Classified as a DSM-5 feeding and eating disorder, rumination disorder is the regurgitation of food during or soon after eating with a frequency of at least a few times per week, usually daily, for at least one month. Typically, regurgitation occurs without apparent nausea, retching, or concern. Food that may be partially digested is then rechewed, reswallowed, or spit out.
People with rumination disorder have different reasons for maintaining this behavior, such as self-soothing, oral stimulation, relief of abdominal discomfort, or concerns with weight. Yet a common thread is the continuation of the behavior to gain a sense of control when dealing with negative feelings.
“In some cases it may cause embarrassment or social anxiety, yet those with rumination disorder may not want to change the behavior as it brings them comfort,” says Allison Lansky, EdS, LMFT, CEDS, NCC, Lead Senior Primary Therapist at Penn Medicine Princeton Center for Eating Disorders.
An Effective Treatment Protocol
The first step in the assessment of a patient with suspected rumination disorder is an evaluation with a gastroenterologist. When medical reasons for the behavior have been ruled out, those with rumination disorder can benefit from a treatment approach that incorporates cognitive behavioral therapy (CBT).
Through Lansky’s efforts, a five- to eight-session rumination disorder protocol is now available for Princeton Center for Eating Disorders patients. The protocol was modeled after a rumination disorder clinical trial underway at Massachusetts General Hospital and Drexel University. In addition to incorporating CBT theory, the protocol includes specific practical techniques like diaphragmatic breathing, psychotherapy to address underlying issues, and pharmacotherapy if needed.
One of the main goals of treatment is to help patients recognize the premonitory urge that precipitates rumination.
“We work to bring the voluntary component of behavior from the unconscious to the conscious mind,” explains Lansky. “Once patients are aware that they have control, they can use specific techniques to change that behavior. In a short time, patients gain skills they can benefit from for the rest of their lives.”
Candidates for Inpatient TreatmentIn severe cases, rumination disorder can lead to malnutrition. Sometimes, it co-occurs with another eating disorder. Patients who have rumination disorder and/or other eating disorders who have medical complications secondary to the use of eating disorder symptoms may meet criteria for inpatient treatment at Princeton Center for Eating Disorders. The center accepts patients of all genders ages 8 and older. |