Rumination disorder: symptoms, causes and treatment

Rumination disorder is a rare health disorder, And is included in the DSM 5 chapter on eating disorders and food intake (APA, 2013). Regurgitation, which is caused by a contraction of the stomach, is at the center of the problem with this disorder.

The term “rumination” comes from the Latin word ruminare, which means “to chew the bowl of food”. It was mentioned in ancient times in the writings of Aristotle, and was first documented clinically 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 “rumia”. In this article, we’ll discuss its symptoms and prevalence, along with the underlying causes and treatment.

    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 again, swallowed or spat out by the sufferer, without showing symptoms of disgust, repulsion or nausea.

    Moreover, rumination disorder does not only occur during anorexia nervosa, bulimia nervosa, binge eating disorder, or food avoidance / restriction disorder.

    Regurgitation should be frequent, occurring at least several times a week, usually daily. Unlike involuntary vomiting that anyone may suffer (uncontrollably), regurgitation may be voluntary. Adults who have it claim that they have no control over the disorder and cannot stop doing it.

    The characteristic body position of children who suffer from it is to keep the back straight and arched with the head back, making sucking movements with their tongue. They may have the effect of obtaining satisfaction from the regurgitation activity. Following the activity, minors they may be irritable and hungry between episodes of rumination.

    On another side, symptoms of malnutrition and weight loss may appear in adolescents and adults, especially when regurgitation is accompanied by voluntary restriction of food intake caused by social anxiety that causes them to witness other people (for example, they avoid breakfast at school for fear of “ throwing up and being seen ”).

    It should be noted that repeated regurgitation it cannot be attributed to an associated gastrointestinal condition or other medical condition, Such as gastroesophageal reflux disease.

    prevalence

    Although the prevalence data is not complete, it appears that it occurs most often in infants, children and people with intellectual functional diversity.

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

    Causes of rumination disorder

    Wrinkle syndrome is a little known phenomenon and there are many speculations about what causes regurgitation.

    The most widely documented organic mechanism is that food intake generates gastric distension, 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 which leads to the return of partially digested material to the mouth.

    People with this disorder experience a sudden release of IED. While this relaxation can be voluntary (and learned, as in bulimia), the ruminant itself generally remains involuntary. Patients often describe a sensation similar to the appearance of rot that precedes rumination.

    The most important causes of rumination disorder are mainly of psychosocial origin. Some of the most common causes are: having lived in a psychosocial environment with low cognitive stimulus, having received negligent care for the main figures of affection (and even situations of abandonment), experiencing very stressful events in their life (such as the death of a loved one, city changes, separation by parents …) and traumatic situations (child sexual abuse).

    In addition, parenting difficulties are considered to be one of the most important predisposing factors for the development of this disorder in children and adolescents.

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

    treatment

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

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

    In children and people with intellectual disabilities behavior modification techniques, Including treatments using operative techniques, are those that have shown the most effectiveness.

    Some examples are: withdrawing the child’s attention when performing the behavior we want to reduce and giving him primary or unconditional reinforcements (affection and attention) or materials (a treat) when he is not regurgitating. Other authors bet on putting an unpleasant taste (bitter or sour) on the tongue at the onset of typical rumination movements.

    In the case of children, it is important for the family to understand the disorder and learn some guidelines for action when dealing with problematic behavior, and as is generally advised in such cases, be very patient. If the relationship between parent and child is not good, it is necessary to work on the emotional difficulties that may be fueling the problem.

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