Rumination Disorder: Symptoms, Causes And Treatment
Rumination disorder is a rare health disorder, and is included within the DSM 5 chapter on Eating and Eating Disorders (APA, 2013). The focus of the problem with this disorder is regurgitation, which is caused by a contraction of the stomach.
The term “rumination” comes from the Latin word ruminare, which means “to chew the cud.” 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, “rumination”. In this article we are going to address its symptoms and their prevalence, as well as the causes that cause them and their treatment.
Rumination disorder consists of repeated regurgitation of food for a period of at least one month Furthermore, these regurgitated foods can be chewed, swallowed, or spit out by the person suffering from it, without showing symptoms of disgust, repulsion or nausea.
Furthermore, rumination disorder does not occur solely in the course of anorexia nervosa, bulimia nervosa, binge eating disorder, or avoidant/restrictive eating disorder.
Regurgitation should be frequent, occurring at least several times a week, typically daily. Unlike involuntary vomiting that any person can suffer (uncontrollable), regurgitation can be voluntary. Adults who suffer from it claim that they have no control over this disorder and that they cannot stop doing it.
The characteristic body position of children who suffer from it is maintaining a tense and arched back with their head backwards, making sucking movements with their tongue. They may appear to derive satisfaction from the activity of regurgitating. As a result of the activity, the minors They may be irritable and hungry between bouts of rumination
On the other hand, symptoms of malnutrition and weight loss may appear in adolescents and adults, especially when regurgitation is accompanied by a voluntary restriction of food intake produced by social anxiety that other people may witness it (for example, they avoid having breakfast at school for fear of vomiting and being seen) .
It should be noted that repeated regurgitation cannot be attributed to an associated gastrointestinal condition or other medical condition such as gastroesophageal reflux.
Prevalence
Although prevalence data are inconclusive, it appears that It occurs more frequently in babies, children and people with intellectual functional diversity
The age of onset of rumination disorder in children is usually around 3 and 12 months. This eating problem can produce severe symptoms of malnutrition in children, becoming potentially fatal.
Causes of rumination disorder
Rumination syndrome is a little-known phenomenon, and there are several speculations about the causes of regurgitation.
The most widely documented organic mechanism is that food intake generates gastric distention, which is followed by abdominal compression and subsequent relaxation of the lower esophageal sphincter (ISS). A cavity is created between the stomach and the oropharynx which leads to partially digested material returning to the mouth.
People who suffer from this disorder have a sudden relaxation of the LES. While this relaxation may be voluntary (and learned, as in Bulimia), the rumination itself remains generally involuntary. Patients often describe a sensation similar to the onset of a belch 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 from the main attachment figures (and even abandonment situations), experiencing highly stressful events in their lives (such as a death of a loved one, changes of city, separation by parents…) and traumatic situations (child sexual abuse).
Furthermore, difficulties in the parent-child bond are considered 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-stimulating and calming function, similar to the function that repetitive motor behaviors such as rocking can have.
Treatment
The treatment will be different depending on age and intellectual capacity of the individual who presents it.
In adults and adolescents, biofeedback and relaxation or diaphragmatic breathing techniques after ingestion or when regurgitation occurs have been shown to be useful.
In children and people with intellectual deficits behavior modification techniques including treatments that use operant techniques, are those that have shown the most effectiveness.
Some examples are: withdrawing attention from the child while he or she performs the behavior we want to reduce and giving him primary or unconditioned reinforcements (affection and attention) or materials (a candy) when he does not regurgitate. Other authors advocate putting an unpleasant taste (bitter or acidic) on the tongue when typical rumination movements begin.
In the case of children, It is important that the family understands the disorder and learns some guidelines for action When faced with problematic behavior, and as is usually advised in these cases, be very patient. If the relationship between parents and child is not good, it is necessary to work on the emotional difficulties that may be maintaining the problem.
