Rumination is repeated regurgitation of food after eating; the regurgitation does not involve nausea or retching and may be voluntary.
(See also Introduction to Eating Disorders.)
Patients with rumination disorder repeatedly regurgitate food after eating, but they have no nausea or involuntary retching. The food may be spit out or re-swallowed; some patients rechew the food before re-swallowing. Regurgitation occurs several times per week, typically daily.
Regurgitation disorder may occur in infants, children, adolescents, or adults.
The regurgitation can be intentional or unintentional and often can be directly observed by the clinician.
Some patients are aware that the behavior is socially undesirable and attempt to disguise it by putting a hand over their mouth or limiting their food intake. Some avoid eating with other people and do not eat before a social activity or work so that they do not regurgitate in public.
Patients who spit out the regurgitated material or who significantly limit their intake may lose weight or develop nutritional deficiencies.
Diagnosis of Rumination Disorder
Clinical criteria (1)
Rumination disorder is diagnosed when
Patients repeatedly regurgitate food over a period of ≥ 1 month.
Gastrointestinal (GI) disorders that can lead to regurgitation (eg, gastroesophageal reflux, Zenker diverticulum) or other eating disorders (eg, anorexia nervosa) in which rumination sometimes occurs have been excluded.
If regurgitation occurs in a patient with another disorder, it is severe enough to warrant specific treatment.
Clinicians may observe the regurgitation directly, or the patient may report it.
Clinicians also evaluate nutritional status to check for weight loss and nutritional deficiencies.
Diagnosis reference
1. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision, DSM-5-TRTM, Feeding and eating disorders.
Treatment of Rumination Disorder
Behavioral modification
Behavioral modification techniques, including treatments that use cognitive behavioral strategies, may help.
Key Points
Rumination is repeated regurgitation of food after eating but does not involve nausea or involuntary retching.
Some patients with rumination disorder are aware that the behavior is socially unacceptable and try to disguise or hide it.
Some limit how much they eat (to prevent others from seeing them regurgitate), sometimes resulting in weight loss or nutritional deficiencies.
Diagnose rumination disorder in patients who report repeatedly regurgitating food for ≥ 1 month after excluding other possible causes (eg, GI disorders, other eating disorders).
Treat using behavioral modification techniques.
