Rumination disorder: symptoms, causes and treatment
Rumination disorder is a rare alteration of health , and is included in the DSM 5 chapter on Eating Disorders and Food Intake (APA, 2013). The focus of the problem of this disorder is regurgitation, which is caused by a contraction of the stomach.
The term "rumination" comes from the Latin word ruminare, which means "chew the food bolus". It was mentioned in antiquity in the writings of Aristotle, and was clinically documented for the first time in the seventeenth century by the Italian anatomist Fabricus ab Aquapendende.
The name of this disorder is due to the analogous regurgitation of the herbivorous animals, the "rumination". In this article we will address its symptoms and its prevalence, as well as the causes that originate it and its treatment.
- Related article: "The 10 most common eating disorders"
Symptoms of rumination disorder
The rumination disorder consists of Repeated regurgitation of food for a minimum period of one month . In addition, these regurgitated foods can be chewed again, swallowed, or spit by the person who suffers, without showing symptoms of disgust, repulsion or nausea.
In addition, rumination disorder does not occur only in the course of anorexia nervosa, bulimia nervosa, binge eating disorder or avoidance / restriction disorder of food intake.
Regurgitation should be frequent, occurring at least several times a week, typically on a daily basis. Unlike involuntary vomiting that anyone can suffer (uncontrollable), regurgitation can be voluntary. Adults who suffer from it claim that they have no control over this disorder and that they can not stop.
The characteristic body position of the children who suffer from it is keeping the back tense and arched with the head back, making sucking movements with the tongue. They can give the impression of obtaining satisfaction from the activity of regurgitating. As a result of the activity, minors they may be irritable and hungry between episodes of rumination .
On the other hand, symptoms of malnutrition and weight loss may appear in adolescents and adults, especially when the regurgitation is accompanied by a voluntary restriction of the food intake produced by the social anxiety that generates them that other people can witness it (for example, they avoid breakfast at school for fear of vomiting and being seen) .
It should be noted that repeated regurgitation can not be attributed to an associated gastrointestinal condition or other medical condition , such as, for example, gastroesophageal reflux.
Prevalence
Although the prevalence data are inconclusive, it seems that 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 food problem can produce severe symptoms of malnutrition in children, becoming potentially fatal.
Causes of rumination disorder
The rumination syndrome is a little known phenomenon, and several are speculations about the causes of regurgitation.
The most widely documented organic mechanism is that food intake generates gastric distension, which is followed by abdominal compression and the posterior relaxation of the lower esophageal sphincter (EEI). A cavity is created between the stomach and the oropharynx that leads to the partially digested material returning to the mouth.
People with this disorder have a sudden relaxation of the LES. While this relaxation may be voluntary (and learned, as in Bulimia), rumination itself remains generally involuntary. Patients often describe a sensation similar to the appearance of an eructation 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 psychosocial environment that is not very stimulating at the cognitive level, having received negligent care for the main figures of attachment (and even situations of abandonment), experiencing highly stressful events in their lives (such as some death). of a loved one, changes of city, separation by parents ...) and traumatic situations (child sexual abuse).
In addition, difficulties in the paternal-filial bond are considered as 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 seem to have a self-stimulating and calming function, similar to the function that repetitive motor behaviors such as balancing may have.
Treatment
The treatment will be different depending on the age and the 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 in people with intellectual deficits the behavior modification techniques , including treatments that employ operant techniques, are those that have shown more efficacy.
Some examples are: withdraw attention to the child while performing the behavior we want to reduce and give primary reinforcements or unconditioned (affection and attention) or materials (a bauble) when it does not regurgitate. Other authors bet by putting an unpleasant taste (bitter or acid) on the tongue when it is starting the typical movements of rumination.
In the case of children, It is important that the family understands the disorder and learns some patterns of action Beware of problem behavior, and as is often advised in these cases, have a lot of patience. If the relationship between the parents and the child is not good, it is necessary to work on the emotional difficulties that may be keeping the problem.
