DSM-IV-TR › Disorders usually first diagnosed in infancy, childhood, or adolescence › Feeding and eating disorders of infancy or early childhood › Rumination disorder 

307.53 Rumination Disorder

Diagnostic Features

The essential feature of Rumination Disorder is the repeated regurgitation and rechewing of food occurring after feeding that develops in an infant or child after a period of normal functioning and lasts for at least 1 month (Criterion A). Partially digested food is brought up into the mouth without apparent nausea, retching, disgust, or associated gastrointestinal disorder. The food is then either ejected from the mouth or, more frequently, chewed and reswallowed. The symptoms are not due to an associated gastrointestinal or other general medical condition (e.g., Sandifer's syndrome, esophageal reflux) (Criterion B) and do not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa. If the symptoms occur exclusively during the course of Mental Retardation or a Pervasive Developmental Disorder, they must be sufficiently severe to warrant independent clinical attention (Criterion C). The disorder is most commonly observed in infants but may be seen in older individuals, particularly those who also have Mental Retardation. Infants with the disorder display a characteristic position of straining and arching the back with the head held back, make sucking movements with their tongues, and give the impression of gaining satisfaction from the activity.

Associated Features and Disorders

Infants with Rumination Disorder are generally irritable and hungry between episodes of regurgitation. Although the infant is apparently hungry and ingests large amounts of food, malnutrition may occur because regurgitation immediately follows the feedings. Weight loss, failure to make expected weight gains, and even death can result (with mortality rates as high as 25% reported). Malnutrition appears to be less likely in older children and adults in whom the disorder may be either continuous or episodic. Psychosocial problems such as lack of stimulation, neglect, stressful life situations, and problems in the parent-child relationship may be predisposing factors. Understimulation of the infant may result if the caregiver becomes discouraged and alienated because of the unsuccessful feeding experiences or the noxious odor of the regurgitated material. In some instances, Feeding Disorder of Infancy or Early Childhood may also develop. In older children and adults, Mental Retardation is a predisposing factor.

Prevalence

Rumination Disorder appears to be uncommon. It may occur more often in males than in females.

Course

The onset of Rumination Disorder may occur in the context of developmental delays. The age at onset is between ages 3 and 12 months, except in individuals with Mental Retardation in whom the disorder may occur at a somewhat later developmental stage. In infants, the disorder frequently remits spontaneously. In some severe cases, however, the course is continuous.

Differential Diagnosis

In infants, congenital anomalies (e.g., pyloric stenosis or gastroesophageal reflux) or other general medical conditions (e.g., infections of the gastrointestinal system) can cause regurgitation of food and should be ruled out by appropriate physical examinations and laboratory tests. Rumination can be distinguished from normal vomiting of early infancy by the apparently voluntary nature of the rumination (e.g., observation of characteristic preparatory movements followed by regurgitation and sucking or chewing movements that appear to be pleasurable). Rumination Disorder is not diagnosed if the symptoms occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa.

Diagnostic criteria for 307.53 Rumination Disorder

1. Repeated regurgitation and rechewing of food for a period of at least 1 month following a period of normal functioning.
2. The behavior is not due to an associated gastrointestinal or other general medical condition (e.g., esophageal reflux).
3. The behavior does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa. If the symptoms occur exclusively during the course of Mental Retardation or a Pervasive Developmental Disorder, they are sufficiently severe to warrant independent clinical attention.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision^TM. Copyright 2000 American Psychiatric Association. All Rights Reserved.