Rumination disorder: symptoms, causes and treatment

Rumination disorder is a rare health disorder, and is included within the DSM 5 chapter on Eating and Eating Disorders (APA, 2013). The focus of the problem in this disorder is regurgitation, which is caused by a contraction of the stomach.

The term “rumination” comes from the Latin word ruminare, which means “chewing the bolus”. It was mentioned in ancient times in the writings of Aristotle, and was first clinically documented in the 17th century by the Italian anatomist Fabricus ab Aquapendende.

The name of this disorder is due to the analogous regurgitation of herbivorous animals, the "rumination". In this article we will address its symptoms and their prevalence, as well as the causes that originate it and its treatment.

• Related article: "The 10 most common eating disorders"

Symptoms of rumination disorder

Rumination disorder consists of repeated regurgitation of food for a minimum period of one month. In addition, these regurgitated foods can be chewed, swallowed, or spit out again by the person suffering from it, without showing symptoms of disgust, revulsion or nausea.

Furthermore, rumination disorder does not occur solely in the course of anorexia nervosa, bulimia nervosa, binge eating disorder, or avoidance / restriction of food intake disorder.

Spitting up should be frequent, occurring at least several times a week, typically on a daily basis. Unlike the involuntary vomiting that anyone may suffer (uncontrollable), regurgitation may be voluntary. Adults who suffer from it say that they have no control over this disorder and that they cannot stop doing it.

The characteristic body position of children who suffer from it is keeping the back tense and arched with the head back, making sucking movements with the tongue. They may give the impression of getting satisfaction from the spit-up activity. As a result of the activity, the minors may be irritable and hungry between rumination episodes.

On the other hand, symptoms of malnutrition and weight loss may appear in adolescents and adults, especially when regurgitation is accompanied by a voluntary restriction of food intake produced due to the social anxiety that other people can witness it (for example, they avoid having breakfast at school for fear of vomiting and being seen).

Notably, repeated regurgitation cannot be attributed to an associated gastrointestinal or other medical condition, such as gastroesophageal reflux.

Prevalence

Although the prevalence data are inconclusive, it appears that occurs more frequently in infants, children, and people with intellectual functional diversity.

The age of onset of rumination disorder in children is usually around 3 and 12 months. This food problem can produce severe symptoms of malnutrition in children, becoming potentially fatal.

Causes of rumination disorder

Rumination syndrome is a little known phenomenon, and there are several speculations about the causes of regurgitation.

The most widely documented organic mechanism is that food intake generates gastric distention, which is followed by abdominal compression and subsequent relaxation of the lower esophageal sphincter (EEI). A cavity is created between the stomach and the oropharynx that leads the partially digested material back into the mouth.

People with this disorder have a sudden relaxation of the LES. While this relaxation may be voluntary (and learned, as in Bulimia), rumination itself remains generally involuntary. Patients often describe a burp-like sensation that precedes rumination.

The most important causes of rumination disorder are mostly psychosocial in origin. Some of the most common causes are: having lived in a psychosocial environment that is not cognitively stimulating, having received care neglected by major attachment figures (and even situations of abandonment), experiencing highly stressful events in their lives (such as the death of a loved one, city changes, separation by parents ...) and traumatic situations (sexual abuse childish).

In addition, difficulties in the parent-child bond are considered one of the most important predisposing factors in the development of this disorder in children and adolescents.

In both children and adults with intellectual deficits or other neurodevelopmental disorders, regurgitation behaviors appear to have a role self-stimulating and calming, similar to the function that repetitive motor behaviors such as the rocking.

Treatment

Treatment will be different depending on age and intellectual capacity of the individual presenting it.

In adults and adolescents biofeedback and the relaxation techniques or diaphragmatic breathing after ingestion or when regurgitation occurs have been shown to be helpful.

In children and in people with intellectual deficits behavior modification techniques, including treatments that employ operant techniques, are those that have shown the most efficacy.

Some examples are: withdrawing attention from the child while performing the behavior we want to reduce and give primary or unconditional reinforcements (affection and attention) or materials (a treat) when not regurgitate. Other authors bet on putting an unpleasant taste (bitter or acid) on the tongue when it is beginning the typical rumination movements.

In the case of children, it is important for the family to understand the disorder and learn some guidelines for action In the face of problematic behavior, and as is often advised in these cases, be very patient. If the relationship between the parents and the child is not good, it is necessary to work on the emotional difficulties that may be maintaining the problem.