Chewing and Spitting & Rumination Disorder: Understanding These Hidden Eating Behaviors

Introduction: You're Not Alone in This

Living abroad brings its own challenges. Add to that a secret behavior you've never told anyone about – spending hours chewing and spitting food, or involuntarily regurgitating what you've eaten – and you might feel utterly alone. You're not.

In the shadow of well-known eating disorders like anorexia and bulimia exist behaviors that are just as consuming, just as painful, yet far less discussed: chewing and spitting (C&S) and rumination disorder. You might have been doing this for years, hiding it from everyone, convinced you're the only person who does this. The shame might be overwhelming. The isolation, crushing.

But here's what you need to know: these aren't moral failings. They're not weird quirks you should just "get over." They're complex behavioral patterns that develop for reasons beyond your conscious control, and they're more common than you think.

Recent research reveals startling statistics: approximately 34% of patients hospitalized for eating disorders report having engaged in chewing and spitting at least once, while rumination disorder affects an estimated 3% of the global adult population – though this figure is likely underestimated due to the intense stigma surrounding these behaviors. A 2021 international study across 26 countries with over 54,000 participants confirmed that rumination disorder is far more prevalent than previously recognized, affecting people of all ages and backgrounds.

These behaviors don't reflect weakness or lack of willpower. They emerge from complex interactions between psychological, biological, and environmental factors that go far beyond simple conscious control. Understanding the mechanisms at work is the first step toward freeing yourself from the shame that surrounds them.

The Expatriate Factor: When Cultural Isolation Compounds Eating Struggles

As an English-speaking person living in France, you face unique challenges that can exacerbate eating difficulties:

Language barriers in healthcare: Explaining complex psychological and physical symptoms in a second language is exhausting. The fear of not being understood or being dismissed can prevent you from seeking help.

Cultural differences in food attitudes: French culture places enormous emphasis on food, meals, and eating rituals. This can be triggering when you're struggling with your relationship with food. The pressure to conform to local eating norms – long meals, multiple courses, bread at every meal – can intensify anxiety around eating.

Isolation from usual support systems: Your family, close friends, therapist back home – all the people who usually help you through difficult times – are suddenly thousands of miles away. The loneliness can make maladaptive coping behaviors more appealing.

Identity stress: The process of adapting to a new culture while maintaining your sense of self can be destabilizing. Eating behaviors sometimes become a way to exert control when everything else feels chaotic.

Healthcare navigation challenges: Understanding the French healthcare system, finding English-speaking specialists, dealing with insurance (mutuelle), getting reimbursed – it's all confusing and can delay getting the help you need.

This article will explore both chewing-spitting and rumination disorder with the scientific rigor they deserve while maintaining a compassionate, non-judgmental approach. Because understanding what's happening in your brain and body is the first step toward healing. And you deserve that healing, even if you don't believe it yet.

Chewing and Spitting: When Taste Becomes a Prison

What Exactly Is Chewing and Spitting?

Chewing and spitting (C&S) involves prolonged chewing of food without swallowing, followed by expulsion. This isn't just occasionally spitting out food you don't like. It's a compulsive behavior that can consume hours of your day and profoundly impact your quality of life.

Here's what many people don't know: C&S isn't classified as a distinct eating disorder in the DSM-5. Instead, it's considered a symptom that can appear across different eating disorder diagnoses, particularly anorexia nervosa, bulimia nervosa, or under the category "Other Specified Feeding or Eating Disorder" (OSFED, previously called EDNOS – Eating Disorder Not Otherwise Specified).

The Psychology Behind the Behavior

At its core, chewing and spitting often represents a desperate attempt to resolve an impossible conflict: the desire to enjoy the taste of food while avoiding its ingestion and associated calories. It's as if your brain is trying to negotiate a compromise with tyrannical food rules that have taken over your life.

Research shows this behavior is more strongly associated with restrictive eating patterns than with binge-purge behaviors. People who engage in C&S tend to score higher on measures of body image concerns, shape and weight preoccupation, as well as elevated levels of depression, anxiety, and obsessive-compulsive behaviors.

