Pica is an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and paint chips.
Pica is the persistent eating of substances such as dirt or paint that have no nutritional value. An affected person might eat relatively harmless items, such as ice. Or they might eat potentially dangerous items, likes flakes of dried paint or pieces of metal. In the latter case, the disorder can lead to serious consequences, such as lead poisoning.
Usually, what people with pica eat does not harm them, but sometimes what they eat causes complications, such as blockages in the digestive tract or lead poisoning.
Doctors usually diagnose pica when a person over age 2 has been eating things that are not food for a month or more.
Behavioral modification techniques may help, but little is known about specific treatments for pica.
Nutritional deficiencies and other complications are treated as needed.
This disorder occurs most often in children and pregnant women. It’s usually temporary. See your doctor right away if you or your child can’t help but eat nonfood items. Treatment can help you avoid potentially serious side effects.
Pica also occurs in people who have intellectual disabilities. It’s often more severe and long-lasting in people with severe developmental disabilities.
Pica often occurs with other mental health disorders associated with impaired functioning (e.g., intellectual disability, autism spectrum disorder, schizophrenia).
Iron-deficiency anemia and malnutrition are two of the most common causes of pica, followed by pregnancy. In these individuals, pica is a sign that the body is trying to correct a significant nutrient deficiency. Treating this deficiency with medication or vitamins often resolves the problems.
A medical professional should assess if the behavior is sufficiently severe to warrant independent clinical attention (e.g., some people may eat nonfood items during pregnancy, but their doctor may determine that their actions do not indicate the need for separate clinical care)
The Handbook of Clinical Child Psychology currently estimates that prevalence rates of pica range from 4%-26% among institutionalized populations. Research among non-institutionalized populations takes the form of individual case studies, making prevalence rates difficult to estimate.
Symptoms of Pica
People with pica eat nonfood items regularly. The behavior must continue for at least one month to qualify as pica.
If you have pica, you may regularly eat things such as:
- ice
- soap
- buttons
- clay
- hair
- dirt
- sand
- the unused remainder of a cigarette
- cigarette ashes
- paint
- glue
- chalk
- feces
You may also eat other nonfood items.
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The persistent eating, over a period of at least one month, of substances that are not food and do not provide nutritional value.
The ingestion of the substance(s) is not a part of culturally supported or socially normative practice (e.g., some cultures promote eating clay as part of a medicinal practice).
Typical substances ingested tend to vary with age and availability. They may include paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal, ash, clay, starch, or ice.
The eating of these substances must be developmentally inappropriate. In children under two years of age, mouthing objects—or putting small objects in their mouth—is a normal part of development, allowing the child to explore their senses. Mouthing may sometimes result in ingestion. In order to exclude developmentally normal mouthing, children under two years of age should not be diagnosed with pica.
Generally, those with pica are not averse to ingesting food.
Causes
There’s no single cause of pica. In some cases, a deficiency in iron, zinc, or another nutrient may be associated with pica. For example, anemia, or iron deficiency, may be the underlying cause of pica in pregnant women. Your unusual cravings may be a sign that your body is trying to replenish low nutrient levels.
People with certain mental health conditions such as schizophrenia and obsessive-compulsive disorder may develop pica as a coping mechanism.
Some people may even enjoy and crave the textures or flavors of certain nonfood items. In some cultures, eating clay is an accepted behavior. This form of pica is called geophagia.
Dieting and malnourishment can both lead to pica. In these cases, eating nonfood items may help you feel full.
Diagnosis
If pica is suspected, a medical evaluation is important to assess for possible anemia, intestinal blockages, or potential toxicity from ingested substances. If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical exam. The doctor may use certain tests — such as X-rays and blood tests — to check for anemia and look for toxins and other substances in the blood, and to check for blockages in the intestinal tract. The doctor also may test for possible infections caused by eating items contaminated with bacteria or other organisms. A review of the person’s eating habits also may be conducted.
Before making a diagnosis of pica, the doctor will evaluate the presence of other disorders — such as intellectual disabilities, developmental disabilities, or obsessive-compulsive disorder — as the cause of the odd eating behavior. This pattern of behavior must last at least one month for a diagnosis of pica to be made.
There are no laboratory tests for pica. Instead, the diagnosis is made from a clinical history of the patient.
Diagnosing pica should be accompanied by tests for anemia, potential intestinal blockages, and toxic side effects of substances consumed
Treatment
Sometimes behavioral modification
Treatment of nutritional deficiencies and other complications
Behavioral modification techniques may help, but little is known about specific treatments for this disorder. Behavioral modification techniques help people unlearn undesirable behaviors while learning desirable behaviors.
Nutritional deficiencies and other complications are treated. Blockages in the digestive tract may require surgery.
Pica may last several months, then disappear on its own, particularly in children.
Your doctor will probably begin by treating any complications you’ve acquired from eating nonfood items. For example, if you have lead poisoning from eating paint chips, your doctor may prescribe chelation therapy. In this procedure, you’ll take medication that binds with lead. This will allow you to excrete the lead in your urine. Your doctor may also prescribe other medications for lead poisonings, such as ethylenediaminetetraacetic acid, or EDTA.
If they think your pica is caused by nutrient imbalances, your doctor may prescribe vitamin or mineral supplements. For example, they might recommend taking regular iron supplements.
Your doctor may also order a psychological evaluation to determine if you have obsessive-compulsive disorder or another mental health condition. Depending on your diagnosis, they may prescribe medications, therapy, or both.
Given the risk of medical complications (such as lead poisoning) associated with pica, close medical monitoring is necessary throughout the treatment of the eating behavior. Additionally, close collaboration with a mental health team skilled in treating pica is ideal for optimal treatment of these complex cases.
Scientists in the autism community have developed several different effective interventions, including redirecting the person’s attention away from the desired object and rewarding them for discarding or setting down the non-food item.