217 Rumination Syndrome (307.53)
DSM-IV-TR criteria
A. Repeated regurgitation and re-chewing of food for a period of at least 1 month that follows a normal functioning period
B. The behavior does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa.
- If the symptoms occur exclusively during the course of Mental Retardation or a Pervasive Developmental Disorder, they are sufficient to warrant independent attention.
C. The behavior is not due to an associated gastrointestinal or other general medical condition.
- Esophogeal reflux, GI tract problems, etc.
Associated Features
- Rumination Syndrome may be diagnosed when a person deliberately brings food back into the mouth after being swallowed, and either re-chews and re-swallows it or removes it from the mouth.
- Rumination Syndrome is also referred to as Merycism.
- This disorder is most commonly found in cases of Mental Retardation and is usually found in infants.
- The regurgitation is not caused by a medical condition.
Etiology
- Rumination Syndrome is most common in infants and mentally handicapped persons, but also occurs in children, adolescents and adults of normal intelligence. In infants, it is thought to be caused by a lack of physical contact or nurturing. It also might be done in an effort to self-soothe.
- Studies show there is a correlation to heredity, in most cases the parents of the patient had this disorder.
- It can be brought on by a previous serious illness or through the transition of drugs.
- In adults and adolescents the disorder can be split into two categories, habit-induced or trauma-induced.
- Habit-induced usually stems when a person has a history of regurgitation, such as Bulimia Nervosa or Professional Regurgitation. The act can manifest itself to a state beyond the person’s realm of control.
- Trauma-induced might stem from emotional or physical injury, usually one that involves excessive vomiting.
Epidemiology
- This disorder has a low prevalence and is often misdiagnosed as Bulimia Nervosa, Anorexia Nervosa, or Gastroesophageal Reflux disease (GERD).
- It is more predominantly female
- It is found more quickly in males than in females, the average for males is 11 whereas in females it’s 13.8 making the average age 12.9.
- In infants the prevalence rate is 6-10% of the population and 8-10% of institutionalized adults.
- It’s been shown that up to 20% of people with Bulimia Nervosa ruminate.
Treatments
Treatment for infants with Rumination Syndrome may be as simple as being fed by someone other than the primary caregiver; this is most effective if the parent is the cause of the disorder, for example, if they aren’t caring or nurturing as they should be. Counseling for parents is also strongly recommended. Therapy to increase the parent-child bond can be done to deplete rumination.
In adults, often giving gum to appease an oral fixation may be helpful. Some of the same treatments for Anorexia Nervosa and Bulimia Nervosa have been shown to be helpful. Behavior Modification has also been successful in treating this disorder. Treatment also depends on the age and cognitive ability of the patient.
Diaphragmatic breathing has shown good results, by teaching to breathe with the diaphragm the muscles used to ruminate are occupied by breathing.
Children that are in serious life-threatening danger due to rumination may need to be hospitalized until their condition can be stabilized.
The Mayo Clinic has been one of the leaders in treating Rumination Syndrome and they have a high success rate. For the most successful outcome, the Mayo Clinic uses a collaboration of pediatricians, psychologists and gastroenterologists.
Medical treatment such as proton pump inhibitors or H2 receptor antagonists may be offered to help the patient protect the lining of the esophagus due to severe regurgitation.
Additional links:
- http://www.pbs.org/wgbh/nova/thin/program.html
- http://www.videomd.com/AneorexiaNervosa-fv-659.aspx
- http://www.disordered-eating.co.uk/index.html
- Girl discusses Rumination Disorder
https://www.youtube.com/watch?v=w2zpD3ncI5U