PICA (A Comprehensive Overview)

This article is a detailed overview of PICA and discusses some pertinent aspects related to this disorder.

Also, this article reveals possible symptoms, diagnostic aspects and possible treatments that offers insight into this problem.

Pica is a psychological disorder that is characterized by a healthy appetite for non-food substances that are non-nutritive and are not usually eaten by a normal person.

This includes consumption of ice, hair, paint, chalk, stones, and even feces.

According to DSM 5 (Diagnostic and statistical manual of mental disorders 5th edition), actions cannot be considered as pica if they do not persist for as long as 4 to 5 weeks.

It should also occur at an age in which it can be regarded as inappropriate to each such object.

Pica can usually lead to intoxication in children, like younger children, often toddlers, tend to eat random things.

This can impact their mental and physical growth and may cause their digestive system harm leading to problems like poisoning and diarrhea.

It can also lead to surgical emergencies and intestinal obstruction.

It can be linked to many other disorders, either mental or developmental.

People with mental disabilities like autism, pregnant women, and young children are the typical patients of this disorder. 

Small children that eat paint fragments that contain lead pigment can develop lead poisoning and may lead to gastrointestinal problems and tearing or obstruction in the stomach.

Similarly, eating soil can cause a risk of ingestion of animal waste and parasites.

There is also a risk of ingesting different chemicals and germs.  

Domestic animals like cats and dogs also experience this disorder.

People who are experiencing stress and emotional trauma tend to eat strange objects as a source of comfort to them from their stress and problems.

If an individual has pics they can be seen eating things like ice, soap, buttons, sand, glue, chalk, feces, paint, cigarette ashes, hair, clay, etc. (Delaney, 2015)

WHAT CAUSES PICA?

DSM 5 explains that mineral deficiency in a human can occasionally lead to eating disorders like pica.

However, individuals with pica do not necessarily have any abnormalities relating to their health.

People are usually anemic and have low levels of hemoglobin molecules in their blood, leading to some common forms of pica such as geophagy, amylophagy, hematophagy, etc.

Pregnant women and small children carry a higher risk of being anemic or having low hemoglobin levels.

Pica is also recognized as an OCD in some parts of diagnostic medicine, but currently, it is an eating disorder.

OCD and schizophrenia can also sometimes cause pica. 

Pica can often also be a practice in cultural aspects and have nothing to do with the psychology of a person.

For example, African American women consume kaolin, white clay, as a part of cultural practices.

Kaolin is also widely consumed in Africa. Some people also tend to enjoy the flavors of some items such as soap, shampoo, or slay.

Dieting and malnourishment also sometimes lead to pica as non-food items may also lead to the distinct feeling full without having to eat any nutritional item. 

IS PICA A COMMON DISORDER?

The presence of pica is hard to see with the differences of opinions and diagnosis, the reluctance of patients to admit that they are indeed suffering from an eating disorder. 

The prevailing rate of pica in small children is still unknown, but it is commonly observed among children to eat dirt and paint in their early years.

In institutionalized children with mental retardation, pica occurs in 10–33 percent of individuals.

Pigs, dogs, and cats also suffer from a condition called immune-mediated hemolytic anemia, especially when it involves eating substances such as tile grout, concrete, and sand.

Dogs can exhibit pica and should be tested for anemia with proper testing of CBC and hematocrit leveling.

Several theories have been widely accepted as there is less evidence to prove or disprove any theory regarding any of them.

In the early years, pica was primarily diagnosed in children, and after some time, people started to remove that category and diagnosed people of all ages with it.  

In the early 18th century, pica was considered as a symptom for other disorders rather than being a disorder of their own.

Even to this day, it is commonly observed and recognized as a standard practice in some cultures as a part of their religious and cultural beliefs, healing methods, or religious ceremonies. 

Types of PICA Disorder:

Patients with pica consume materials with no nutritional value to them, such as soap, soil, wood, etc.

Piac usually begins in childhood and may last from a few months to a few years. Some common types of pica are:

• Acuphagia: Acuphagia is the disorder in which patients eat sharp objects. This can lead to esophageal tearing and obstruction in the stomach, which may lead to surgical emergencies.

• Amylophagia: Patients with amylophagia consume excessive amounts of pure starch, and is usually observed in pregnant women.

• Cautopyreiophagia: Cautopyreiophagia is the consumption of excessive amounts of burned matches.

• Coprophagia: Coniophobia is an excessive intake of dust.

• Coprophagia: Coprophagy is the consumption of feces. This may include feces of other species or one’s feces.

• Emetophobia: Emetophobia is the consumption of throw up.

• Geomelophagia: Geomelophagia refers to the intake of raw potatoes and is an unusual iron deficiency anemia.

• Geophagia: Geophagia is the active intake of dirt, soil, or clay. It occurs in animals as well as humans, usually in small children. 

• Hyalophagia: Hyalophagia is a dangerous subtype of pica in which the patient intakes glass, which may lead to surgical emergencies.

• Lithophagia: Lithophagia is a common disorder in which the individual intakes small stones.

• Mucophagy: Mucophagy is the consumption of mucus of fishes or invertebrates.

