Pica

The National Eating Disorders Association defines pica as “the recurrent eating of non-food substances that offer no nutritional value and are not part of a culturally sanctioned practice”.1 To be considered a disorder, this behavior must take place over at least one month.2 Some of these substances may include cloth, hair, wool, starch, soil, string, chalk, feces, metal, pebbles, charcoal, ash, gum, soap, glass, and clay.2 Generally, people with pica have a typical diet, aside from their preferred substance.1

Prevalence Rates

Pica may be more common in less developed countries where education and treatment options regarding eating disorders are limited. Pica ranges from 4% to 26% among people living in mental institutions in the U.S. according to the Handbook of Clinical Child Psychology.1 However, rates among non-institutionalized populations are more challenging to estimate, as research on pica generally focuses on individual case studies.2 A 2013 Nigerian study found the incidence of pica to be 25% in Zambian adolescents and 9% in pregnant African American women living in the United States.3

Causes

Although the cause of pica is unknown, oftentimes, it will occur in conjunction with mental disorders such as autism, intellectual disability, schizophrenia, obsessive compulsive disorder (OCD), or trichotillomania (hair pulling disorder). Mental disorders can make it difficult to stop pica-related behaviors. Pica is more common in people with intellectual disabilities than it is in people with other eating disorders.3 Similar to OCD, patients with pica recognize their behavior as illogical and unhealthy, but have trouble stopping the behavior.4 In one case study, an adult male with a below average IQ ate glass whenever he experienced intense feelings of anxiety. After he ate the glass, he reported feeling relieved. This cycle is a common pattern in other mental disorders.3

Although pica can occur in people of any age and sex, it most commonly occurs in children and lasts only a few months.1 Children are more likely to develop pica if their caretakers do not provide adequate supervision and attention.4 Pica also commonly co-occurs with pregnancy and anemia (iron deficiency). Certain cultural factors can also increase the likelihood of pica behaviors. For example, some cultures value eating clay. However, the DSM-5 does not qualify individuals as having pica if the behavior is part of a culturally endorsed practice. Pica is more common in African countries that have less access to nutritional education than westernized countries.4

Symptoms

Although people with pica do not always suffer negative health consequences from eating non-food items, pica can be life-threatening and may result in the following health complications:

  • Bowel problems, due to an intestinal obstruction from non-food items that prevent the regular flow of food and water through the digestive tract.
  • Development of a bezoar, which is a formation of indigestible material that becomes stuck in the esophagus, stomach, or intestines.
  • Intestinal perforation, which is caused by sharp non-food items, like paperclips, puncturing a hole in the wall of the stomach, intestines, or bowels. 
  • Poisoning, such as by ingestion of toxic substances like soap or lead-based paint.
  • Learning disabilities and brain damage from consumption of toxic items, like paint.
  • Constipation, due to eating objects that cannot be properly digested.
  • Nutritional deficiencies, if people forgo ingesting sufficient healthy food.
  • Infections, due to bacteria or parasites found in ingested objects like dirt or feces.
  • Kidney or liver damage from untreated, persistent infections caused by bacteria.
  • Heavy metal poisoning, due to the consumption of metal-based substances.1

Health complications from pica can be severe and can range from intestinal issues to learning disabilities. It is important that patients with pica seek treatment as soon as possible to avoid experiencing any of these complications. In some pica cases, no specific bodily abnormalities occur, making diagnosis difficult.

Diagnosis

The Diagnostic Statistical Manual 5 (DSM-5) recommends that people be diagnosed with pica if they demonstrate the following behaviors:

  • Recurrent eating of substances with no nutritional value for a period of at least one month.
  • Eating non-food substances that are considered inappropriate considering the developmental stage of the individuals.
  • Eating non-food substances when it is not part of a cultural practice.4

Only a doctor can diagnose an eating disorder, including pica. During diagnosis, will generally conduct a full physical exam to check for intestinal blockages. They will also draw blood to check for anemia (low iron content in blood) or any toxins, such as lead. Doctors will also evaluate the mental state of patients, assessing if the pica occurs in conjunction with any mental disorders or disabilities.2 It is considered developmentally normal for infants to mouth objects, which may lead to the object’s accidental ingestion. These cases do not warrant an official diagnosis until after age 5.4 However, the consumption of foreign objects is still dangerous and caretakers should watch infants closely to prevent any incidences. Females who are pregnant and craving non-food items should not be diagnosed with pica for merely craving such items. They should only be diagnosed if they actually consume these items and if the items could potentially threaten their health. 1

Treatment

When treating pica, patients should understand the health consequences of ingesting certain substances, and the nutritional significance of a healthy diet. Pica can be treated through behavioral techniques, such as positive reinforcement.2 During treatment, a medical professional should closely monitor individuals with pica due to the serious health consequences that can arise. A person with pica would benefit from communicating with skilled mental professionals, who are trained to provide effective treatment.2 Family therapy is especially beneficial in cases with children who ingest non-food items as a result of neglect from their caretakers.3

A Final Note

Pica is the consistent consumption of non-food items over a period of at least one month. Consuming these items can have severe health consequences, so people with pica should seek professional help to discuss treatment options. If individuals are concerned that they or someone they know has pica, it is important to contact a doctor to get a correct and official diagnosis rather than self-diagnosing.

 

References

1. "Pica." National Eating Disorders Association. N.p., n.d. Web. 18 Apr. 2017.

2. "Mental Health and Pica." WebMD. WebMD, n.d. Web. 18 Apr. 2017.

3. "Pica DSM-5." Theravive Counseling. N.p., n.d. Web. 20 May 2017.

4. Golden, Caroline. "Classifying Eating Disorders - DSM-5." DSM-5 | Eating Disorders Victoria. N.p., n.d. Web. 16 May 2017.

Last updated: 4 March 2017.

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