A study by Guarda and colleagues revealed that among patients hospitalized for eating disorders, 34% had engaged in chewing and spitting at least one month before admission, and 19% did so regularly multiple times per week. These numbers underscore that this behavior, far from being anecdotal, represents a significant clinical reality.

How It Escalates: The Vicious Cycle

What might start as an occasional attempt to "cheat" with a forbidden food can rapidly become a compulsive, all-consuming ritual. Sarah, a 28-year-old American living in Paris, shares: "At first, I only did it with chocolate. Then it became all 'dangerous' foods. Now I spend 4 to 5 hours a day chewing and spitting, and I can't eat normally with my friends anymore. I make excuses to eat alone. I've become a hermit."

The behavior progressively becomes automatic, triggered by negative emotions like disgust, remorse, or shame, but paradoxically less distressing than binge-purge episodes for some people. It's often accompanied by a loss of control similar to what's observed in binge eating episodes.

Online communities where people discuss C&S reveal the extent of the shame: "I feel like the most disgusting person alive," "I spend €200 a week on food I don't even eat," "I can't tell my therapist because she'll think I'm crazy."

The Widespread Consequences

Beyond the obvious psychological impact, chewing and spitting can lead to significant physical, social, and financial consequences:

Physical toll:

• Dental problems (enamel erosion, cavities, sensitivity)

• Jaw pain and TMJ (temporomandibular joint) disorders

• Mouth injuries (cheek biting, tongue damage)

• Parotid gland swelling (similar to bulimia)

• Nutritional deficiencies if the behavior replaces normal eating

• Gastrointestinal issues from constant stimulation without satisfaction

Psychological impact:

• Intense shame and guilt

• Progressive social isolation

• Increasing food obsession

• Worsening depressive and anxiety symptoms

• Suicidal ideation in severe cases

• Loss of identity beyond the eating disorder

Social and financial damage:

• Avoidance of group meal situations (huge issue in social French culture)

• Social exclusion and loneliness

• Professional or academic difficulties due to time consumed by the behavior

• Significant financial expenses for food that won't be consumed

• Relationship strain from secrecy and unavailability

Why It's Hard to Stop: The Neurobiological Component

It's not just "in your head" – though that phrase itself is dismissive of genuine suffering. Brain imaging studies show that eating disorders alter neural circuits involved in reward, impulse control, and emotional regulation.

Chewing food activates taste receptors and temporarily stimulates reward pathways in the brain, creating powerful behavioral reinforcement. Over time, this makes the behavior increasingly automatic and compulsive – similar to substance addictions. The temporary relief or pleasure becomes a trap that's progressively harder to escape.

Rumination Disorder: When Your Body Rejects What It Accepted

Definition and Physiological Mechanisms

Rumination disorder (also called rumination syndrome or merycism) involves the regular regurgitation of small amounts of food from the stomach back into the mouth, typically 15-30 minutes after eating. The term comes from the Greek mêrukisma, meaning rumination, referencing the digestive process of ruminant animals like cows.

Here's the crucial distinction: rumination disorder is neither vomiting nor gastroesophageal reflux. It's a process involving two distinct physiological mechanisms:

• Relaxation of the lower esophageal sphincter

• Propulsion of stomach contents up through the throat via alternating contraction and relaxation of the diaphragm

The regurgitated food may then be rechewed and reswallowed, or sometimes spit out. Critical note: regurgitation in rumination disorder typically isn't accompanied by nausea, disgust, or the acidic/bitter taste characteristic of vomiting.

Diagnostic Classifications: A Disorder with Multiple Faces

Rumination disorder occupies a unique place in medical classifications, being recognized as both:

A disorder of gut-brain interaction according to the Rome IV classification (functional gastrointestinal disorders)

A feeding and eating disorder according to the DSM-5

According to DSM-5 criteria, diagnosis requires:

• Repeated regurgitation of food for a period of at least 1 month

• Regurgitated food may be rechewed, reswallowed, or spit out

• The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux, pyloric stenosis)

• The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder (ARFID)

• If occurring in the context of another mental disorder, the symptoms are sufficiently severe to warrant independent clinical attention

More Common Than You Think

Long considered a disorder primarily affecting infants and individuals with intellectual disabilities, rumination disorder is now recognized as affecting adolescents and adults of all ages. The 2021 international study mentioned earlier, conducted across 26 countries with 54,127 participants, revealed a prevalence of approximately 3% in the global adult population, with a slight female predominance (54.4% vs. 45.5%).

