There are some disorders that affect one’s behavior with food but it is not related to a desire to lose weight or change your appearance. One example of this is Rumination Disorder, which can often be confused with a GI condition. In some cases, it may be accompanied by other medical symptoms and can take a thorough examination to find the correct diagnosis.
Rumination syndrome has the same core features in children and adults: repeated regurgitation of undigested food, usually one to two hours after a meal, after almost every meal. People with this condition describe the behavior as involuntary. In some cases they will swallow the regurgitated food, in others, they may spit it out. Rumination syndrome is rare, but it has long been known to affect infants and mentally disabled adults. In the past few years, it has been shown to affect neurotypical adults as well. On rare occasion, it may be seen in combination of a traditional eating disorder, like anorexia or bulimia, thus complicating the diagnosis and treatment.
It is important to distinguish rumination disorder from Gastro Esophogeal Reflux Disorder (GERD), which is common at all ages of development. All babies will “spit up” from time to time. If an infant’s eating is otherwise normal and the baby does not demonstrate any unusual behaviors during or after a feeding, is gaining weight appropriately, and showing a positive response to being fed, chances are this is normal reflux.
After you get a full picture of the disorder, you can then understand the recovery process, so that it’s easier to take control of it.
However, treatment between the two isn’t quite the same.
Factors Affecting Treatment
This is relevant because it will affect what kind of treatment your doctor may decide to pursue.
Once a diagnosis of rumination syndrome has been reached, the doctor will consider:
- How old you are
- Your overall health
- Your health history
- How well you handle specific medicines, procedures, or therapies
- How long your condition is expected to last
- How long the condition has already lasted
- Your personal preference
When rumination syndrome appears in young children or mentally disabled adults who cannot advocate for themselves, treatment options are often left up to the parent or guardian. Therefore the adult caregivers must consider what kinds of interventions make the most sense for them, considering their relationship with the patient and the personal resources of the person supporting the individual with rumination disorder.
When the patient is an infant, certain treatment options like behavioral therapy are not considered because the baby is too young for such an intervention.
Treating Rumination as an Eating Disorder
Rumination syndrome has been linked to other eating disorders, especially bulimia nervosa, though the exact connection remains unclear since the disorder is relatively rare. It is not unheard of though, for individuals with bulimia to also complain of this symptom. In many cases, the regurgitation will improve along with the bulimia and with improved health and well-being generally.
It is important to recognize though that regurgitation because of rumination and regurgitation because of bulimia are entirely different actions. The regurgitation from bulimia (called purging) is most typically self-induced, is really more like vomiting, and is for the purpose of ridding oneself of foods recently ingested for the purpose of weight loss or to soothe uncomfortable emotions. Because the body is being forced to vomit, stomach acid is carried up the esophageal tract.
Rumination does not technically involve vomiting, as the individual hasn’t actually digested the food and isn’t regurgitating stomach acid. This happens without apparent nausea or a preexisting gastrointestinal disorder.
Like other eating disorders, rumination has strong links to anxiety, since regurgitation is often a soothing action to sufferers. Therefore it is important to not only treat the behavior itself, but also to address the source of the anxiety in order to diminish their desire to utilize this behavior.
Rumination Treatment Options
With that in mind, let’s take a closer look at the available treatment options for rumination syndrome.
One of the most important tools in treating rumination is behavior therapy focusing on habit reversal.
Treatment for rumination is focused on two areas:
- Preventing the physical action of rumination to allow normal, healthy digestion
- Treating the psychological effects of rumination
Since rumination occurs after almost every meal, usually within the first hour or two after a meal, patients develop a conditioned psychological response.
After a while, rumination becomes a part of their regular routine after each meal. Interestingly, some individuals with this disorder do not experience any kind of distress or anxiety about the regurgitation, thus making it more difficult to treat. Others anticipate that the rumination will occur after a meal and begin to feel nervous or distressed about the behavior potentially happening. Ironically, it is this heightened anxiety that can actually bring on regurgitation, further reinforcing the cycle.
Because of this, behavior therapy is a crucial component of a successful recovery plan. The whole goal is to change the learned behavior responsible for regurgitation and by changing the factors that reinforce it.
Depending on the case, there are a few different medication options that your doctor may decide to pursue.
First, if repeated, frequent rumination is causing damage to the esophagus, your doctor may prescribe proton pump inhibitors. These medications help protect the lining of the esophagus until behavior therapy is able to reduce the frequency and severity of regurgitation.
Your doctor may also investigate whether regurgitation is part of an anxiety response or related to an unmanaged anxiety disorder. If this anxiety is not manageable with therapy alone, they may look into whether antidepressant drugs could be beneficial to you.
Diaphragmatic Breathing Techniques
Alongside behavior therapy, a doctor will often instruct you to learn diaphragmatic breathing techniques.
These techniques are designed to be used when you recognize regurgitation will occur. You learn to control your breathing in order to relax the diaphragm (regurgitation cannot occur when the diaphragm is relaxed).
If rumination is part of an anxiety response, these breathing exercises can also help you manage your anxiety in a safer manner.
The Right Balance of Distractions
Finally, doctors will often instruct patients with rumination to find the right combination of coping skills.
During meal times, distractions should be removed as much as possible. This will allow you to eat at a calm pace and prevent anxiety surrounding food. The idea is to make eating a relaxing experience in itself.
After mealtimes, though, distraction is the name of the game, especially if you know rumination will happen soon. The idea is to redirect your nervous energy so your body cannot focus on regurgitation. This is a tool often used in treating other eating disorders as well.
However, the important thing is to use healthy distractions, like socializing with friends, taking a brisk walk, playing a game, or whatever helps you relax in a way that’s positive.
Friends, family, and even pets are excellent helpers. Asking a friend to eat a meal with you and play a game after, taking your dog for a walk, helping your parents do the dishes are all great ways to create distractions (without feeling like people are hovering over you).
If You Need Rumination Treatment
The key to successful rumination treatment isn’t what doctor you see or what method you try.
The key is to remember that you’re not on your own.
Eating disorders are solitary illnesses. They make you feel like you’re alone in the world, even in a room of your dearest friends. They make you feel as though you can’t reach out to others, or that others won’t help if you asked.
Eating is one of our most essential social behaviors. So when you’re recovering from an eating disorder, one of the best things you can do for yourself is to enlist the help of a solid support network.
Besides your loved ones, one of the most important people in your corner is an experienced medical professional you can rely on.
Do you find yourself relating to Rumination eating disorder? Eating disorder recovery can be a process that may be difficult to handle all on your own. Thankfully, you don’t have to. You can recover from the above types of eating disorders, don’t wait until your symptoms get worse.
I’m Dr. Amy Boyers, a Clinical Psychologist in Miami who specializes in eating disorder treatment (all types including anorexia treatment, bulimia treatment, and binge eating treatment) and other long term conditions, including addictions, bipolar, and OCD. I offer personalized and sophisticated eating disorder treatment services, individual and family psychotherapy, family member support and education, in-home meal support, cognitive behavioral therapy, anxiety treatment, depression treatment, and much more.
Have any questions about the eating disorder recovery process? I’d be happy to answer them. Simply reach out to me and I’ll be sure to answer anything you want to know.
I look forward to helping you obtain a brighter tomorrow.
Want to learn more about other eating disorders? Read our full guide to the different types of eating disorders.