108 - 6B85 Rumination regurgitation disorder

6B85 Rumination-regurgitation disorder

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Boundaries with other disorders and conditions (differential diagnosis) Boundary with nutritional deficiencies Individuals who ingest non-nutritive substances as a symptom of specific nutritional deficiencies should not be diagnosed with pica unless the behaviour persists after the deficiency is corrected. For example, anaemia caused by vitamin B12, folate or iron deficiency can be associated with a craving to eat dirt. Boundary with disorders of intellectual development The ingestion of non-nutritive substances is common in children or adults with disorders of intellectual development. An additional diagnosis of pica may be given, as long as that the individual is able to distinguish between edible and non-edible substances, if the behaviour is persistent or potentially dangerous enough to require specific clinical attention. Boundary with factitious disorder and malingering Individuals with factitious disorder or who are malingering may swallow harmful substances or objects in order to present themselves as ill. For example, prisoners may swallow harmful substances or objects in order to be transferred to hospital or to a setting that is less harsh or less restrictive. Pica should not be diagnosed in such cases. Boundary with other mental, behavioural and neurodevelopmental disorders Individuals with anorexia nervosa may eat non-nutritive substances (e.g. tissues, paper) in order to suppress hunger. In trichotillomania (hair-pulling disorder) or excoriation (skin-picking) disorder, individuals sometimes eat hair or skin that they pull or pick from the body. Eating of non-nutritive substances may also occur in other mental, behavioural or neurodevelopmental disorders such as autism spectrum disorder and schizophrenia. In all such cases, an additional diagnosis of pica should be assigned only if the behaviour is persistent or severe enough to require clinical attention. That is, the behaviour causes damage to health, impairment in functioning or significant risk due to the frequency, amount or nature of the substances or objects ingested. Rumination-regurgitation disorder Essential (required) features • The intentional and repeated bringing up of previously swallowed food back to the mouth (regurgitation), which may be re-chewed and re-swallowed (rumination), or may be deliberately spat out (but not as in vomiting), is required for diagnosis. • The regurgitation behaviour is frequent (at least several times per week) and sustained over a period of at least several weeks. • The diagnosis should only be assigned to individuals who have reached a developmental age of at least 2 years. 6B85 Feeding and eating disorders | Rumination-regurgitation disorder

417 Feeding and eating disorders • The regurgitation behaviour is not a manifestation of another medical condition that directly causes regurgitation (e.g. oesophageal strictures or neuromuscular disorders affecting oesophageal functioning) or causes nausea or vomiting (e.g. pyloric stenosis). Additional clinical features • In rumination-regurgitation disorder, the regurgitation behaviour is intentional; for example, individuals may contract the tongue or abdominal muscles or cough in order to induce regurgitation. Individuals with rumination-regurgitation disorder are able to regurgitate food with relative ease, and may derive some reduction of anxiety or pleasure from the behaviour. • Individuals with rumination-regurgitation disorder often experience shame and embarrassment about the behaviour, and try to keep the behaviour a secret because they recognize it as socially unacceptable. • Individuals with rumination-regurgitation disorder are often reluctant to seek treatment. The disorder may persist for a very long duration if left untreated. Course features • Rumination-regurgitation disorder is slightly more prevalent among individuals with disorders of intellectual development and autism spectrum disorder, whereby it may serve a self-soothing or self-stimulating function. • Rumination-regurgitation disorder may be chronic or continuous, or it may be episodic. In episodic cases, the behaviour may be associated with stress or anxiety. • Adolescents and adults may be less likely to re-chew the regurgitated food, and older adults may choose to swallow or spit out the material depending on the social situation. Developmental presentations • Onset of rumination-regurgitation disorder may occur across early and later childhood, adolescence and adulthood. • Rumination-regurgitation disorder can create a substantial risk of choking in very young children due to their inability to control their swallowing. Feeding and eating disorders | Rumination-regurgitation disorder