These figures suggest the disorder is vastly under-diagnosed, likely due to the taboo and shame surrounding it. Many affected individuals conceal their behavior, sometimes since childhood, leaving them alone with their symptoms.

Triggers and Risk Situations

Rumination disorder may manifest or worsen in certain situations:

• Periods of intense stress or anxiety

• Following bariatric surgery (estimated prevalence of 31% in this population)

• In association with other eating disorders

• In the context of developmental or attachment disorders (particularly in children)

• During major life transitions (like moving to a new country – sound familiar?)

The behavior sometimes appears to serve a self-soothing or self-stimulating function, particularly in children or individuals with neurodevelopmental disorders. However, in many adults, it occurs without apparent reason and in the absence of identifiable factors.

The Hidden Nature of Adult Rumination

If adult rumination cases are rarely reported, it's because this syndrome is often concealed by those who suffer from it. Considered taboo, it leaves them alone with their symptoms, which they hide from those around them. This habit, often starting in childhood, is a source of shame because it's not considered socially acceptable behavior.

James, a 34-year-old British expat working in Paris, describes: "I've been doing this since I was 12. At first, it was just at home. Now it happens at business lunches, at restaurants with clients. I've developed elaborate techniques to hide it – fake coughing, constant use of napkins, excusing myself to the bathroom. The anxiety about being discovered is sometimes worse than the physical discomfort."

Unaddressed, this behavior can lead to problems with self-confidence and relational isolation. However, it can become more noticeable during stress, as the person pays less attention to concealing their behavior – which can be when friends or family finally notice something's wrong.

Deconstructing the Myths: These Behaviors Aren't Choices

Myth 1: "It's Just a Lack of Willpower"

No. Absolutely not. Chewing-spitting and rumination disorder aren't behaviors you can simply "stop if you really want to." They're maintained by complex neurobiological and psychological mechanisms that operate beyond conscious control.

Neuroscience research demonstrates that eating disorders modify brain circuits involved in reward, impulse control, and emotional regulation. The circuits don't just "return to normal" because you decide they should. Healing requires rewiring these pathways, which takes time, professional support, and specific interventions.

For rumination disorder specifically, the mechanisms relate more to dysfunction in the gut-brain axis. Regurgitation can become a conditioned response to certain triggers, independent of the person's will. Telling someone to "just stop" is like telling someone with a tic disorder to "just be still" – it fundamentally misunderstands the nature of the problem.

Myth 2: "It's Not as Serious as Other Eating Disorders"

This is dangerously wrong. While these behaviors are less known and less studied than anorexia or bulimia, they can have equally severe consequences on physical health, mental wellbeing, and quality of life.

People who engage in chewing-spitting generally present greater eating disorder psychopathology than those who don't, with higher scores for anxiety, depression, and even suicidal ideation. Rumination disorder, if unaddressed, can lead to malnutrition, dehydration, serious dental problems, digestive complications, and in severe cases, medical emergencies.

The psychological toll is immense. The shame, secrecy, and time consumed by these behaviors can completely derail your life. Your career suffers. Your relationships suffer. You suffer.

Myth 3: "Just Eat Normally and It'll Stop"

This idea misses the entire nature of these disorders. Telling someone to simply "eat normally" ignores the factors that led to the behavior's installation: intense anxiety around food, rigid food rules, emotional regulation difficulties, possible trauma, or associated neurodevelopmental issues.

It's like telling someone with depression to "just be happy" or someone with anxiety to "just relax." If it were that simple, don't you think they would have done it already?

Recovery requires specialized support that addresses the roots of the problem, not just its manifestations. You need to understand why your brain developed this coping mechanism before you can develop healthier alternatives.

