), 378-387.
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Pathophysiology
See also:
Absah, I., Rishi, A., Talley, N. J., Katzka, D., & Halland, M. (2017). Rumination syndrome: pathophysiology, diagnosis, and treatment. Neurogastroenterology & Motility, 29(4), e12954.
Differential Diagnosis
Investigations
Physical Exam
Treatment
Psychotherapy
See also:
Murray, H. B., Juarascio, A. S., Di Lorenzo, C., Drossman, D. A., & Thomas, J. J. (2019). Diagnosis and treatment of rumination syndrome: a critical review. The American journal of gastroenterology, 114(4), 562.
Behavioural therapy and diaphragmatic breathing have been recommended.
There may be some evidence for the use of metoclopramide, cimetidine, and haloperidol.
Resources
For Patients
For Providers
Articles
Research
1)
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
2)
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
3)
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
4)
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
5)
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
6)
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
7)
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
8)
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
9)
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
10)
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
11)
Murray, H. B., Juarascio, A. S., Di Lorenzo, C., Drossman, D. A., & Thomas, J. J. (2019). Diagnosis and treatment of rumination syndrome: a critical review. The American journal of gastroenterology, 114(4), 562.
12)
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (Eleventh edition.). Philadelphia: Wolters Kluwer.