Rumination disorder is a lesser known eating disorder but is a serious condition that can worsen over time and can lead to severe health implications if left untreated.

According to the DSM-5 criteria, a person with rumination disorder will repeatedly regurgitate their food effortlessly and painlessly for more than a month. This regurgitation isn’t forcefully expelled from the mouth as it is in vomiting and is not the result of a medical condition such as a gastrointestinal condition. Rumination occurs when food that is swallowed but not yet digested is regurgitated and may be re-chewed, re-swallowed, or spat out.

Rumination disorder is known to affect children as well as individuals with developmental disabilities. However, the disorder can occur in infants, children, adolescents and adults from all walks of life.

According to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), rumination disorder is an eating disorder presentation that falls under the classification of ‘other’ feeding and eating disorders. Other feeding and eating disorders are distinguished by an enduring disturbance of eating or eating-related behaviour that leads to significant health consequences. This classification assists in identifying and categorising conditions that do not meet the full criteria of eating disorders such as anorexia nervosa, bulimia nervosa, binge eating disorder or avoidant/restrictive food intake disorder (ARFID).

It is important to note that this classification of rumination disorder as an other feeding and eating disorder is not a suggestion of a less serious eating disorder, but simply a different grouping or presentation of symptoms.

Some of the more common signs and symptoms of rumination disorder are:

• Regularly regurgitating food that has been partly digested
• No obvious physical condition leading to this behaviour
• Re-chewing, re-swallowing or spitting out regurgitated food
• Secretive behaviour around eating or hiding the behaviour i.e. by covering one’s mouth during meals
• Avoidance of social eating or eating around others
• Stomach aches and indigestion
• Chapped or raw lips

If left untreated rumination disorder can lead to dehydration, malnutrition, weight loss, damage to teeth and gums, and electrolyte imbalance.

There are several differences between rumination disorder and bulimia nervosa including behaviours and underlying motivation.

Bulimia nervosa is a serious mental illness characterised by recurrent binge-eating episodes (the consumption of abnormally large amounts of food in a short period of time), immediately followed by compensatory behaviours such as self-induced vomiting, fasting, over-exercising and/or the misuse of laxatives, enemas or diuretics. Rumination disorder typically involves frequent regurgitation, usually within half an hour of eating but does not involve the binge-purge cycle of bulimia nervosa.

Rumination is understood to be subconscious behaviour whereby the individual won’t appear to make an effort to bring up their food, nor do they appear distressed or disgusted by the behaviour. In contrast, those experiencing bulimia nervosa engage in compensatory behaviours such as purging as a way to cope with feelings of shame and guilt following a binge and use these behaviours as an attempt to control weight or shape. An individual experiencing rumination disorder may re-chew, re-swallow or spit out food. However, elimination is the motivation of compensatory behaviours exercised by an individual experiencing bulimia nervosa.

It is important to note that rumination disorder is a serious condition and people with the condition often do not feel in control of their disorder. The condition may also intersect with other feeding and eating disorders and individuals with anorexia nervosa, bulimia nervosa, binge eating disorder or avoidant/restrictive food intake disorder (ARFID) may also experience rumination disorder.

If you suspect that you or someone you care about has rumination disorder, it is important to seek help immediately. EDV recommend visiting your GP as the first port of call. The earlier you seek help the closer you are to recovery. 

Eating Disorders Victoria has a broad range of services for people affected by eating disorders, including carers and the EDV Hub can offer support, information and referrals. Contact the EDV Hub on 1300 550 236 between 9.30am – 4.30pm, Monday  – Friday or email edv@eatingdisorders.org.au.