Rumination Disorder

Question 1

how many criteria are there for rumination disorder

Answer 1

4

Question 2

criterion A for rumination disorder

Answer 2

repeated regurgitation of food over a period of at least ONE MONTH

regurgitated food may be re-chewed, re-swallowed or spit out

Question 3

criterion B for rumination disorder

Answer 3

the repeated regurgitation is not attributable to an associated GI or other medical condition (i.e GERD, pyloric stenosis)

Question 4

criterion C for rumination disorder

Answer 4

the eating disturbance does not occur exclusively during the course of AN, BN, binge eating disorder or ARFID

Question 5

criterion D for rumination disorder

Answer 5

if the symptoms occur in the context of another medical disorder (i.e ID or other neurodevelopmental disorder) they are sufficiently severe to warrant additional clinical attention

Question 6

what is the essential feature of rumination disorder

Answer 6

REPEATED REGURGITATION of food occurring after feeding or eating over period of at least one month

Question 7

how might someone present clinically if they have rumination disorder

Answer 7

previously swallowed food that may be partially digested if brought up into the mouth WITHOUT apparent nausea, involuntary retching, or disgust

display characteristic position of STRAINING and ARCHING THE BACK with the head held back, making SUCKING MOVEMENTS with their tongue

Question 8

how often does regurgitation occur in rumination disorder

Answer 8

frequently–> at least several times per week, typically daily

Question 9

at what age is rumination disorder typically diagnosed

Answer 9

can be dx across the lifespan, especially in those with ID

Question 10

how do individuals describe the regurgitation behaviour in rumination disorder

Answer 10

as being habitual or outside of their control

Question 11

how might people with rumination disorder appear affectively when regurgitating? in between periods of regurgitation?

Answer 11

they may give the impression of gaining SATISFACTION from the activity

they may be IRRITABLE, HUNGRY between episodes of regurgitation

*in infants + older individuals with ID, regurgitation and rumination behaviours appear to have a SELF SOOTHING or SELF STIMULATING function (similar to other repeated motor behaviours like headbanging)

Question 12

what are common features in infants with rumination disorder

Answer 12

weight loss

failure to make expected weight gains

*malnutrition might occur despite infants apparent hunger and the ingestion of relatively large amounts of food, particularly in severe cases, when regurgitation immediately follows each feeding episode and regurgitated food is expelled

Question 13

how might rumination disorder affect social functioning in children and adults

Answer 13

may try to disguise regurgitation by placing hand over the mouth, coughing

some will avoid eating with others, or will avoid eating before social events i.e eating breakfast before school as it may be followed by regurgitation

Question 14

what is the prevalence of rumination disorder

Answer 14

inconclusive, per DSM

Question 15

in which populations is prevalence of rumination disorder higher

Answer 15

those with intellectual disability

Question 16

what is the age of onset of rumination disorder

Answer 16

can be in infancy, childhood, adolescence or adulthood

in infants–> usually between 3-12 months

Question 17

what is the natural course of rumination disorder occurring in infancy

Answer 17

frequently remits spontaneously, but course can be protracted and can result in medical emergencies (i.e severe malnutrition)

can potentially be fatal, especially in infancy

Question 18

what is the natural course of rumination disorder generally

Answer 18

can be episodic or can occur continuously until treated

Question 19

environmental risks for rumination disorder

Answer 19

psychosocial problems like lack of stimulation, neglect, stressful life situations, problems in the parent child relationship

Question 20

ddx rumination disorder

Answer 20

GI conditions–> gastroparesis, pyloric stenosis, hiatal hernia, Sandifer syndrome in infants

AN, BN–> may also engage in regurgitation as a means of disposing of ingested calories due to concerns about weight gain

Question 21

what is Sandifer syndrome

Answer 21

movement disorder that affects infants

Babies with Sandifer syndrome twist and arch their backs and throw their heads back. These strange postures are brief and sudden. They commonly occur after the baby eats.

Question 22

what conditions may be comorbid with Babies with Sandifer syndrome twist and arch their backs and throw their heads back. These strange postures are brief and sudden. They commonly occur after the baby eats.

Answer 22

regurgitation with associated rumination can co occur wiht another medical condition or another mental disorder (i.e GAD).

Question 23

list treatments for rumination disorder

Answer 23

diaphragmatic breathing–> most support by evidence

other behavioural interventions

baclofen

neuromodulators

Question 24

how does diaphragmatic breathing treat rumination disorder

Answer 24

operates as competing response to habitual abdominal wall contraction by relaxing the abdominal wall

some may benefit from biofeedback guided diaphragmatic breathing

*first line

Question 25

name some other behavioural interventions for rumination disorder

Answer 25

aversion training

general relaxation

distraction i.e gum chewing

CBT-RD

Question 26

which medication is the only one with RCT for rumination disorder

Answer 26

baclofen (antispasmodic)

patients reported greater subjective overall improvement in symptoms

Question 27

is there evidence to use neuromodulators like TCAs in treatment of rumination disorder

Answer 27

no not yet