Rumination Disorder: Symptoms, Causes, and Effective Treatment for Children, Teens, and Young Adults
When Eating Becomes Distressing: Understanding Rumination Disorder and How Treatment Can Help
If your child, teenager, or young adult repeatedly regurgitates food shortly after eating, you may feel confused, worried, and frustrated. Many families spend months—or even years—searching for answers before discovering that the behavior is not intentional and may not be caused by a gastrointestinal condition.
Rumination Disorder is a legitimate feeding and eating disorder that can significantly impact physical health, emotional wellbeing, nutrition, social functioning, and quality of life. It is also recognized as a disorder of gut–brain interaction in gastroenterology literature, which helps explain why symptoms often sit at the intersection of the digestive system, nervous system, and learned behavioral patterns (Murray et al., 2019; Haworth et al., 2024).
The good news is that effective treatment is available, and recovery is possible.
At Ezer Psychotherapy, we provide evidence-based treatment for Rumination Disorder for children, adolescents, and young adults throughout Minnesota, Wisconsin, North Dakota, and Florida through secure telehealth services.
What Is Rumination Disorder?
Rumination Disorder is characterized by the repeated regurgitation of food after eating. The food may be rechewed, reswallowed, or spit out. Unlike vomiting, the regurgitation is typically effortless and does not involve nausea, retching, or illness (Murray et al., 2019; Absah et al., 2017).
According to DSM-5-TR criteria, symptoms must:
Occur repeatedly for at least one month
Not be explained by a medical condition alone
Not occur exclusively during another eating disorder such as anorexia nervosa, bulimia nervosa, binge-eating disorder, or ARFID
Be clinically significant enough to warrant treatment if occurring alongside another mental health or medical condition (American Psychiatric Association, 2022)
Many individuals describe the experience as food “coming back up” into their mouth shortly after meals.
Common Signs and Symptoms of Rumination Disorder
Symptoms may include:
Repeated regurgitation of food after meals
Re-chewing food that has been regurgitated
Re-swallowing regurgitated food
Spitting out regurgitated food
Avoidance of eating due to fear of symptoms
Weight loss or difficulty gaining weight
Malnutrition or nutritional deficiencies
Stomach discomfort
Bad breath
Social anxiety around eating
Embarrassment or shame related to symptoms
Children and adolescents may avoid school lunches, social gatherings, restaurants, sports activities, or family meals because they worry about symptoms occurring in front of others. Pediatric studies have found that rumination syndrome can be associated with school absenteeism, weight loss, hospitalization, and prolonged diagnostic delays (Chial et al., 2003; Jia et al., 2024).
What Causes Rumination Disorder?
There is no single cause of Rumination Disorder. Research suggests that multiple factors may contribute.
Learned Physiological Responses
In many cases, the body develops an automatic abdominal muscle contraction pattern that increases pressure in the stomach and leads to regurgitation after eating. Over time, this pattern can become habitual and occur without conscious awareness (Absah et al., 2017; Murray et al., 2019).
Stress and Anxiety
Periods of increased stress, anxiety, illness, or life transitions may contribute to the development or worsening of symptoms. Anxiety and depression are also commonly reported in some individuals with rumination symptoms, although they are not required for diagnosis (Haworth et al., 2024; Robles et al., 2020).
Medical Triggers
Some individuals develop rumination symptoms after:
Gastrointestinal illness
Acid reflux or reflux-like symptoms
Stomach infections
Chronic nausea
Other digestive conditions
Even after the original medical issue improves, the regurgitation pattern may continue. Rumination can also be mistaken for reflux, vomiting, or gastroparesis, which is why appropriate medical evaluation is important before assuming a diagnosis (Halland et al., 2018; Nikaki et al., 2019).
Co-Occurring Mental Health Concerns
Rumination Disorder can occur alongside:
Anxiety disorders
Obsessive-compulsive symptoms
Emetophobia, or fear of vomiting
Autism spectrum disorder
Feeding difficulties
Other eating disorders
Treatment should be individualized when these concerns are present.
