PICA

Pica is characterized by an appetite for substances that are largely non-nutritive, such as paper, clay, metal, chalk, soil, glass, or sand. According to DSM-IV criteria, for these actions to be considered pica, they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate, not part of culturally sanctioned practice and sufficiently severe to warrant clinical attention. 


There are different variations of pica, as it can be from a cultural tradition, acquired taste, or a neurological mechanism such as an iron deficiency or a chemical imbalance. It can lead to intoxication in children, which can result in an impairment in both physical and mental development. In addition, it can also lead to surgical emergencies due to an intestinal obstruction as well as more subtle symptoms such as nutritional deficiencies and parasitosis.

Pica has been linked to mental disorders and they often have psychotic comorbidity. Stressors such as maternal deprivation, family issues, parental neglect, pregnancy, poverty, and a disorganized family structure are strongly linked to pica. It is more commonly seen in women and children, and in areas of low socioeconomic status. Particularly it is seen in pregnant women, small children, and those with developmental disabilities such as autism. 

Children eating painted plaster containing lead may suffer brain damage from lead poisoning. There is a similar risk from eating soil near roads that existed before tetraethyllead in petrol was phased out (in some countries) or before people stopped using contaminated oil (containing toxic PCBs or dioxin) to settle dust. In addition to poisoning, there is also a much greater risk of gastro-intestinal obstruction or tearing in the stomach.  Another risk of eating soil is the ingestion of animal feces and accompanying parasites. Pica can also be found in other animals and is commonly found in dogs.

How is Pica Diagnosed?
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 mental retardation, 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.

How Is Pica Treated?
Given the risk of medical complications (such as lead poisoning) associated with pica, close medical monitoring is necessary throughout 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.

The Handbook for Clinical Child Psychology currently supports general behavioral strategies as the most effective treatment approach for pica, with training in which foods are edible and which foods cannot be eaten through the use of positive reinforcement.

Complications Associated With Pica
There are many potential complications of pica, such as:

• Certain items, such as paint chips, may contain lead or other toxic substances and eating them can lead to poisoning, increasing the child's risk of complications including learning disabilities and brain damage. This is the most concerning and potentially lethal side effect of pica.
• Eating non-food objects can interfere with eating healthy food, which can lead to nutritional deficiencies.
• Eating objects that cannot be digested, such as stones, can cause constipation or blockages in the digestive tract, including the intestines and bowels. Also, hard or sharp objects (such as paperclips or metal scraps) can cause tears in the lining of the intestines.
• Bacteria or parasites from dirt or other objects can cause serious infections. Some infections can damage the kidneys or liver.
• Co-existing developmental disabilities can make treatment difficult.

What Is the Outlook for People With Pica?
Pica usually begins in childhood and typically lasts for just a few months. However, it is likely to be more difficult to manage in children who are developmentally disabled.

Can Pica Be Prevented?
There is no specific way to prevent pica. However, careful attention to eating habits and close supervision of children known to put things in their mouths may help catch the disorder before complications can occur.

Culled and edited. Credits: WebMD, Wikipedia, Google images