• Pagophagia: Pagophagia is the consumption of ice.

• Plumbophagaia: It is the intake of lead, usually in the form of paint, leading to lead poisoning.

• Trichophagia: Trichophagia is the intake of fibrous objects such as hair and wool.

• Urophagia: Urophagia is the intake of urine. In some cultures, urine was used for health benefits too.

• Hematophagia: hematophagy, which is also commonly known as vampirism is the intake of blood by human beings.

• Xylophagia: Xylophagis is the intake of wood of common derivatives of woods such as paper.

Pregnant women can experience pica.

For most women, all cravings can disappear in the third trimester, including those that come with pica.

However, pica is a mental health condition.

Therefore, if you continue to experience it after giving birth, it might be an eating disorder that requires further treatment.

HOW IS IT DIAGNOSED AND TREATED?

There is no apparent diagnosis for pica by testing for it as it is an unusual type of disorder.

Pica occurs in people that have abnormal levels of nutrients and malnutrition.

Doctors check for those symptoms by testing blood levels for the presence of the appropriate amount of iron, zinc, and other elements.

Lead levels are usually the best way to check for lead poisoning in small children who may have eaten lead paint off their home walls.

People who eat soil or animal waste are tested for infection.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, has some criteria that must be met.

It specifies that the person must have been eating uncommon and low nutritional objects for at least four weeks.

That person must be of a definitive age in which that eating can be considered as abnormal.

Eating some of those substances must not be a part of cultural practices.

People having medical conditions such as autism, pregnancy, etc. should not only be considered having pica but should immediately be treated with extra medical care with their previous medical treatments for their conditions.

Sometimes people having physical disorders eat non-nutritive substances as a part of Kleine-Levin syndrome.

In such instances, it cannot be diagnosed as a pica. The treatment for this disorder may have family guiding, psychological sessions as well as medications.

Once a doctor tests for possible nutritional deficiencies, a doctor advises people with iron, zinc, calcium, or other deficiencies to start taking supplementary pills. Psychogenic therapy has also been widely used in institutions to deal with pica successfully.

However, doctors try to avoid medications until psychogenic causes have been ruled out by a professional.

People having different causes for pica have different ways to be treated for it.

A person having pica from social attention and deficiencies will have a different course of treatment.

Behavior-based treatment options are also used for mentally ill and disabled individuals with pica. 

They show that almost 80% of pica patients have recovered and showed less severity due to behavioral therapy.

Pica treatments also include vision screening, physical restraint, aversive presentation on pica being attempted, negative practice, and differential reinforcement (Hartmann, 2018).

Parents having children with pica disorders are advised to discuss their child’s environment and habits to try and overcome pica in an as early an age as possible. 

WHAT ARE THE COMPLICATIONS ASSOCIATED?

Pica can cause many complications in patients ingesting harmful substances like lead, chalk, glass, feces, etc.

It can cause problems like

• Poisoning: Lead eating is the major leading cause too much worse effects on the patients with pica, harming the digestive system and causing health problems.

• Choking: people can choke on a small object that they ingest, like glass, paper pieces, stones, etc. and may die.

• Parasitic infections: pica patients may ingest harmful substances either directly, or through soil or dirt they eat off the ground, road, or any other places.

• Intestinal blockages: Eating sensitive substances that may block the abdominal opening,  like stones, can cause gastrointestinal tract to be blocked and may cause constipation. Eating glass or other pointed objects may also lead to intestinal tearing, causing severe surgical emergencies leading to internal bleeding.

Medical emergencies relating to pica are treated in the best way possible by medical professionals.

However, it is visible that this disorder can lead to severe complications in the human body if not stopped immediately by therapy or by medications.

Some Useful Resources 

1. Conquering Your Stress & Fears: A Treatment Guide for Anxiety and Trauma-Related Disorders
2. Pica in Individuals with Developmental Disabilities (Autism and Child Psychopathology Series)
3. Reversing Pica Disorder: Healing Herbs The Raw Vegan Plant-Based Detoxification & Regeneration 
4. The Woman Who Ate Her House
5. Food Refusal and Avoidant Eating in Children, including those with Autism Spectrum Conditions

CONCLUSION

PICA may cause parasitic diseases, leading to toxic conditions like toxoplasma or Toxocara infections leading to the ingestion of feces or dirt that cannot be prevented.

Proper nutrition may help some children keep from developing it.

If you pay close attention to eating habits and supervise children who tend to put things into their mouths, you may catch the disorder early, before complications can happen. 

If your child has been diagnosed with pica, you can reduce his or her risk of eating non-food items by keeping those items out of reach in your home.

Be sure to monitor your child’s outside play, as well and try not to leave them alone. 

Side Note: I have tried and tested various products and services to help with my anxiety and depression. See my top recommendations here, as well as a full list of all products and services our team has tested for various mental health conditions and general wellness.

FREQUENTLY ASKED QUESTIONS

REFERENCES

Pica – Eating disorder

What is pica? Is it an eating disorder?

Pica causes, symptoms and treatment?

How can you identify pica?

Information about pica – the eating disorder

Definition, causes and treatment for pica