Is Rumination Disorder an Eating Disorder?
Yes. Rumination Disorder is classified in DSM-5-TR under Feeding and Eating Disorders (American Psychiatric Association, 2022).
However, unlike anorexia nervosa or bulimia nervosa, individuals with Rumination Disorder are typically not engaging in regurgitation for weight-control purposes. The behavior is often involuntary or automatic and is usually driven by physiological and behavioral processes rather than body image concerns (Murray et al., 2019).
Why Early Treatment Matters
Without treatment, Rumination Disorder can lead to:
Nutritional deficiencies
Weight loss
Growth concerns in children
Dehydration
Dental problems
Social isolation
School difficulties
Increased anxiety around eating
Research suggests that longer delays between symptom onset and diagnosis may be associated with lower likelihood of symptom resolution after treatment, highlighting the importance of timely recognition and support (Jia et al., 2024).
How Is Rumination Disorder Treated?
The most effective treatment approach typically combines education, behavioral interventions, practice, and family support. Pediatric treatment research is still limited, but behavioral approaches—especially diaphragmatic breathing—are consistently described as central to treatment (Murray et al., 2019; Sartori et al., 2024).
Diaphragmatic Breathing Training
One of the best-supported interventions for Rumination Disorder is diaphragmatic breathing. This technique helps create a competing response to the abdominal wall contractions that contribute to regurgitation (Murray et al., 2019; Halland et al., 2018).
This technique helps:
Reduce abdominal contractions
Interrupt regurgitation reflexes
Improve awareness of bodily sensations
Promote relaxation during and after meals
Many clients experience symptom reduction when they consistently practice diaphragmatic breathing before, during, and after meals, although some individuals need additional behavioral treatment or medical support if symptoms persist.
Cognitive Behavioral Therapy (CBT)
CBT can help individuals:
Reduce anxiety related to eating
Address avoidance behaviors
Increase confidence during meals
Challenge fears associated with symptoms
Develop healthier coping strategies
Comprehensive CBT-based treatment may be especially helpful when diaphragmatic breathing alone is not enough or when anxiety, avoidance, urges, or food-related fears maintain symptoms (Murray et al., 2020; Lamparyk & Stephens, 2022).
Family-Based Interventions
For children and adolescents, parents play a crucial role in treatment.
Family involvement can help:
Support consistent meal routines
Reduce accommodations that maintain symptoms
Increase treatment adherence
Create a supportive eating environment
Exposure-Based Treatment
When fear, anxiety, or avoidance have developed around eating, gradual exposure approaches may help individuals regain confidence with meals and social eating situations.
Collaboration with Medical Providers
Treatment often works best when therapists collaborate with:
Pediatricians
Primary care providers
Gastroenterologists
Registered dietitians
Other specialists involved in care
A medical evaluation can help rule out or address conditions such as reflux, obstruction, gastroparesis, dysphagia, or other causes of regurgitation. Objective testing is not always required when the clinical history is clear, but it may be helpful when symptoms are atypical or diagnostic uncertainty remains (Halland et al., 2018; Puoti et al., 2024).
Rumination Disorder Treatment at Ezer Psychotherapy
At Ezer Psychotherapy, we specialize in treating feeding and eating disorders in children, adolescents, and young adults.
Our approach focuses on:
Comprehensive assessment
Evidence-based behavioral interventions
Diaphragmatic breathing training
Cognitive Behavioral Therapy (CBT)
Family involvement when appropriate
Coordination with medical providers
Compassionate, individualized care
We understand how confusing and frustrating Rumination Disorder can be for both clients and families. Many people arrive feeling discouraged after numerous medical appointments and unsuccessful attempts to stop symptoms on their own.
Our goal is to help clients regain confidence around eating, reduce symptoms, improve nutrition, and return to living a full and meaningful life.
