Eating disorders, like other mental health conditions, have a number of terms and phrases used to describe behaviors and patterns which most commonly present.
Two of the words most often used — rumination and regurgitation — are fundamentally different even though they sound similar. However, both are unhealthy and potentially harmful behaviors which should be addressed in comprehensive treatment plans.
What is rumination?
Rumination, in the context of eating disorders, refers to the regurgitation of food after consumption, which is then either re-chewed, re-swallowed or spit out. This behavior, although less commonly discussed than other eating disorders, poses significant health risks and mental health distress.
Rumination is a behavior characterized by the repeated regurgitation of food that is not connected to a medical condition (like reflux). It typically occurs soon after eating and is performed without nausea or disgust. While it can affect individuals of all ages, it is often observed in infants and children, but can persist into adulthood as part of an eating disorder.
According to Merck Manual, “Regurgitation sometimes occurs with no apparent physical cause. Such regurgitation is called rumination.
In rumination, small amounts of food are regurgitated from the stomach, usually 15 to 30 minutes after eating. The material often passes all the way to the mouth where a person may chew it again and reswallow it.
“Rumination is usually involuntary. However, for some people, the disorder is probably a learned habit and may be part of an eating disorder. Some people are able to voluntarily open their lower esophageal sphincter and propel stomach contents into the esophagus and throat by increasing pressure in the stomach via rhythmic contraction and relaxation of the diaphragm (the muscle that separates the chest from the abdomen and that is responsible for each breath).”
The causes of rumination depend on each person, but it may develop as a coping mechanism for stress or anxiety, providing temporary relief or distraction from emotional distress. Physiologically, it might involve learned behaviors or conditioned responses where the act of regurgitation becomes habitual.
Rumination syndrome is recognized as a separate eating disorder, distinct from more commonly known disorders like anorexia nervosa or bulimia nervosa. However, it can co-occur with these disorders, particularly when individuals use rumination as a method of weight control. The behavior is often mistaken for bulimia nervosa because of the regurgitation aspect, but it lacks the binge-eating typically seen with bulimia.
The long-term health consequences of rumination can be severe if left untreated, and may include:
- Dental erosion;
- Malnutrition;
- Weight loss;
- Electrolyte imbalances;
- Gastrointestinal problems;
- Esophagitis and increased risk of esophageal damage.
Psychologically, individuals may experience social isolation, shame and anxiety, worsening the distress associated with eating disorders. Chronic rumination can result in a diminished quality of life, impacting social interactions and daily functioning.
What is regurgitation?
According to research, “…regurgitation, which is the sudden, effortless return of small volumes of gastric or esophageal contents into the pharynx. Regurgitation implies cricopharyngeal relaxation or insufficiency, and is further characterized by the absence of preceding nausea, retching, or autonomic symptoms.”
In other words, regurgitation is different from vomiting; it typically occurs without the forceful abdominal contractions that characterize vomiting. Individuals may regurgitate food shortly after eating, and it can be re-chewed, re-swallowed or expelled. This behavior can be involuntary, but in some cases, it may be used deliberately as a method of controlling weight.
This same source goes on to say, “The rumination syndrome is a functional cause of regurgitation that can either be voluntary or involuntary.” In other words, regurgitation is most commonly seen as a symptom in those struggling with rumination syndrome. Although less common, it can also be observed in individuals with bulimia nervosa, where regurgitation may be used as a method to avoid weight gain after eating. However, unlike bulimia nervosa, rumination syndrome does not involve binge eating.”
Addressing regurgitation in eating disorders requires a comprehensive approach that includes medical, mental and nutritional interventions. Cognitive-behavioral therapy (CBT) is often effective in helping individuals understand and change the patterns of behavior that contribute to regurgitation. Nutritional counseling can help ensure that the individual maintains a balanced diet and addresses any nutrient deficiencies.
Medical treatment might involve medications to manage any gastrointestinal symptoms or underlying conditions contributing to regurgitation. In some cases, biofeedback therapy is used to help patients gain control over the involuntary muscles involved in regurgitation.
Seeking help?
With certain learned behaviors it can be increasingly difficult to break the habit of performing these behaviors. Oftentimes, mental health treatment and medical intervention is required to help clients get back to a healthy and balanced state of living.
Seeds of Hope is here to help. To learn more about our professional staff, eating disorder treatments and personalized therapy plans, contact us anytime by calling (610) 268-9245 or filling out an online contact form.
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