and have a negative effect on development an d learning potential. Some older individuals
with rumination disorder deliberately restrict their food intake because of the social un-
desirability of regurgitation. They may therefore present with  weight loss or low weight.
In older children, adolescents, and adults, soci al functioning is more likely to be adversely
affected. 
Differential Diagnosis
Gastrointestinal conditions. It is important to differentiate regurgitation in rumination
disorder from other conditions characterized by gastroesophageal re flux or vomiting. Con-
ditions such as gastroparesis, pyloric stenosis, hiatal hernia, and Sandifer syndrome in in-
fants should be ruled out by appropriate physical examinations and laboratory tests.
Anorexia nervosa and bulimia nervosa. Individuals with anorexia nervosa and bulimia
nervosa may also engage in regurgitation with subsequent spitting ou t of food as a means
of disposing of ingested calories be cause of concerns about weight gain. 
Comorbidity
Regurgitation with associated rumination can occur in the context of a concurrent medical
condition or another mental disorder (e.g., ge neralized anxiety disorder). When the regur-
gitation occurs in  this context, a diagnosis of ruminati on disorder is appropriate only when
the severity of the disturbance exceeds that routinely associated with such conditions or
disorders and warrants additional clinical attention.