Rumination, or the chewing and re-swallowing of regurgitated stomach contents, can be found in up to 10% of institutionalized individuals with severe or profound mental retardation. Serious physical consequences, including death, can result from the disorder. Unfortunately, rumination can be subtle and difficult to observe and often continues untreated. Additionally, the research literature has provided divergent results without clear treatment guidance for clinicians. We present an overview of the history of rumination, a review of the literature on its etiology and treatment, and recommendations for future research.
“Rumination” refers to the behavior of chewing and swallowing regurgitated stomach contents. Approximately 6 to 10% of institutionalized persons with severe or profound mental retardation ruminate regularly (Johnston and Greene, 1992; Rogers et al., 1992; Singh, 1981). Rumination can lead to serious medical complications, including malnutrition, weight loss, gastric disorders, upper respiratory distress, dental problems, aspiration, choking, and pneumonia (Clauser and Scibak, 1990; Konarski et al., 1992; Luiselli, 1989). In fact, it is estimated to be the primary cause of death in 5 to 10% of individuals who ruminate (Konarski et al., 1992). Additionally, because this behavior is repugnant to others it can contribute to social isolation and compromised attempts at community integration and normalization (Konarski et al., 1992). The purpose of this paper is to update the literature reviews on rumination published by Singh (1981)and Starin and Fuqua (1987). Included is a discussion of the history of the disorder, distinguishing characteristics in medical and behavioral diagnosis, a review of the research on treatment, and recommendations for further research.
In general, there appears to be a convergence of results supporting behavioral approaches to diagnosis and treatment. However, when evaluating individuals who ruminate, particularly if they are severely or profoundly mentally retarded, ramifications of medical diagnosis and treatment deserve careful attention. Research findings on satiation, although showing strong effects, have been inconsistent across studies. Therefore, future research on satiation procedures should focus on methodological rigor. Additionally, it is recommended that researchers consider naturalistic field studies as well as current functional analysis methodologies (e.g., Iwata et al., 1994/1982) to explore situational and social variables that maintain ruminative behavior.
