What is Pica?
The American Psychiatric Association has a guidebook called the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) that describes a condition called pica. Pica is a disorder where a person eats things that don’t have nutritional value such as dirt, paper, or ice for at least a month. The name ‘pica’ comes from the Latin word “pica-pica,” which is a type of bird known for the random items it collects and eats out of curiosity.
To diagnose someone with this disorder, the person’s unusual eating behavior should last for at least a month and it should not be a normal part of their culture or appropriate for their age and developmental stage. This diagnosis is usually only given to children over 24 months old because it’s quite normal for younger children to put all sorts of non-food items in their mouths.
Although we see this mostly in kids, pica is also a common disorder among people with intellectual difficulties. It’s also frequently seen in pregnant women. There are also some parts of the world where eating non-nutritional substances is considered normal. Though pica usually stands alone as a condition, it can sometimes coexist with other disorders such as schizophrenia (a mental disorder that affects a person’s ability to think, feel, and behave), obsessive-compulsive disorder (OCD, a condition where a person has recurring thoughts and behaviors they cannot control), and trichotillomania (a disorder causing people to pull out their hair).
What Causes Pica?
There is no clear reason as to why pica, a condition that causes people to crave non-food items, occurs. Many studies have suggested a variety of factors, but none have been definitively proven. Some people believe that pica could be related to psychological conditions, such as stress, child neglect and abuse, or a lack of proper maternal care. Others argue that it might be due to a physical problem, like a lack of iron in the blood.
Specifically, several studies have discovered low levels of iron and other essential nutrients in individuals with pica. However, this explanation is not entirely satisfactory because the substances consumed by people with pica often don’t give the body more iron.
An alternative theory that some researchers are considering is that consuming non-food substances might be a way to protect the body from harmful toxins. This could be especially important during critical stages of body growth and development, like childhood and pregnancy. The theory suggests that these non-food items might bind to toxins, reducing how much the body absorbs.
One particular form of pica, pagophagia, consists of craving and consuming ice. A Japanese study has suggested that for people who are anemic, consuming ice could help increase blood flow to the brain and improve brain function. This could occur because eating ice triggers certain body responses that lead to the constriction of peripheral blood vessels and increase blood flow centrally.
However, the exact cause of pica remains uncertain. But several risk factors are commonly associated with developing this condition, including stress, cultural factors, learned behaviors, low socioeconomic status, mental health disorders, nutritional deficiencies, child neglect, pregnancy, epilepsy, and family history of psychological issues.
Risk Factors and Frequency for Pica
Pica is a condition that’s hard to track accurately due to reasons like varying definitions used in studies, under-reporting from those who have the condition, and the influence of cultural and societal elements.
- Pica mostly appears in pregnant women and young children.
- In a study conducted in Germany, out of 804 children, 99 (around 12.3%) were found to have pica behavior at some point in their lives.
- Looking at pica during pregnancy, a study found that around 27.8% of pregnant women said they experienced pica. This study also noted that the instances of pica varied across the world, with Africa displaying a higher prevalence.
- Pica is also common among individuals with intellectual disabilities, with about 10% affected. The severity of these disabilities tends to correlate with the incidence of pica.
Signs and Symptoms of Pica
When checking for pica, it’s necessary to talk with the person or their caregiver to get a thorough history. The details about what was eaten, how much, how often, where it usually happens, where the object was found, if anything else was consumed and if there are any symptoms of poisoning should be collected.
Although the physical exam might not show any signs in most cases, there’s a need to look out for symptoms of poisoning or complications. Some things that could happen from eating non-food items are:
- Consuming a bezoar (a mass found trapped in the gastrointestinal system), which could cause blockage and potentially ulcers and perforation,
- Lead poisoning, which could show as tiredness, headache, seizures, signs of brain disease, paralysis of cranial nerves, and swelling of the optic disc,
- Parasitical infections, such as Toxocara and Ascaris, from eating clay. These infections could show symptoms like fever, cough, inflammation of the heart and brain, enlarged liver, and vision problems.