Myth 4: "It's a Choice for Attention"

Let's be crystal clear: no one chooses these behaviors for attention. In fact, most people go to extraordinary lengths to hide them. The shame and secrecy are part of what makes these disorders so insidious and hard to treat.

If you're hiding in bathrooms to spit out food, or timing your regurgitation episodes for when you're alone, or spending hundreds of euros on food you won't eat – that's not attention-seeking. That's suffering in silence.

Toward a Compassionate Approach: How to Address These Disorders

The Importance of Differential Diagnosis

Before any treatment, it's essential to rule out organic medical causes, particularly for rumination disorder. Gastroesophageal reflux disease (GERD), pyloric stenosis, gastroparesis, or other gastrointestinal conditions can produce similar symptoms. Tests like endoscopy, esophageal manometry with impedance monitoring, or gastric emptying studies may be necessary.

For chewing-spitting, evaluation should also explore the presence of other concurrent eating disorders and their specificities, as the therapeutic strategy will be adapted to the overall context.

Dietary and Nutritional Approach: Rebuilding a Peaceful Relationship with Food

As a dietitian specialized in eating disorders, my approach with people presenting these behaviors is built around several key principles:

Nutritional rehabilitation and stabilization: If malnutrition is present, we establish a progressive, safe refeeding plan that accounts for your specific difficulties. The goal is never to force eating but to support your body's return to adequate nutrition.

Meal restructuring: We work on regularity of meals and snacks, meal composition, and gradual reintroduction of food diversity. For rumination disorder, initially smaller, more frequent meals may facilitate tolerance.

Non-restrictive approach: Unlike traditional diets, the goal is to abolish food prohibitions that often fuel chewing-spitting. Every food has a place in balanced eating, and no food should generate guilt. This is particularly important for expatriates who may already feel restricted by limited access to familiar foods.

Working with food sensations: Relearning to listen to your hunger and satiety signals, recognizing textures, tastes, temperatures. Mindful eating can be a valuable tool for reconnecting with the meal experience.

Managing the food environment: Identifying triggering situations and implementing progressive adaptive strategies. For example, with chewing-spitting, starting by eating in the presence of a trusted person can be a first step.

Essential Multidisciplinary Support

These behaviors require coordinated care involving several professionals:

Primary care physician or medical nutritionist: Oversees somatic monitoring, prescribes necessary tests, monitors general condition and possible complications (dental, digestive, deficiencies).

Specialized psychiatrist or psychologist: Works on psychopathological aspects, associated mood disorders, possible trauma, and proposes adapted psychotherapy. Cognitive-behavioral therapies (CBT) have shown effectiveness, particularly for rumination disorder with diaphragmatic breathing training.

Specialized eating disorder dietitian (like me): Supports food restructuring, manages food-related anxiety, and helps restore a peaceful relationship with food while respecting cultural considerations.

Other professionals may be involved as needed: dentist for oral complications, gastroenterologist for digestive aspects of rumination, speech therapist for associated oral disorders, psychiatrist for medication management if appropriate.

Specific Techniques for Rumination Disorder

For rumination syndrome, a specific behavioral approach has proven particularly effective: diaphragmatic breathing. This technique involves learning to recognize the precursor signs of regurgitation and immediately practicing deep breathing exercises that prevent the involuntary abdominal contractions leading to regurgitation.

The principle: by breathing deeply through the diaphragm after meals and maintaining this breathing for 15-30 minutes, you can progressively "unlearn" the rumination reflex. Studies show this approach can be highly effective for people without intellectual disabilities.

For those who don't respond to this approach, other options include biofeedback, and in some cases, medications like baclofen or certain tricyclic antidepressants may be considered.

Managing Chewing and Spitting

For chewing-spitting, the approach is primarily psychotherapeutic and dietary:

Identify triggers: What emotions, situations, thoughts precede the behavior? Keeping a journal can be enlightening. For expatriates, cultural stressors and feelings of displacement often emerge as significant triggers.

