Rumination disorder: symptoms, causes and treatment

This psychological disorder involves uncontrolled regurgitation of food.

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

The term "rumination" comes from the Latin word ruminare, meaning "to chew the cud." It was mentioned in antiquity 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 derived from the analogous regurgitation of herbivorous animals, "rumination". In this article we will address its symptoms and prevalence, as well as its causes and treatment.

Symptoms of rumination disorder

Rumination disorder consists of repeated regurgitation of food over a period of at least one month.. In addition, these regurgitated foods may be rechewed, swallowed, or spit out by the sufferer without showing symptoms of disgust, revulsion, or nausea.

In addition, rumination disorder does not occur only in the course of anorexia nervosa, bulimia nervosa, binge eating disorder, or food avoidance/restriction disorder.

Regurgitation should be frequent, occurring at least several times per week, typically on a daily basis. Unlike the involuntary vomiting that any individual may suffer from (uncontrollable), regurgitation may be voluntary. Adult sufferers report that they have no control over the disorder and are unable to stop.

The characteristic body position of children with the disorder is the maintenance of a tense and arched back with the head backwards, making sucking movements with the tongue. They may appear to derive satisfaction from the activity of regurgitating. As a result of the activity, infants may be irritable and hungry. may be irritable and hungry between episodes of rumination..

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

It should be noted that repeated regurgitation cannot be attributed to an associated Gastrointestinal or other medical condition, such as gastroesophageal reflux.such as gastroesophageal reflux.

Prevalence

Although prevalence data are inconclusive, it appears to occur most often in infants, children, and adults. it occurs more frequently in infants, children and in people with intellectual disability..

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

Causes of rumination disorder

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

The most widely documented organic mechanism is that ingestion of food generates gastric distension, which is followed by abdominal compression and subsequent relaxation of the lower esophageal sphincter. (LES). A cavity is created between the stomach and the oropharynx that leads to partially digested material backing up 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), the rumination itself is still usually involuntary. Patients often describe a sensation similar to the appearance of a burp that precedes rumination.

The most important causes of rumination disorder are mostly of psychosocial origin.. Some of the most common causes are: having lived in a cognitively unstimulating psychosocial environment, having received negligent care by the main attachment figures (and even situations of abandonment), experiencing highly stressful events in their lives (such as death of a loved one, changes of city, separation from parents...) and traumatic situations (child sexual abuse).

In addition, difficulties in the parental-filial bond are considered to be 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 self-stimulatory and calming function, similar to the function that repetitive motor behaviors such as rocking may have.

Treatment

The treatment will be different depending on the age and intellectual capacity of the individual with of the individual presenting.

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

In children and in people with intellectual deficits behavior modification techniquesincluding treatments using operant techniques, have been shown to be the most effective.

Some examples are: withdrawing attention from the child while he/she is performing the behavior we want to reduce and giving him/her primary or unconditioned reinforcement (affection and attention) or material reinforcement (a sweets) when he/she does not regurgitate. Other authors suggest putting an unpleasant taste (bitter or sour) on the tongue when the child is starting the typical rumination movements.

In the case of children, it is important that the family understands the disorder and learns some guidelines for action in the face of problematic behavior. and, as it is usually advised in these cases, to have a lot of patience. 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.