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Rumination syndrome (RS) is a feeding and eating disorder defined by repeated regurgitations of food material soon after eating, followed by re-swallowing, or spitting of the material (Murray, 2019). The first report of rumination was back in the 17th century when Edouard Brown Sequard, a physician, developed the learned behavior of regurgitations while experimenting with swallowing sponges to study gastric acid responses (Khan, 1998). Although the disorder was recognized and medicalized, few studies have been done since to study the disorder in detail. Therefore, the diagnosis of RS varies across different studies, often leading to it being misdiagnosed or undiagnosed. For instance, RS is often misdiagnosed for other conditions that cause vomiting, like gastroesophageal reflux disease and gastroparesis (Khan, 1998). The universal criterion for RS is repeated episodes of regurgitations that last more than a month and are not primarily caused by medical conditions or other eating disorders (Bryant‐Waugh, 2018).
The cause of RS is unknown, but several hypotheses have tried to explain the mechanisms behind the disorder. One hypothesis is that RS is a conditioned response to a specific stimulus. For instance, regurgitating after eating certain foods may trigger the same response when eating that same food. In other cases, individuals may feel a visceral sensation of pressure in the esophagus and abdomen, followed by a premonitory urge to regurgitate. After regurgitating, individuals are relieved of this urge and the abdominal wall contraction, which may positively reinforce the regurgitation behavior. Other hypotheses pose that the soothing sensation caused by regurgitation may serve as a coping mechanism to relieve psychological distress (Murray, 2019). Despite the lack of research on the disorder, proper and timely diagnosis and treatment of RS is necessary. Without proper diagnosis and treatment, RS can cause severe health problems, like dental damage, electrolyte imbalance, nausea, abdominal pain, heartburn, and nutrient deficiency (Murray, 2019; Khan. 1998). Currently, the first line of treatment is diaphragmatic breathing, which is a breathing exercise to strengthen the diaphragm. Such exercises have been shown to help contain the food material in the stomach. Other intervention methods, like relaxation, aversion training, distractions, or cognitive behavioral therapy can also enhance treatment. In some cases, medications like Baclofen or neuromodulators may help relieve the symptoms (Murray, 2019). However, more research is warranted to study the mechanisms behind the disorder and how to diagnose best and treat it. References Bryant‐Waugh, R., Micali, N., Cooke, L., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2018). Development of the PICA, Arfid, and rumination disorder interview, a multi‐informant, semi‐structured interview of feeding disorders across the lifespan: A pilot study for ages 10–22. International Journal of Eating Disorders, 52(4), 378–387. https://doi.org/10.1002/eat.22958 Khan, S., Hyman, P., & DiLorenzo, C. (1998). Rumination syndrome in adolescents. Journal of Pediatric Gastroenterology & Nutrition, 27(4), 479. https://doi.org/10.1097/00005176-199810000-00085 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. https://doi.org/10.14309/ajg.0000000000000060 Vijayvargiya, P., Iturrino, J., Camilleri, M., Shin, A., Vazquez-Roque, M., Katzka, D. A., Snuggerud, J. R., & Seime, R. J. (2014). Novel association of rectal evacuation disorder and rumination syndrome: Diagnosis, comorbidities, and treatment. United European Gastroenterology Journal, 2(1), 38–46. https://doi.org/10.1177/2050640613518774
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Avoidant/Restrictive Food Intake Disorder (ARFID) is a feeding disorder that is characterized by restrictive nutrient intake. Although it may seem similar to Anorexia Nervosa or Bulimia Nervosa, ARFID is different in that the restrictive eating patterns are not motivated by a distorted body image or a fear of gaining weight (Bourne, 2020). Because it fails to meet the criteria for AN or BN, it was an unclassified disorder until 2013, when it was defined in the publication of DSM-5 (Zimmerman, 2017). To meet the criteria for ARFID, the restrictive eating must not be a result of a cultural practice (like religious fasting), shortage of food, or a distorted body image. ARFID may be due to a variety of reasons such as a lack of interest in food, avoidance of certain sensory characteristics of food, or fear or eating due to past aversive experiences like choking or gastrointestinal distress (Coglan, 2019). It is easy to confuse ARFID with “picky eating” but ARFID necessarily involves a clinically significant nutrient deficiency that requires proper diagnosis and treatment.
