Pica is an eating disorder that is characterized by the chronic craving and consumption of nonfood items such as dirt, clay, paint chips, chalk, cornstarch, baking soda, coffee grounds, cigarette butts or ashes and feces.
Pica is more common in people with developmental disabilities (e.g., autism, mental retardation), children between the ages of 18 months and 2 years and pregnant women. Even though infants younger than 2 years may try to eat nonfood items, it is not generally considered abnormal behavior for that age. In most cases, toddlers spontaneously outgrow the disorder and pica in pregnant women usually resolves after giving birth.
In addition, pica has also been observed in underdeveloped countries where there is widespread poverty, especially among some societies where the consumption of nonfood items (e.g., certain types of soil) is a culturally accepted practice.
Pica can result in serious health complications including lead poisoning (from eating paint chips in older buildings with lead-based paint), bowel problems, intestinal obstruction or perforation, dental and/or gum injury, parasitic infections and malnutrition. In addition, this eating disorder may be life-threatening if a patient consumes a toxic or lethal substance. Pregnant women with the disorder may cause harm to the fetus if hazardous substances are consumed or if nutritional deficiencies occur.
The cause of pica is unknown, although medical experts believe that certain conditions and situations may contribute to its development. Some of these conditions may include poverty, nutritional deficiencies and/or malnutrition, and a history of eating disorders (e.g., anorexia nervosa, bulimia nervosa).
Individuals with pica may also have other types of behavioral or emotional health disorders including obsessive-compulsive disorder(OCD) and schizophrenia.
Pica is usually diagnosed after a physical examination conducted by a physician, which includes a medical history. Patients may also be referred to a psychologist or other mental health professional for an evaluation.
Due to the complex nature of eating disorders, pica usually requires a comprehensive treatment plan including medical care and monitoring of health complications (e.g., stomach problems), psychotherapy (e.g., behavior therapy) and dental care to treat any tooth or gum injuries that may result from prolonged eating of nonfood substances.
The outlook for patients with pica is generally favorable, especially with early treatment.
About pica
Pica is an eating disorder that involves the chronic craving and consumption of nonfood items for at least one month. Individuals with pica have been reported to put in their mouths and/or ingest a wide variety of items or substances, including – but not limited to – dirt, clay, sand, stones, pebbles, paint chips, wood, chalk, cornstarch, baking soda, coffee grounds, cigarette ashes and/or butts, burnt match heads, feces, fingernails, glue, hair, buttons, sand, coal, plastic, paper, pencil erasers, light bulbs, string, toothpaste and soap.
In infants up to 2 years old, this type of behavior is common and not generally considered abnormal. In most cases, toddlers spontaneously outgrow the behavior. Pica has also been observed in underdeveloped countries where there is widespread poverty. In some societies the consumption of nonfood items (e.g., certain types of soil or soil and herb preparations) is a culturally accepted practice. For example, in portions of Uganda, soil is available for purchase for the purpose of ingestion.
Pica is more common in people, especially children and young adults, with mental disorders that are usually first diagnosed in infnancy, childhood, or adolescence (e.g., autism, mental retardation) or those who have suffered brain injuries resulting in epilepsy or other more serious impairments. According to the American Psychiatric Association (APA), the incidence of pica may be as high as 15 percent in patients with severe mental retardation. Pica may occur in both males and females, although it is typically rare in healthy people of average intelligence who live in developed countries.
Pica may also co-exist with other types of mental health disorders including obsessive-compulsive disorder(OCD), schizophrenia (as a result of delusional beliefs) and Kleine-Levin syndrome (a rare condition characterized by episodes of excessive sleep, excessive food consumption, sexual disinhibition and hallucinations).
It is possible, although uncommon, for individuals with other eating disorders such as anorexia nervosa and bulimia nervosa to develop pica due to the compulsive nature of these illnesses. The binge eating typical of bulimia, as well as the malnutrition that may result from either disorder, may contribute to pica. In some cases, pica has also been reported in pregnant women. In the case of pregnancy, however, pica usually resolves on its own after the mother gives birth.
Left untreated, pica may result in serious health consequences. Complications of eating nonfood items may include lead poisoning (from eating paint chips in older buildings with lead-based paint), bowel problems, intestinal obstruction or perforation, dental injury, parasitic infections and malnutrition. This eating disorder may also be potentially life-threatening if a patient consumes a toxic or lethal substance. In addition, pregnant women with the disorder may cause harm to the fetus if they consume hazardous substances or if there are nutritional deficiencies.
Pica was named after the Latin word for magpie, a bird that is known for its large and indiscriminate appetite. The exact prevalence of the eating disorder is not known because pica is believed to be under recognized and underreported. Some patients may withhold information from their physician or deny it when questioned due to embarrassment and/or fear of the condition.
Potential causes of pica
The exact causes of pica are not known. However, researchers believe that certain conditions and situations may contribute to the development of this eating disorder. These include:
Cultural factors. In some places (e.g., portions of southern Africa), the consumption of earth substances (geophagia), such as certain types of soil or soil and herbal preparations, is sometimes practiced.
Mental health disorders. Pica may co-exist with other types of mental health disorders including obsessive-compulsive disorder(OCD), schizophrenia (as a result of delusional beliefs) and Kleine-Levin syndrome (a rare condition characterized by episodes of excessive sleep in addition to behavioral and/or cognitive disturbances including excessive food consumption, sexual disinhibition and hallucinations).
