Rumination eating disorder (RED) occupies a relatively obscure corner of the vast landscape of eating disorders. Despite its lesser-known status compared to disorders like anorexia nervosa or bulimia nervosa, RED presents significant challenges for those who experience it, and can offer a bumpy road when recovering.
Nevertheless, with the right treatment plan remains dedicated to each individual’s personal needs, recovery and healing is possible.
What is rumination eating disorder?
Rumination eating disorder is characterized by the repeated regurgitation of food, which may be rechewed, reswallowed or spit out. Unlike similar behaviors observed in other eating disorders, RED is not attributable to a medical condition or a conscious decision to lose weight.
According to John Hopkins Medicine, “Someone with this problem will often eat meals normally. But after about 10 to 15 minutes, undigested food comes back up into the mouth from the food pipe (esophagus). This may continue for about 1 to 2 hours. The person may rechew and reswallow the food. Or they may spit it out. Often this happens at every meal, day after day.”
What are the signs of rumination disorder?
Eating disorders manifest in different people in different ways, with rumination disorder being no exception. Knowing the signs of rumination disorder that are most commonly present can help in effective diagnosis and treatment.
Common signs of rumination disorder include:
- Regurgitating — The most defining symptom of RED is the repeated regurgitation of recently ingested food. This regurgitation is voluntary and often occurs soon after eating;
- Rechewing and reswallowing or spitting out — Following regurgitation, individuals may rechew the food and either reswallow it or spit it out;
- Nausea-free regurgitation — Unlike other conditions where vomiting is a symptom, RED does not typically involve nausea, retching or disgust, and it is often described as effortless;
- Nutritionally deficient — Individuals may experience weight loss and signs of malnutrition, due to insufficient nutrient absorption;
- Dental problems — The repeated exposure of teeth to stomach acids can lead to dental issues like tooth decay and enamel erosion;
- Halitosis (bad breath) — Chronic regurgitation can cause persistent bad breath due to the remnants of food and digestive acids in the mouth.
- Social withdrawal and anxiety — Some may feel embarrassed or anxious about their behavior, leading to social withdrawal and the experience of social anxiety;
- GI issues — Although nausea is not a common symptom, some individuals may experience general stomach discomfort or pain associated with repeated regurgitation.
Early recognition and intervention are key to managing RED effectively. Because of its nature, it is important that anyone battling this disorder seeks help from the right sources to address signs and symptoms they’re experiencing.
How is rumination eating disorder treated?
Depending on the situation, treatment can vary using any of the following methods based on each individual’s needs and symptoms.
1. Medical intervention
The first step in treating rumination disorder is a comprehensive medical evaluation to make sure that no underlying physical health issues (like GI diseases) are contributing to the behavior. A pediatrician or gastroenterologist will typically conduct a physical exam and possibly recommend diagnostic tests to rule out conditions like gastroesophageal reflux disease or hiatal hernia.
If the disorder is indeed confirmed as rumination, and no other primary gastrointestinal issue is found, treatment can proceed with a focus on behavioral and psychological interventions.
2. Behavioral therapy
In order to properly treat rumination disorder, undergoing certain behavioral therapies are crucial. Techniques from Applied Behavior Analysis (ABA) have shown effectiveness, particularly in cases involving young children or individuals with developmental disabilities.
These techniques often involve:
- Habit reversal training — Which involves increasing awareness of the behavior, identifying triggers and replacing the rumination with more appropriate responses. For instance, when the urge to regurgitate is detected, the individual might be taught to engage in deep breathing instead;
- Biofeedback — Helps gain control over involuntary physiological functions. By learning to recognize and modify these responses, individuals can reduce how often they engage in rumination;
- Scheduled feeding times — Structured and consistent meal schedules can help reduce instances of rumination. Small, frequent meals might be recommended to keep the stomach from getting overfull, which might trigger regurgitation.
3. Therapeutic modalities
Psychotherapy, like cognitive-behavioral therapy (CBT), can benefit older children and adults with rumination disorder. CBT helps individuals identify negative thought patterns and develop healthier attitudes toward food and eating, as well as provides tools to cope with anxiety and stress, symptoms often linked to compulsive eating behaviors.
Support groups and family therapy may also play crucial roles in treatment. Educating the family about the disorder and involving them in therapy can foster a supportive home environment, thereby boosting recovery.
4. Nutrition-based education
Help from a nutritionist or dietitian can be an important component of treatment as these professionals can help track the individual’s nutritional intake and offer guidance on modifying food texture or consistency to lessen discomfort and any consequential urges to regurgitate.
5. Medication
In some cases, medication may be prescribed to manage symptoms or co-occurring conditions such as anxiety or depression, known to exacerbate rumination behavior. However, medication alone is not typically sufficient to treat rumination disorder and is most effective when combined with other therapeutic approaches.
Are you looking for a supportive recovery environment?
If you or a loved one are struggling with rumination behaviors or are in need of more educational support or resources, contact Seeds of Hope by calling 610-897-0508 or fill out an online contact form to get in touch with a staff member today.