ARFID is most common amongst older children and young adolescents, but spans across all ages. ARFID has several comorbidities, including OCD, generalized anxiety disorder, autism spectrum disorder, and learning disorder. Compared to AN or BN, ARFID has a lower hospitalization rate (Norris, 2013), a higher percentage of males, and a younger age of onset (Fisher, 2014). Because it is most common among younger children, it is often diagnosed and treated by pediatricians. However, there is currently very little empirical data on proper treatment and prevention. Also, as the disorder can be due to such a variety of reasons, an individualized approach to treatment is warranted with a focus on behavioral and nutritional intervention (Zimmerman, 2017). For instance, for ARFID patients that have had an aversive or traumatic experience with food, systematic desensitization and management of anxiety may be the best course of treatment. For patients whose disorder is not motivated by psychological factors, a treatment with a focus on nutritional and dietary supplement may be more appropriate (Zimmerman, 2017). All in all, more research is warranted to explore risk factors, prognosis, and treatment of ARFID. References Bourne, L., Bryant-Waugh, R., Cook, J., & Mandy, W. (2020). Avoidant/Restrictive Food Intake disorder: A systematic scoping review of the current literature. Psychiatry Research, 288, 112961. https://doi.org/10.1016/j.psychres.2020.112961 Coglan, L., & Otasowie, J. (2019). Avoidant/restrictive food intake disorder: What do we know so far? BJPsych Advances, 25(2), 90–98. https://doi.org/10.1192/bja.2018.48 Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., Callahan, S. T., Malizio, J., Kearney, S., & Walsh, B. T. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: A “New disorder” in DSM-5. Journal of Adolescent Health, 55(1), 49–52. https://doi.org/10.1016/j.jadohealth.2013.11.013 Norris, M. L., Robinson, A., Obeid, N., Harrison, M., Spettigue, W., & Henderson, K. (2013). Exploring avoidant/restrictive food intake disorder in eating disordered patients: A descriptive study. International Journal of Eating Disorders, 47(5), 495–499. https://doi.org/10.1002/eat.22217 Zimmerman, J., & Fisher, M. (2017). Avoidant/Restrictive Food Intake disorder (ARFID). Current Problems in Pediatric and Adolescent Health Care, 47(4), 95–103. https://doi.org/10.1016/j.cppeds.2017.02.005 Anorexia Nervosa (AN) is one type of eating disorder that has a lifetime prevalence of 4% among females and 0.3% among males (van Eeden, 2021). AN, like all other eating disorders, is classified as a mental disorder. The three criteria for diagnosing AN are: prolonged self-restriction of nutrient intake, fear of gaining weight, and a distorted self body image or self-perceived weight. Due to their obsession with self-body image, patients with AN will often find extreme measures of losing weight, such as calorie counting, starvation, excessive exercise, purging, and taking laxatives (Morris, 2007). There are other factors that lead to extreme weight loss, such as depressive episodes and medical conditions; however, AN is different in that there is an underlying psychological fear of gaining weight that fuels this unhealthy behavior.
What causes AN? There seems to be both biological and environmental bases for the development of AN. Many patients with AN seem to differ in the structure and function of their brains. For example, AN patients show decreased dopamine (reward system) and serotonin (impulse control) levels (Moore, 2022). The median age of onset is around 15, and the disorder is most common among female teens. AN is also significantly more prevalent in Western cultures, which suggest an environmental basis for the condition. This may potentially be due to how the media portrays body expectations and weight loss. For instance in Western cultures, models and actors exhibit unrealistic standards for thinness, often accentuated by photoshop and make up, and athletes in sports like ballet, running, martial arts have to lose weight to optimize performance. There also exist other risk factors for AN, like childhood obesity, mood disorders, sexual abuse, and familial problems (Moore, 2022). Out of all psychiatric disorders, AN has the highest mortality, with most of the deaths resulting from suicide or complications from nutrient deficit (Morris, 2007). Patients with AN often have comorbid disorders like major depressive disorder, generalized anxiety disorder, or obsessive compulsive disorder. This means treatment of AN often necessarily involves treating the mental health of the patients. There are also numerous physical complications from malnutrition, such as delayed onset of puberty, amenorrhea (absence of menstruation), bone weakness, and respiratory, cardiac, or gastrointestinal problems (Peterson, 2019). Therefore, AN is a serious disorder that requires a careful, multidisciplinary approach to treatment. Because there is no known cure or cause of AN, it is incredibly important to recognize the disorder early and help patients manage it. The two most common intervention methods are nutrition rehabilitation, where patients are slowly given nutrients to restore their body homeostasis, and psychotherapy, which aims to target the underlying mental health issues. In severe cases, partial hospitalization may be necessary. Another method of treatment is family intervention and education (Moore, 2022). In this way, family members are educated on how to reduce risk factors for AN and help manage the symptoms of the disorder. Medications, like antipsychotics or antidepressants, may also be helpful in the treatment of AN. References Moore, C. A., & Bokor, B. R. (2022, August 29). Anorexia nervosa - statpearls . NIH National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK459148/ Morris, J., & Twaddle, S. (2007). Anorexia nervosa. BMJ, 334(7599), 894–898. https://doi.org/10.1136/bmj.39171.616840.be Peterson, K., & Fuller, R. (2019). Anorexia nervosa in adolescents. Nursing, 49(10), 24–30. https://doi.org/10.1097/01.nurse.0000580640.43071.15 van Eeden, A. E., van Hoeken, D., & Hoek, H. W. (2021). Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry, 34(6), 515–524. https://doi.org/10.1097/yco.0000000000000739 |
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