Develop alternative strategies: Learn other ways to manage difficult emotions, anxiety, or the desire to eat without guilt. This might include:

• Emotion regulation skills (DBT-based techniques)

• Distress tolerance practices

• Alternative sensory experiences (ice, temperature changes, textures)

• Social connection instead of isolation

Progressive exposure: Gradually reintroduce swallowing "forbidden" foods, first in a safe therapeutic setting, then progressively in daily life. We start with foods that provoke less anxiety and gradually work up to more challenging ones.

Work on cognitions: Deconstruct rigid beliefs around food, weight, body appearance that maintain the behavior. Challenge the "good food/bad food" dichotomy that's often at the root of C&S.

Relapse prevention: Identify high-risk situations and establish an anticipated action plan. For expatriates, this might include planning for visits home, navigating French social eating situations, or managing work stress.

The Path to Recovery: Hope Is Justified

Inspiring Recovery Stories

Sophie, a 32-year-old Canadian living in Paris, practiced chewing-spitting since adolescence: "For 15 years, I lived with this shame. I thought I was the only person in the world doing this. When I finally dared to talk about it with my doctor and she referred me to a specialized team – an English-speaking team, which made all the difference – I realized I wasn't alone and it was treatable. Today, after 2 years of follow-up, I eat normally. Difficult moments still exist, but I know how to manage them differently. I can actually enjoy a meal at a Parisian café without the anxiety consuming me."

Thomas, a 27-year-old American, suffered from rumination disorder since childhood: "The breathing techniques changed my life. At first, I didn't believe something so simple could work, but with daily practice, regurgitation episodes decreased by 80%. I can finally eat in restaurants without anxiety. I can go on dates. I can be present at social events instead of constantly worried about when it's going to happen."

Emily, a 35-year-old Australian who moved to Paris for work: "Finding an English-speaking dietitian who understood eating disorders was a game-changer. Being able to express myself fully in my native language, discuss the cultural challenges of being an expat, and not have to translate my emotions – it made the healing possible. I didn't realize how much the language barrier was preventing me from getting help."

The Journey Stages

Recovery isn't linear. There will be advances, plateaus, sometimes temporary setbacks. This is normal and part of the process. Here's what you can expect:

Phase 1: Recognition and Assessment (1-2 months)
Breaking the silence, accepting you need help, undergoing a complete evaluation (medical, nutritional, psychological). This phase can be difficult as it involves naming the problem and abandoning protective denial. For expatriates, this might also involve navigating the French healthcare system, which adds complexity.

Phase 2: Stabilization and Learning (3-6 months)
Learning basic techniques (diaphragmatic breathing for rumination, identifying triggers for chewing-spitting), stabilizing nutritional status if necessary, beginning to develop alternative strategies. This is where you build your toolkit.

Phase 3: Transformation and Practice (6-12 months)
Refining strategies, managing increasingly complex situations, rebuilding a more flexible relationship with food, progressing toward greater autonomy in managing the disorder. You're actively practicing your new skills in real-world situations.

Phase 4: Consolidation and Relapse Prevention (12+ months)
Maintaining gains, developing resilience to difficult situations, integrating new habits sustainably, progressively spacing out follow-ups while keeping a safety net. You're living life, not just managing a disorder.

Good Prognosis Factors

Several elements are associated with better outcomes:

• Early diagnosis and treatment

• Active engagement in treatment

• Support from loved ones

• Absence of severe concurrent psychiatric disorders

• Access to a specialized multidisciplinary team

• Capacity to develop alternative emotional regulation strategies

• Cultural and linguistic alignment with treatment providers

But even without these factors, recovery remains possible. It simply requires more time, patience, and adaptation of therapeutic strategies. Your recovery is worth the investment.

Navigating the French Healthcare System: Practical Guide for Expatriates

Understanding Your Options

Public healthcare (Sécurité Sociale): If you're registered in the French social security system (as an employee, student, or resident), you're entitled to healthcare coverage. However, specialized eating disorder treatment may have limited coverage, and co-pays (tickets modérateurs) can add up.

