Comment on Starin and Fuqua's (1987) review of research on rumination and vomiting.

The authors wrote a short letter to the editor. They looked at a 1987 review on rumination and vomiting.

They said the review downplayed two things that still have the best proof: aversive procedures and feeding until full.

Their goal was to remind readers that, in 1988, these harsh but well-studied tools still led the pack.

The letter found no new data. Instead, it claimed the 1987 review moved the field backward.

It argued that gentle, non-aversive tricks had almost no solid studies behind them.

So, for life-threatening rumination, the strongest—yet still thin—evidence stayed with aversive and satiation methods.

Perez et al. (2015) later pooled 30 years of data and showed noncontingent reinforcement (NCR) can slash problem behavior by a huge margin. Their mega-review includes the same rumination cases Attwood et al. (1988) said lacked proof.

Verriden et al. (2019) ran a clean experiment that echoes the 1988 stance: when NCR plus DRA failed, adding a mild punisher worked fast. This supports the older claim that sometimes you must escalate.

Coffey et al. (2020) found that a quick, interview-led FA almost always leads to a working treatment. Their paper shows we now have kinder ways to find the “why” before choosing any procedure, harsh or not.

Today you have better options than the 1988 crew could imagine. Start with a brief IISCA to find the function. Try NCR with the matched reinforcer first. If the client still loses weight or risks aspiration, follow Verriden’s model: test a mild punisher in a multielement design and add only the winner. You move from least to most intrusive, but you do it with data every step.