Rumination Disorder Flashcards
how many criteria are there for rumination disorder
4
criterion A for rumination disorder
repeated regurgitation of food over a period of at least ONE MONTH
regurgitated food may be re-chewed, re-swallowed or spit out
criterion B for rumination disorder
the repeated regurgitation is not attributable to an associated GI or other medical condition (i.e GERD, pyloric stenosis)
criterion C for rumination disorder
the eating disturbance does not occur exclusively during the course of AN, BN, binge eating disorder or ARFID
criterion D for rumination disorder
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
what is the essential feature of rumination disorder
REPEATED REGURGITATION of food occurring after feeding or eating over period of at least one month
how might someone present clinically if they have rumination disorder
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
how often does regurgitation occur in rumination disorder
frequently–> at least several times per week, typically daily
at what age is rumination disorder typically diagnosed
can be dx across the lifespan, especially in those with ID
how do individuals describe the regurgitation behaviour in rumination disorder
as being habitual or outside of their control
how might people with rumination disorder appear affectively when regurgitating? in between periods of regurgitation?
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)
what are common features in infants with rumination disorder
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
how might rumination disorder affect social functioning in children and adults
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
what is the prevalence of rumination disorder
inconclusive, per DSM
in which populations is prevalence of rumination disorder higher
those with intellectual disability
what is the age of onset of rumination disorder
can be in infancy, childhood, adolescence or adulthood
in infants–> usually between 3-12 months
what is the natural course of rumination disorder occurring in infancy
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
what is the natural course of rumination disorder generally
can be episodic or can occur continuously until treated
environmental risks for rumination disorder
psychosocial problems like lack of stimulation, neglect, stressful life situations, problems in the parent child relationship
ddx rumination disorder
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
what is Sandifer syndrome
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.
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.
regurgitation with associated rumination can co occur wiht another medical condition or another mental disorder (i.e GAD).
list treatments for rumination disorder
diaphragmatic breathing–> most support by evidence
other behavioural interventions
baclofen
neuromodulators
how does diaphragmatic breathing treat rumination disorder
operates as competing response to habitual abdominal wall contraction by relaxing the abdominal wall
some may benefit from biofeedback guided diaphragmatic breathing
*first line
name some other behavioural interventions for rumination disorder
aversion training
general relaxation
distraction i.e gum chewing
CBT-RD
which medication is the only one with RCT for rumination disorder
baclofen (antispasmodic)
patients reported greater subjective overall improvement in symptoms
is there evidence to use neuromodulators like TCAs in treatment of rumination disorder
no not yet