Private insurance (Mutuelle): Most French residents have complementary private insurance that covers what the state system doesn't. Coverage for psychological and dietary consultations varies widely – check your contract or ask your HR department.

International insurance: If you're on an expat package, you may have more comprehensive mental health coverage. Many international insurers now recognize eating disorders as serious medical conditions requiring treatment.

Out-of-pocket options: If navigating the French system feels overwhelming, some practitioners (like me) offer clear pricing for English-speaking clients and can provide documentation for potential reimbursement.

Finding English-Speaking Specialists in Paris

Eating disorder specialists: Several centers in Paris have English-speaking staff, including:

• Maison de Solenn (adolescents and young adults)

• Institut Mutualiste Montsouris

• American Hospital of Paris (private, expensive, but comprehensive English-speaking services)

Support networks:

• 📚 LIONNES Paris: Feminist collective offering support groups and English-speaking practitioners

• 📚 SOS Anor: Bilingual resources and support

• 📚 American Church in Paris: Community support groups

Making the Most of Your Consultations

Before your appointment:

• Write down your symptoms and questions in English so you don't forget

• Prepare a brief summary of your eating disorder history

• List any medications or supplements you're taking

• Note any questions about French healthcare logistics

During consultations:

• Don't hesitate to ask for clarification if you don't understand

• Request written summaries or treatment plans

• Ask about expected costs and reimbursement procedures

• Discuss cultural considerations that affect your eating patterns

Between appointments:

• Keep a journal in English (it's easier to process emotions in your native language)

• Connect with expatriate support groups

• Stay in touch with supports back home while building local connections

Resources and Support: You're Not Alone

Where to Find Help

National helpline (French, but some English support available):
☎️ Anorexie Boulimie Info Écoute: 09 69 325 900 (non-surcharged call)
Anonymous and confidential listening line for people with eating disorders and their loved ones.

Specialized associations:

• 📚 FFAB (French Federation for Anorexia and Bulimia): Directory of specialized structures (some English-speaking), information for professionals and families

• 📚 SOS Anor: Support and group discussion, some English resources

• 📚 FNA-TCA: National federation of eating disorder associations

International resources:

• 📚 NEDA (National Eating Disorders Association): US-based but excellent English resources

• 📚 Beat Eating Disorders (UK): Support for British expats

• 📚 NEDIC (Canada): Resources in English for Canadians abroad

Specialized Consultations

Treatment for these behaviors requires specific expertise in eating disorders. As a bilingual dietitian nutritionist specialized in eating disorders, I offer consultations in Paris (6th and 20th arrondissements) and Le Raincy, as well as via video conference for those who can't travel.

My approach follows a compassionate, non-restrictive, patient-centered care philosophy. The goal is never to constrain you to eat in a certain way, but to support you toward a freer, more peaceful relationship with food, respecting your pace and your specific needs – including the unique challenges of being an expatriate.

For Loved Ones: How to Help Without Harming

If you have a friend or family member suffering from chewing-spitting or rumination disorder:

Avoid: Comments about their weight or appearance, injunctions to "eat normally," intrusive surveillance, punishments or rewards tied to eating, moral judgments about the behavior, minimizing their suffering.

Do: Listen without judgment, express your concern with kindness ("I'm worried about you" rather than "You should stop"), encourage consultation without pressure, maintain the relationship beyond the disorder, seek your own support if needed (support groups for families/friends).

Cultural considerations for supporting expatriates: Understand that cultural displacement adds an extra layer of difficulty. Don't minimize the challenges of living abroad. Offer practical help like accompanying them to appointments or helping navigate French bureaucracy.

Conclusion: Toward Progressive Liberation

Chewing-spitting and rumination disorder are complex behaviors that deserve to be recognized, understood, and supported with the same rigor and compassion as better-known eating disorders. They don't define who you are. They're strategies your psyche developed to cope with difficulties, and these strategies can be transformed.

Recovery is possible. It requires courage to take that first step toward help, patience to accept that the path takes time, and self-compassion to get through difficult moments. But you don't have to do it alone. Specialized professionals, associations, support groups exist to accompany you – including English-speaking resources right here in Paris.

