The essential feature of rumination disorder is the repeated regurgitation of food occur- ring after feeding or eating over a period of at least 1 month (Criterion A). Previously swal- lowed food that may be partially digested is brought up into the mouth without apparent nausea, involuntary retching, or disgust. The food may be re-chewed and then ejected from the mouth or re—swallowed. Regurgitation in rumination disorder should be fre- quent, occurring at least several times per week, typically daily. The behavior is not better explained by an associated gastrointestinal or other medical condition (e.g., gastroesoph- ageal reflux, pyloric stenosis) (Criterion B) and does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restric- tive food intake disorder (Criterion C). If the symptoms occur in the context of another mental disorder (e.g., intellectual disability [intellectual developmental disorder], neuro- developmental disorder), they must be sufficiently severe to warrant additional clinical attention (Criterion D) and should represent a primary aspect of the individual’s presen- tation requiring intervention. The disorder may be diagnosed across the life span, par- ticularly in individuals who also have intellectual disability. Many individuals with rumination disorder can be directly observed engaging in the behavior by the clinician. In other instances diagnosis can be made on the basis of self—report or corroborative informa- tion from parents or caregivers. Individuals may describe the behavior as habitual or out- side of their control.
Infants with rumination disorder display a characteristic position of straining and arching the back with the head held back, making sucking movements with their tongue. They may give the impression of gaining satisfaction from the activity. They may be irritable and hungry between episodes of regurgitation. Weight loss and failure to make expected weight gains are common features in infants with rumination disorder. Malnutrition may occur despite the infant’s apparent hunger and the ingestion of relatively large amounts of food, particularly in severe cases, when regurgitation immediately follows each feeding episode and regurgitated food is expelled. Malnutrition might also occur in older children and adults, particularly when the regurgitation is accompanied by restriction of intake.
Adolescents and adults may attempt to disguise the regurgitation behavior by placing a hand over the mouth or coughing. Some will avoid eating with others because of the ac- knowledged social undesirability of the behavior. This may extend to an avoidance of eat- ing prior to social situations, such as work or school (e.g., avoiding breakfast because it may be followed by regurgitation).
Prevalence data for rumination disorder are inconclusive, but the disorder is commonly reported to be higher in certain groups, such as individuals with intellectual disability.
Onset of rumination disorder can occur in infancy, childhood, adolescence, or adulthood.
The age at onset in infants is usually between ages 3 and 12 months. In infants, the disorder frequently remits spontaneously, but its course can be protracted and can result in medical emergencies (e.g., severe malnutrition). It can potentially be fatal, particularly in infancy.
Rumination disorder can have an episodic course or occur continuously until treated. In infants, as well as in older individuals with intellectual disability (intellectual developmen- tal disorder) or other neurodevelopmental disorders, the regurgitation and rumination be- havior appears to have a self—soothing or self—stimulating function, similar to that of other repetitive motor behaviors such as head banging.
Environmental. Psychosocial problems such as lack of stimulation, neglect, stressful life situations, and problems in the parent—child relationship may be predisposing factors in infants and young children.
Functional Consequences of Rumination Disorder
Malnutrition secondary to repeated regurgitation may be associated with growth delay and have a negative effect on development and learning potential. Some older individuals with rumination disorder deliberately restrict their food intake because of the social un- desirability of regurgitation. They may therefore present with weight loss or low weight.