From the Guidelines
Rumination disorder management should prioritize a comprehensive assessment and treatment plan, including screening for eating disorders, assessment of eating-related behaviors, and psychosocial impairment, as recommended by the American Psychiatric Association 1. The primary goal of treatment is to address the underlying eating disorder and associated behaviors, rather than just the symptoms of rumination.
- Key components of the assessment include:
- Evaluating the patient's height and weight history
- Assessing patterns of restrictive eating, food avoidance, binge eating, and other eating-related behaviors, including rumination and regurgitation
- Examining patterns and changes in food repertoire and compensatory behaviors
- Evaluating psychosocial impairment and family history of eating disorders
- Treatment approaches may include behavioral techniques, such as habit reversal therapy, and dietary modifications, such as eating smaller, more frequent meals and avoiding distractions while eating 1.
- Additionally, supportive care, including psychological support and biofeedback therapy, may be beneficial in helping patients manage anxiety, depression, and abdominal muscle contractions associated with rumination 1.
- While medications like proton pump inhibitors may be used to reduce associated acid reflux symptoms, they are not a primary treatment for rumination disorder 1.
- Overall, a comprehensive treatment plan that addresses the underlying eating disorder and associated behaviors, rather than just the symptoms of rumination, is essential for effective management of rumination disorder 1.
From the Research
Rumination Disorder Management
- Rumination syndrome is a gastrointestinal disorder characterized by effortless regurgitation of recently ingested food, leading to impaired quality of life among those affected 2.
- The pathogenesis of rumination syndrome remains incompletely understood, but therapeutic options such as behavioral therapy with diaphragmatic breathing and pharmacotherapy with baclofen appear effective 2.
- A randomized trial of behavioral therapy, biofeedback therapy led to a 74% reduction in rumination activity, while a recent randomized trial of baclofen led to symptomatic improvement in 63% of patients with rumination syndrome 2.
Treatment Options
- Behavioral therapy consisting of diaphragmatic breathing, with or without biofeedback, remains the most effective treatment strategy for patients with rumination syndrome 2, 3.
- The combination of a tricyclic antidepressant (TCA) with diaphragmatic breathing/relaxation techniques is also an effective treatment modality for the management of rumination syndrome, addressing underlying factors such as anxiety and psychological stress 4.
- Other treatments, such as rumination-focused cognitive therapy and concreteness training, have shown promising results in reducing rumination and improving symptoms of depression 5, 6.
Mechanisms and Consequences
- Rumination has multiple negative consequences, including exacerbating psychopathology, interfering with problem-solving, and reducing sensitivity to changing contingencies 6.
- The mechanisms underlying rumination involve habit development, executive control, abstract processing, goal discrepancies, and negative bias, which can be targeted by psychological interventions 6.
- Treatments for rumination, such as those designed to specifically target these mechanisms, may be effective at reducing rumination and improving symptoms of related disorders 6.