Every small step counts. Every shared meal, every food swallowed without being spit out, every regurgitation avoided through breathing techniques is a victory that brings you closer to a freer life. And that freedom – you deserve it.

Living as an expatriate already requires enormous courage and adaptability. You've already proven you can face challenging transitions. This is another transition – from a life constrained by these behaviors to a life where food is just food, not a battlefield. That life is waiting for you.

Living and eating are two sides of the same coin.
Lighten your relationship with food and free yourself from what holds you back!

Contact and Appointment Information

Alexis Alliel
Bilingual Dietitian Nutritionist Specialized in Eating Disorders
State Diploma - Non-Restrictive and Compassionate Approach

📞 Phone: +33 6 22 41 55 21
(English-speaking consultations available)

📍 Consultation Locations:

• Paris 6th: 59 rue de Seine (Tuesday, Wednesday) - LIONNES Cabinet

• Paris 20th: 11 Rue Saint Blaise (Monday)

• Le Raincy (93): By appointment

• Video consultations: Available anywhere in France and internationally

🗓️ Online appointment booking: Doctolib - Alexis Alliel
(Platform in French, but consultations conducted in English available)

📋 Professional Identification Numbers:

• RPPS Number: 10007258733

• ADELI Number: 75 95 0878 1

📚 Additional Resources on the Site

You might also be interested in these articles:

• 📚 Anorexia Recovery: Understanding and Support

• 📚 Bulimia Treatment: Breaking the Cycle

• 📚 ARFID and Oral Disorders

• 📚 Nutritional Rehabilitation and Food Reeducation

• 📚 PCOS and Eating Disorders

• 📚 Being a Bilingual Patient: Navigating Eating Disorder Care in France

📖 SOURCES AND REFERENCES BOX

Official and Scientific Sources:

1. American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR. Washington, DC: American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425787

2. 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." The American Journal of Gastroenterology, 114(4), 562-578. https://doi.org/10.14309/ajg.0000000000000060

3. Guarda, A. S., Schreyer, C. C., Hansen, J. L., & Vanderheyden, D. A. (2015). "Chewing and Spitting in Eating Disorders and Its Relationship to Binge Eating." Eating Behaviors, 16, 59-61.

4. De Zwaan, M., Becker, S., Friederich, H. C., Zipfel, S., Hilbert, A., & Herpertz, S. (2021). "Prevalence of Rumination Syndrome: A Cross-Sectional Online Survey in 26 Countries." Neurogastroenterology & Motility, 33(4), e14000.

5. Sasegbon, A., Hasan, S. S., Disney, B. R., & Vasant, D. H. (2022). "Rumination Syndrome: Pathophysiology, Diagnosis and Practical Management." Frontline Gastroenterology, 13(5), 440-446. https://doi.org/10.1136/flgastro-2021-101856

6. Rome Foundation (2016). Rome IV - Functional Gastrointestinal Disorders: Disorders of Gut-Brain Interaction, 4th edition.

7. National Eating Disorders Association (NEDA). "Rumination Disorder." Accessed October 2025. https://www.nationaleatingdisorders.org/rumination-disorder/

8. Birmingham, C. L., & Firoz, T. (2006). "Rumination in Eating Disorders: Literature Review." Eating and Weight Disorders, 11(3), e85-e89.

9. Hartmann, A. S., Becker, A. E., Hampton, C., & Bryant-Waugh, R. (2012). "Pica and Rumination Disorder in DSM-5." Psychiatric Annals, 42(11), 426-430.

10. Thomas, J. J., & Murray, H. B. (2016). "Cognitive-Behavioral Treatment of Adult Rumination Behavior in the Setting of Disordered Eating: A Single Case Experimental Design." International Journal of Eating Disorders, 49(10), 967-972.

Support Resources:

• Anorexie Boulimie Info Écoute: 09 69 325 900

• FFAB (French Federation): https://www.ffab.fr/

• SOS Anor: https://sosanor.org/

• NEDA (US): https://www.nationaleatingdisorders.org/

• Beat (UK): https://www.beateatingdisorders.org.uk/