Case Study: Chewing Gum Treatment of Rumination in an Adolescent With an Eating Disorder

Pica and rumination behavior among individuals seeking treatment for eating disorders or obesity

“…For some cases in our own sample, it was unclear whether a behavior was frequent enough to qualify as “regular” or “persistent.” Similarly, optimal follow‐up questions clarifying rumination would also assist assessors in ascertaining the voluntary versus involuntary nature of the behavior. For example, several participants in our sample echoed those in past studies and described motivations related to taste and food selectivity, or to shape and weight, both of which suggest some degree of volitional control. The overlap of symptoms between the two conditions can render differential diagnosis challenging, but the picture becomes even more complicated when patients themselves cannot distinguish voluntary behavior from physiologic phenomena.…”

“…We then asked additional questions querying DSM‐5 criteria from the diagnostic checklist for DSM‐5 feeding and eating disorders developed by B. Timothy Walsh M.D., Chair of the DSM‐5 Work Group. At the residential eating disorders center, we assessed eating disorder psychopathology with the Eating Disorder Examination interview version 16.0 . In a convenience subsample of 16 cases who were double‐coded based on an audio‐recording of the original interview, the two raters conferred the same eating disorder diagnosis in 93.8% of cases (inter‐rater reliability κ = 0.92).…”

“…10 In another sample of eight patients presenting with rumination behavior, five met criteria for eating disorders, 25 while other case studies have highlighted presentations of rumination behavior comorbid with AN 19 and binge eating. 26 Case reports on patients with BN have included their description of rumination as an independent weight control measure-both as a "step above the vomiting," 27 and a way to enjoy food without purging or gaining weight. 19 In summary, available data from case reports and case series suggest that pica and rumination behavior are observable clinical phenomena that sometimes co-occur with other forms of disordered eating.…”

Managing a patient with rumination

“…PPIs may, in fact, lengthen the period of rumination following a meal, which usually ceases when the food in the stomach becomes acidic 10. Chewing gum in the postprandial period has been shown to reduce rumination in the paediatric population 24 25. Baclofen (an agonist of gamma-aminobutyric acid receptor) has recently been shown to be effective in reducing the symptoms of rumination syndrome 26.…”

Rumination

“…The only contraindications are psychosis or intellectual inability to understand and participate in the biofeedback instructions. It has been used effectively in adults [22,23].…”