It is also frequently reported in individuals with autism and mental retardation. Though to some degree this may be due to the inability of these patients to differentiate between food and nonfood items, it is thought that it may be more commonly related to a form of self-stimulation.
Nutritional deficiencies and/or malnutrition. Pica has been reported in individuals with deficiencies in minerals such as iron, calcium and zinc as well as other nutrients and vitamins (e.g., thiamine, niacin, vitamins C and D). However, it is unclear whether pica is related to an attempt to correct these deficiencies. Poverty may be the cause of malnutrition in some people. Children who are abused or neglected may also be malnourished.
Pregnancy. The craving and consumption of nonfood items associated with pica – especially dirt, clay and laundry starch – may sometimes occur in pregnant women. Iron deficiency during pregnancy appears to be related to excessive eating of ice. However, pica that develops during pregnancy usually resolves on its own once the mother gives birth.
History of dieting and/or other eating disorders. Individuals who undergo prolonged diets may attempt to ease hunger by eating nonfood substances to achieve a feeling of fullness. It is possible, although uncommon, for individuals with other eating disorders such as anorexia and bulimia to develop pica due to the compulsive nature of these illnesses as well as the malnutrition that may result from them.
Signs and symptoms of pica
Pica is an eating disorder that is characterized by the chronic consumption – for a period of at least one month – of nonfood items including dirt, clay, paint chips, chalk, cornstarch, baking soda, coffee grounds, cigarette ashes and/or butts, burnt match heads, feces, glue, hair, buttons, sand, coal, plastic, paper, pencil erasers, toothpaste and soap.
Physicians generally diagnose pica based on the patient’s symptoms and eating habits. During an initial consultation, a physician will perform a thorough physical examination including:
Checking vital signs, such as heart rate and blood pressure
Evaluation of the patient’s skin, abdomen and teeth
A physician will also compile a comprehensive medical history including any history of physical and psychological disorders, such as:
Autism
Brain injuries
Mental retardation
Obsessive-compulsive disorder(OCD)
Physicians will also inquire about the patient’s history of dieting and/or eating patterns. Neurological examinations may also be performed to evaluate potential causes of the abnormal eating behavior, such as a brain tumor or injury.
In addition, a physician may order diagnostic tests to look for any signs of complications of pica including malnutrition, intestinal obstruction or perforation, digestive problems (e.g., constipation, diarrhea), dental injuries and infection or disease as a result of eating items contaminated with bacteria or other organisms.
Additional diagnostic tests may include:
Blood tests. Laboratory analyses – including a complete blood count (CBC) – of blood samples to measure levels of hormones, enzymes, proteins, electrolytes, vitamins and other substances. These tests can assess the function of various organ systems including the liver, kidney and thyroid and pituitary glands. A blood test may also indicate toxins and/or other poisonous substances in the blood.
Urinalysis. Chemical examination of a patient’s urine sample to screen for urinary tract infections, kidney disease and diseases of other organs that result in the appearance of abnormal metabolites (break-down products) in the urine.
Imaging tests (e.g., x-ray, CAT scan). These tests are useful in detecting the presence of any damage and/or blockages in the stomach, digestive tract and organs caused by eating nonfood substances.
Once pica has been diagnosed, a non-psychiatrist physician may refer the patient for supplementary treatment with a mental and/or behavioral health specialist (typically a psychiatrist or psychologist) for evaluation. Other specialists such as social workers and dentists may also be consulted.
Treatment and prevention of pica
Pica typically resolves itself spontaneously, especially in healthy children and pregnant women. However, in individuals with conditions such as autism and mental retardation, the eating disorder often continues into adolescence and adulthood. When pica is associated with other mental disorders, these also need to be treated.
In severe cases of disease or infection following the consumption of a poisonous or toxic substance (e.g., lead, rat poison), immediate hospitalization of the patient is necessary to prevent death.
The sooner an individual with pica is diagnosed and begins treatment, the better the outcome is likely to be. Due to its complexity, pica usually requires a comprehensive treatment plan involving various health professionals including psychiatrists,psychologists, social workers and/or primary health physicians. Behavioral therapy, a type of psychotherapy that focuses on modifying the patient’s abnormal or atypical behavior, is generally used for the treatment of pica.
Patients with pica-related dental problems (e.g., tooth and gum injuries) may be referred to a dentist (dental health specialist) for treatment.
Patients with pica are urged to get regular check-ups with their physician to monitor their overall health and treat any complications, such as intestinal obstruction and/or perforation.
Because individuals with pica may deny or not tell their physician that they regularly consume nonfood items out of shame or fear, the disorder is believed to be widely under recognized and underreported.
Family members and other individuals close to the patient are urged to ensure that the person suspected of having pica receives needed care and rehabilitation. For some patients, such as those with severe developmental disabilities, medical treatment may be long term.
Questions for your doctor regarding pica
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients and their families may wish to ask the doctor the following pica-related questions:
What are some of the items that individuals with pica typically crave?
What is causing my pica?
When should I be concerned if my child starts eating nonfood items?
What are the complications associated with pica? Do I have any of these?
How will you determine if I have pica?
What type of treatment will I need?
How long will my treatment process take?
Should I receive therapy? What type of therapy would be best for me?
I have a family member or friend with pica. What are the best ways to help them?
