Rumination Disorder: Symptoms, Causes, and Treatment

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Living with rumination disorder can seriously impact a young person’s life, affecting their health and ability to form friendships with others. However, with effective support, recovery is possible for anyone.

What Is Rumination Disorder?

Rumination disorder is a type of eating disorder where you repeatedly and unintentionally regurgitate undigested food. It is either re-chewed, re-swallowed or spat out. This often occurs effortlessly and painfully, without symptoms of nausea or disgust.

It’s unclear what causes rumination syndrome, although certain mental and physical health conditions may make developing the condition more likely. Rumination disorder can seriously affect a young person’s daily life and may lead to weight loss, malnutrition, and social isolation.

Is Rumination Disorder an Eating Disorder?

Rumination disorder is a type of eating disorder classified in the Diagnostic and Statistic Manual for Mental Disorders (DSM-5). It’s also one of several functional gastrointestinal disorders.

Some other types of eating disorders include:

  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder

Eating disorders are serious conditions that can cause long-term damage to a young person’s mental and physical health. Any young person living with an eating disorder requires immediate care and attention. Remember, an eating disorder is never a young person’s fault. It’s a medical condition that can often only be overcome with effective treatment and compassionate support.

What Causes Rumination Syndrome?

It’s not clear what exactly causes rumination syndrome. Some young people develop the syndrome after a stressful life event, acute illness, or surgery. Many people with rumination disorder also have other mental illnesses like anxiety or depression. However, it is unclear to what extent these co-occurring disorders cause rumination syndrome and to what extent they are a consequence.

Some of the risk factors for developing rumination disorder include:

  • Emotional neglect (in infants)
  • Emotional stress
  • Presence of mental health diagnoses such as obsessive-compulsive disorder, anxiety, depression, adjustment disorder, post-traumatic stress disorder, and attention deficit-hyperactivity disorder (ADHD)
  • Developmental delay
  • Fibromyalgia, a chronic disorder that causes pain throughout the body

Rumination Disorder As a Process of Negative Thinking

While traditionally, many scientists have conceptualised rumination disorder as a consequence of mental health conditions like anxiety or depression, more recent evidence suggests that the disorder may play a role in developing and maintaining them.

According to a 2021 article published in World Psychology, we can conceptualise rumination disorder as a type of negative thinking that can exacerbate or sustain symptoms of mental health conditions.

For example, while rumination is not a conscious action, it may be underpinned by beliefs that it helps young people cope with their problems. It may also represent a dysfunctional control mechanism that allows a young person to suppress distressing thoughts. In each of these cases, rumination maintains negative patterns of emotional distress and complex thoughts and may prevent young people from addressing the root causes of these issues.

What Are the Signs and Symptoms of Rumination Syndrome?

Rumination syndrome is still a relatively unknown condition. This means that young people living with the condition often go unnoticed, or their condition is misdiagnosed. Being aware of the signs and symptoms of rumination syndrome is important so that you can spot the development of the disorder in a child and help them get the support they require.

Some of the signs of rumination disorder include:

  • Repeated regurgitation of food that has been partly digested
  • Re-chewing and swallowing food regurgitated food
  • Hiding their behaviour, such as by coughing or covering their mouth
  • Avoiding eating around others or before socialising
  • Malnutrition
  • Weight loss
  • Bad breath
  • Experiencing abdominal pain
  • Feeling hungry and irritable before they regurgitate their food

If you think your child could be living with rumination disorder, it’s important to seek help as soon as possible. Rumination disorder can cause severe damage to a young person’s physical health and prevent them from growing and developing healthily. It can also cause interpersonal difficulties, affecting how they socialise and build relationships. However, with effective treatment, young people can learn to manage symptoms and live a healthy and inspired life.

How Is Rumination Syndrome Diagnosed?

The most common method of diagnosing rumination syndrome is by taking a clinical history and conducting a screening for symptoms of the condition. Only a licenced psychiatrist or another medical professional can accurately diagnose mental health disorders.

Medical professionals may use several diagnostic criteria to diagnose the rare behavioural disorder. One of the most common is the DSM-5 criteria, which include:

  • Repeated regurgitation of food for at least a month
  • No obvious underlying physical health condition causing the behaviour
  • The behaviour does not occur only in the context of another eating disorder, such as anorexia or bulima nervosa

Unfortunately, many people wait years to receive an accurate diagnosis of the disorder. This process and its uncertainty can be distressing both for children and adults. Taking your child to a mental health expert that specialises in eating disorders among young people is the best way to receive a quick and accurate diagnosis that paves the way for effective treatment.

How Is Rumination Syndrome Treated?

There are several evidence-based techniques that effectively treat rumination syndrome, helping to manage the symptoms of the disorder so young people can stop bringing up food after meals and enjoy a healthy life. The two most common are breathing exercises and psychotherapy.

Diaphragmatic Breathing Techniques

When a young person with rumination disorder regurgitates food, scientists think there is an increase in abdominal pressure and relaxation of the juncture where the oesophagus meets the stomach. Diaphragmatic breathing is a behavioural therapy that makes the abdominal muscles move differently, preventing them from contracting and stopping the regurgitation of food.

During the breathing exercises, the young person sits comfortably, placing one hand on the chest and the other on the abdomen. They breathe deeply, ensuring that only the hand on the abdomen moves. As they breathe in, their diaphragm contracts, and their abdomen expands.

Young people living with rumination disorder should practice diaphragmatic breathing after eating or when there are signs of incoming regurgitation. With time, it should become natural for them to breathe this way after eating, managing symptoms of rumination syndrome.

Psychotherapy

Some young people develop rumination disorder after distressing events or the onset of mental illness. Rumination disorder may be deeply connected to these issues, constituting one of the processes that manifest as a result of co-occurring conditions like anxiety or depression.

In these cases, psychotherapy may help young people to manage symptoms of co-occurring conditions and develop healthy coping mechanisms that promote lasting mental wellness. This may lead to a reduction or end to symptoms of rumination syndrome.

When Should I Seek Professional Help?

Rumination disorder is a serious condition that can have a lasting impact on your child’s well-being. If you notice any signs of the disorder, it’s important to seek professional help as soon as possible. A mental health professional can accurately identify the disorder and any underlying issues so that treatment and recovery can begin.

The Wave: Specialists in Eating Disorders Amongst Young People

The Wave Clinic offers transformative recovery experiences for young people, focusing on whole-person healing and personal growth. We’re dedicated to helping young people regain their self-esteem, develop healthy coping skills, and explore their goals and dreams for the future. We understand that all mental health issues fit into a much broader picture, treating every part of the person to achieve lasting recovery and change.

Our experienced team includes experts in adolescents and young people’s mental health from across the world. Young people face distinct issues and are at a unique point in their emotional and social development. Accessing specialist treatment, which we provide at the Wave, is crucial to effective clinical care and lasting recovery.

If you think your child may be living with rumination disorder, another eating disorder, or is otherwise struggling with their mental health, contact us today. We offer an unequalled recovery programme founded on clinical expertise and dedication to transformative change.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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