DSM-III

In DSM-III, this disorder is called Rumination Disorder of Infancy

Diagnostic Criteria

A. Repeated regurgitation without nausea or associated gastrointestinal illness for at least one month following a period of normal functioning.

B. Weight loss or failure to make expected weight gain.

Differential Diagnosis

Congenital anomalies, such as pyloric stenosis, or infections of the gastrointestinal system, can cause regurgitation of food and need to be ruled out by appropriate physical examination.

DSM-IV

Diagnostic Criteria

A. Repeated regurgitation and rechewing of food for a period of at least 1 month following a period of normal functioning.

B. The behavior is not due to an associated gastrointestinal or other general medical condition (e.g. esophageal reflux).

C. The behavior does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa. If the symptoms occur exclusively during the course of Mental Retardation or a Pervasive Developmental Disorder, they are sufficiently severe to warrant independent clinical attention.

Differential Diagnosis

General medical conditions

In infants, congenital anomalies (e.g., pyloric stenosis or gastroesophageal reflux) or other general medical conditions (e.g., infections of the gastrointestinal system) can cause regurgitation of food and should be rules out by appropriate physical examinations and laboratory tests.

Normal vomiting of early infancy

Rumination can be distinguished from normal vomiting of early infancy by the apparently voluntary nature of the rumination (e.g., observation of characteristic preparatory movements followed by regurgitation and sucking or chewing movements that appear to be pleasurable).

Anorexia Nervosa and Bulimia Nervosa

Rumination Disorder is not diagnosed if the symptoms occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa.

DSM-5

Diagnostic Criteria

A. Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out.

B. The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux, pyloric stenosis).

C. The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.

D. If the symptoms occur in the context of another mental disorder (e.g., intellectual disability [intellectual developmental disorder] or another neurodevelopmental disorder), they are sufficiently severe to warrant additional clinical attention.

Specify if:

  • In remission: After full criteria for rumination disorder were previously met, the criteria have not been met for a sustained period of time.

Differential Diagnosis

Gastrointestinal conditions

It is important to differentiate regurgitation in rumination disorder from other conditions characterized by gastroesophageal reflux or vomiting. Conditions such as gastroparesis, pyloris stenosis, hiatal hernia, and Sandifer syndrome in infants should be ruled out by appropriate physical examinations and laboratory tests.

Anorexia nervosa and bulimia nervosa

Individuals with anorexia nervosa and bulimia nervosa may also engage in regurgitation with subsequent spitting out of food as a means of disposing of ingested calories because of concerns about weight gain.

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