Testing for Pica
In cases where doctors suspect that a patient has ingested certain substances, tailored lab tests are necessary. For instance, if you’ve been eating non-food items (a condition known as pica), tests may be needed to check your levels of iron, especially if you’re a pregnant woman or a child. Additionally, tests to check levels of lead (commonly found in paint and chalk) and zinc may also be needed in appropriate cases.
It’s also crucial to carry out a basic metabolic panel, particularly when there’s clay ingestion involved. This is because eating clay can cause imbalances in your body chemistry such as low potassium levels (a condition known as hypokalemia).
If you’re experiencing abdominal discomfort, imaging studies are typically necessary. These may include simple abdominal x-rays, barium tests (which help visualize the gastrointestinal tract), and endoscopy (a procedure where a thin tube with a light and camera is used to examine your digestive tract). Repeated imaging tests may be needed to confirm that the ingested substance has passed through your system.
Treatment Options for Pica
To prevent certain conditions, it’s crucial to identify people who are at a higher risk. For instance, children living in older houses with lead paint, and pregnant women, should be screened regularly. This is because they can represent a group at risk of developing certain diseases.
One way to help those who already suffer from conditions (like cravings for harmful substances) is to try to decrease their exposure to these substances. This could be achieved by either lowering their access to these substances or by providing a suitable substitute that has a similar feeling or texture.
If a deficiency in nutrients like iron, zinc, or others is identified, supplying these missing nutrients can be beneficial. In addition, treatment that involves modifying behaviors might be particularly effective in patients with mental disabilities. For example, “differential reinforcement” is often employed. This approach aims to encourage different responses in a patient by guiding their attention away from unwanted behavior and towards other activities.
While there are no specific medications for pica (a disorder that involves eating non-food items), some anecdotal evidence suggests the use of certain antipsychotic drugs might reduce these behaviors. However, these medications also carry the risk of side effects like constipation.
Additionally, besides simply removing the substance a person is craving from their environment, it can be important to investigate any cultural traditions or beliefs that might be contributing to these behaviors. Every person and their circumstance is unique, so it’s crucial to approach each case thoughtfully and carefully.
What else can Pica be?
When a person exhibits pica behaviors, or the desire to eat non-food items, it’s crucial to check for potential mental health issues. The following mental health problems should be considered:
- Other eating disorders
- Schizophrenia and psychosis
- Autism and developmental delay in children
- Substance abuse
- Addiction
These conditions may underlie or contribute to pica, and a proper diagnosis is essential for effective treatment.
What to expect with Pica
Pica is a condition where individuals consume non-food substances. It’s typically harmless if it only happens for a short time. For instance, among pregnant women and children, this habit usually disappears on its own without causing any lasting problems. However, for people facing intellectual difficulties, this condition may continue for years.
If pica becomes a long-term issue, it can cause serious health problems such as bowel obstruction, a condition where the intestines become blocked; bezoars, which are hard, indigestible lumps that get stuck in the digestive tract; and toxicity or poisoning. Substances like dirt and paint can lead to infections and heavy metal toxicity when ingested.
There have been instances where some people with pica had to undergo surgery due to severe bowel obstructions, perforations (holes in the gut), and ulcers (sores in the stomach lining).
Possible Complications When Diagnosed with Pica
Pica, a condition where people eat non-food substances, can lead to various health problems, depending on what has been ingested.
- Geophagia: This is the term for eating clay. It can cause constipation, muscle issues due to low potassium levels, and nutritional deficiencies. Clay can also carry infections, like parasites. One particularly dangerous risk is lead poisoning.
- Pagophagia: This refers to the consumption of ice. It could lead to iron deficiency, which is particularly dangerous during pregnancy. Eating too much ice can also cause dental problems like tooth decay and sensitivity.
- Amylophagia: This means eating excessive amounts of starch. This can lead to iron deficiency as well as high blood sugar and obesity from its high carbohydrate content.
- In addition, the substances consumed may contain harmful contaminants like lead, mercury, arsenic, and fluoride. The resulting toxicity can be harmful. For example, lead poisoning can cause seizures, particularly in pregnant women.
Eating non-food substances during pregnancy can affect the fetus. There have been reports of toxins harming unborn babies, including causing long-term neurological disabilities. For instance, maternal clay eating has been linked to delayed motor function in childhood.