Telehealth Therapy for Rumination Disorder
Ezer Psychotherapy provides online therapy services for clients throughout:
Minnesota (MN)
Wisconsin (WI)
North Dakota (ND)
Florida (FL)
Telehealth allows individuals and families to access specialized eating disorder treatment from the comfort of home while maintaining consistency in care. Some pediatric multidisciplinary programs have reported symptom improvement through telemedicine-based care, although in-person care may still be preferred or needed for some families depending on symptom severity and medical needs (Hawa et al., 2022).
When Should You Seek Help?
Consider seeking professional support if you or your child experiences:
Repeated regurgitation after meals
Weight loss or poor weight gain
Nutritional concerns
Fear of eating
Avoidance of social situations involving food
Ongoing symptoms despite medical evaluation
Early intervention can help prevent symptoms from becoming more entrenched and improve treatment outcomes.
Recovery Is Possible
Rumination Disorder can feel overwhelming, but effective treatment exists. With the right support, many children, adolescents, and young adults experience significant improvement and return to eating with confidence.
If you are looking for specialized Rumination Disorder treatment in Minnesota, Wisconsin, North Dakota, or Florida, Ezer Psychotherapy is here to help.
Schedule a Consultation
If you have questions about Rumination Disorder or would like to discuss treatment options, contact Ezer Psychotherapy today to learn how we can support you or your child on the path toward recovery.
References
Absah, I., Rishi, A., Talley, N. J., Katzka, D., & Halland, M. (2017). Rumination syndrome: Pathophysiology, diagnosis, and treatment. Neurogastroenterology & Motility, 29(4), e12954.
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). American Psychiatric Association Publishing.
Chial, H. J., Camilleri, M., Williams, D. E., Litzinger, K., & Perrault, J. (2003). Rumination syndrome in children and adolescents: Diagnosis, treatment, and prognosis. Pediatrics, 111(1), 158–162.
Halland, M., Parthasarathy, G., Bharucha, A. E., & Katzka, D. A. (2018). Diagnosis and treatment of rumination syndrome. Clinical Gastroenterology and Hepatology, 16(10), 1549–1555.
Hawa, K., et al. (2022). Intensive outpatient treatment of pediatric rumination syndrome in the era of telemedicine. Journal of Pediatric Gastroenterology and Nutrition.
Haworth, J. J., Treadway, S., & Hobson, A. R. (2024). The prevalence of rumination syndrome and rumination disorder: A systematic review and meta-analysis. Neurogastroenterology & Motility, 36(7), e14793.
Jia, M., et al. (2024). Delay in diagnosis is associated with decreased treatment effectiveness in children with rumination syndrome. Journal of Pediatric Gastroenterology and Nutrition.
Lamparyk, K., & Stephens, T. N. (2022). Protocol and outcome evaluation of comprehensive outpatient treatment of adolescent rumination syndrome. Journal of Pediatric Gastroenterology and Nutrition.
Murray, H. B., Juarascio, A. S., Di Lorenzo, C., Drossman, D. A., & Thomas, J. J. (2019). Diagnosis and treatment of rumination syndrome: A critical review. American Journal of Gastroenterology, 114(4), 562–578.
Murray, H. B., et al. (2020). Comprehensive cognitive-behavioral interventions augment diaphragmatic breathing for rumination syndrome: A proof-of-concept trial. Digestive Diseases and Sciences.
Nikaki, K., et al. (2019). Rumination syndrome in children presenting with refractory gastroesophageal reflux symptoms. Journal of Pediatric Gastroenterology and Nutrition.
Puoti, M. G., et al. (2024). The role of high-resolution impedance manometry to identify rumination syndrome in children with unexplained foregut symptoms. Journal of Pediatric Gastroenterology and Nutrition.
Robles, A., et al. (2020). Outcomes of treating rumination syndrome with a tricyclic antidepressant and diaphragmatic breathing. American Journal of the Medical Sciences.
Sartori, R., et al. (2024). Nonpharmacological treatment of rumination syndrome in childhood: A systematic review of the literature. Journal of Pediatric Gastroenterology and Nutrition.
