Psych · General adult psychiatry — feeding and eating disorders
Pica and rumination disorder
Also known as Pica · Rumination disorder · Rumination syndrome · Geophagia · Pagophagia · Amylophagia · Trichophagia · PARDI · Diaphragmatic breathing for rumination
Exam-exhaustive fellowship reference on pica and rumination disorder — DSM-5-TR/ICD-11 criteria, medical complications (lead, bezoar, malnutrition), iron and zinc associations, PARDI assessment, behavioural management in ID/ASD, diaphragmatic breathing and biofeedback, baclofen for refractory rumination, pregnancy and cultural formulation. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Acute abdomen, suspected bezoar, obstruction, or perforation after non-food ingestion — emergency surgical pathway
- Paint chips, soil, or industrial materials with possible lead (or other) toxicity — urgent blood lead and toxicology pathway
- Progressive weight loss, dehydration, or electrolyte disturbance from rumination with food loss — medical stabilisation
- Dangerous pica substances in intellectual disability (glass, batteries, faeces, sharp objects) — immediate environmental safety and senior review
- Misdiagnosing bulimia nervosa purging as rumination (or the reverse) and applying the wrong therapy targets
- Chronic 'reflux' treatment without recognising effortless postprandial regurgitation physiology
Meet the patient
A 19-year-old woman with moderate intellectual disability is admitted after passing a hairball; her mother says she has chewed her hair and eaten laundry starch for years. On the same ward round, a 34-year-old nurse describes "food coming back up" within minutes of every meal for eight months — no nausea, no retching, two normal endoscopies, and a proton-pump inhibitor that does nothing.[1][9][11]
Two exam questions are now live, and you must answer both: is this rumination or reflux? and what kills this pica patient if you miss it? Everything below is the consultant-level answer to those two questions.[2][9]
References16ShowHide
- [1]Leung AKC, Hon KL Pica: A Common Condition that is Commonly Missed - An Update Review Curr Pediatr Rev, 2019.PMID 30868957
- [2]Schnitzler E The Neurology and Psychopathology of Pica Curr Neurol Neurosci Rep, 2022.PMID 35674869
- [3]Miao D, Young SL, Golden CD A meta-analysis of pica and micronutrient status Am J Hum Biol, 2015.PMID 25156147
- [4]Barton JC, Barton JC, Bertoli LF Pica associated with iron deficiency or depletion: clinical and laboratory correlates in 262 non-pregnant adult outpatients BMC Blood Disord, 2010.PMID 21176208
- [5]Ganesan PR, Vasauskas AA The Association Between Pica and Iron-Deficiency Anemia: A Scoping Review Cureus, 2023.PMID 37220446
- [6]Hartmann AS, Zenger M, Glaesmer H, et al. Prevalence of pica and rumination behaviours in adults and associations with eating disorder and general psychopathology: findings from a population-based study Epidemiol Psychiatr Sci, 2022.PMID 35678377
- [7]Hartmann AS, Poulain T, Vogel M, et al. Prevalence of pica and rumination behaviors in German children aged 7-14 and their associations with feeding, eating, and general psychopathology: a population-based study Eur Child Adolesc Psychiatry, 2018.PMID 29675593
- [8]Bryant-Waugh R, Micali N, Cooke L, et al. 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 Int J Eat Disord, 2019.PMID 30312485
- [9]Halland M, Pandolfino J, Barba E Diagnosis and Treatment of Rumination Syndrome Clin Gastroenterol Hepatol, 2018.PMID 29902642
- [10]Halland M, Parthasarathy G, Bharucha AE, Katzka DA Diaphragmatic breathing for rumination syndrome: efficacy and mechanisms of action Neurogastroenterol Motil, 2016.PMID 26661735
- [11]Absah I, Rishi A, Talley NJ, Katzka D, Halland M Rumination syndrome: pathophysiology, diagnosis, and treatment Neurogastroenterol Motil, 2017.PMID 27766723
- [12]Chial HJ, Camilleri M, Williams DE, Litzinger K, Perrault J Rumination syndrome in children and adolescents: diagnosis, treatment, and prognosis Pediatrics, 2003.PMID 12509570
- [13]Pauwels A, Broers C, Van Houtte B, et al. A Randomized Double-Blind, Placebo-Controlled, Cross-Over Study Using Baclofen in the Treatment of Rumination Syndrome Am J Gastroenterol, 2018.PMID 29206813
- [14]Barba E, Accarino A, Soldevilla A, Malagelada JR, Azpiroz F Randomized, Placebo-Controlled Trial of Biofeedback for the Treatment of Rumination Am J Gastroenterol, 2016.PMID 27185077
- [15]Crone C, Fochtmann LJ, Attia E, et al. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders Am J Psychiatry, 2023.PMID 36722117
- [16]Hay P, Chinn D, Forbes D, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders Aust N Z J Psychiatry, 2014.PMID 25351912