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Repeated regurgitation of food over a period of at least 1 month, which may be re-chewed, re-swallowed, or spit out, not attributable to an associated gastrointestinal or other medical condition, and not occurring exclusively during the course of another eating disorder.
Rumination Disorder involves the repeated, effortless bringing-up of previously swallowed food into the mouth, which the person may then re-chew, re-swallow, or spit out — distinct from vomiting, which is typically involuntary, forceful, and associated with nausea. A September 2024 DSM-5-TR update added a new adult-specific code, reflecting recognition that rumination disorder occurs across the lifespan, not only in infancy.
Onset may occur in infancy, childhood, adolescence, or adulthood; the September 2024 update added a distinct adult-specific ICD-10-CM code, and the behavior can persist or first emerge well beyond infancy.
Can lead to significant weight loss and malnutrition, particularly in infants, where it can become medically serious; in older children and adults, it can cause social embarrassment, avoidance of eating in front of others, and, if severe, meaningful nutritional compromise.
More frequently observed in individuals with intellectual disability; the behavior is often experienced by the individual as an effortless, sometimes even pleasurable or self-soothing act rather than the aversive, involuntary experience of vomiting, which is a useful distinguishing clinical detail.
Feeding practices and caregiver interpretation of infant spitting-up or regurgitation vary; a thorough medical evaluation to rule out common, benign causes (like ordinary infant reflux) should precede attributing the pattern to Rumination Disorder.
A common misconception is that rumination is the same as vomiting, or is always involuntary and distressing. Regurgitation in Rumination Disorder is typically effortless and not preceded by nausea or retching, and can be experienced by the individual as self-soothing — a key clinical distinguishing feature from vomiting-based conditions like bulimia nervosa.
If a gastrointestinal or other medical condition is identified as the cause of the regurgitation, or if it occurs exclusively during the course of another eating disorder without independently warranting attention, reconsider those explanations instead of Rumination Disorder.
A 14-year-old with intellectual disability repeatedly brings up swallowed food, re-chews it, and re-swallows or spits it out shortly after most meals, over several months, with a thorough gastrointestinal workup ruling out reflux or structural causes — consistent with Rumination Disorder.
Know
Rumination Disorder is the repeated, effortless regurgitation of food for at least 1 month, distinct from vomiting, not explained by a gastrointestinal/medical condition, and not occurring exclusively within another eating disorder — diagnosable across the lifespan.
Notice
In a case, notice whether the regurgitation is effortless and non-distressing (rumination) rather than forceful and nausea-associated (vomiting), and whether a medical/gastrointestinal cause has been ruled out.
Distinguish
Distinguish from Bulimia Nervosa by the effortless, non-purging quality of the regurgitation (rumination) versus the distressing, often binge-triggered vomiting of bulimia, and from ARFID by the specific behavior of regurgitating already-swallowed food rather than restricting intake.
Recognize
Repeated regurgitation of food over a period of at least 1 month, which may be re-chewed, re-swallowed, or spit out; regurgitation not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux, pyloric stenosis); does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder; if symptoms occur in the context of another mental disorder or neurodevelopmental disorder, severe enough to warrant independent clinical attention.
Distinguish
Distinguish from Bulimia Nervosa by the effortless, non-purging quality of the regurgitation (rumination) versus the distressing, often binge-triggered vomiting of bulimia, and from ARFID by the specific behavior of regurgitating already-swallowed food rather than restricting intake.
A gastrointestinal or other medical condition (such as gastroesophageal reflux disease or pyloric stenosis) must be ruled out first, since Rumination Disorder is specifically not attributable to such a condition. Other eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder, avoidant/restrictive food intake disorder) must be considered, since Rumination Disorder is not diagnosed if the regurgitation occurs exclusively within the course of one of those conditions — though it can be diagnosed alongside them if severe enough to warrant independent attention.
Both are sometimes lumped together simply as 'unusual eating behaviors in children,' but they involve entirely different physical acts and different downstream medical risks -- Pica's danger is largely about ingested substance toxicity/obstruction, while Rumination Disorder's danger is largely about nutritional loss from repeated regurgitation.
Reduced food intake in ARFID is sometimes mistaken for a sign of rumination when a child also shows some food refusal, but ARFID's core issue is restriction/avoidance of intake in the first place, not a regurgitation process occurring after food has already been swallowed.
Regurgitation and vomiting are sometimes conflated as the same behavior, when Rumination Disorder's regurgitation is typically effortless and not preceded by nausea or retching, unlike the vomiting seen in Bulimia Nervosa.
Reason
Apply
Recognize Rumination Disorder's effortless, non-purging regurgitation, distinguished from the binge-purge cycle and body-image concerns of Bulimia Nervosa.
Retrieve
2 question(s) reference this disorder. Practice Rumination Disorder →
Master