Pica
Among eating disorders, pica is one of the most misunderstood. The compulsive eating of non-food items with no nutritional value may be harmless in some cases but can be dangerous with certain items. Understanding the causes and risks of pica is essential to avoiding the serious health risks associated with it. With the right treatment and support, individuals with pica can change their eating habits and live happy, fulfilled lives.
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What Is Pica?
Pica is a type of eating disorder where patients compulsively consume non-food items with no nutritional value. The name “pica” (pronounced “PIKE-ah”) comes from the Latin species name for Eurasian magpies, which are known to eat unusual objects.
Depending on the situation, pica is often harmless or expected. However, persistent eating of certain items can lead to serious health complications.
Individuals with pica may consume items such as:
- Clay, dirt, pebbles, or soil (i.e., geophagia)
- Paper
- Soap
- Cloth, wool, hair, or string
- Paint or paint chips
- Chalk
- Metal
- Charcoal
- Ash
- Pebbles
- Starch
- Talcum powder
- Coffee grounds
- Pet food
- Gum
- Feces or urine
How Common Is Pica?
It’s hard to say exactly how common pica is. However, it’s thought to be more common in children, individuals with certain mental health conditions, and pregnant women. Pica may also be common in certain cultures as part of their sacred traditions for improved health or good luck.
A study from the University of Konstanz in Germany found that around 1.1% of adults experience recurrent Pica behaviors. Another study from Germany found that 5% of youth aged 7 to 14 years experience recurrent Pica behaviors.
Meanwhile, an American outpatient weight loss clinic reported that pica was present in 4% of men and women. Unfortunately, more studies are required to better understand how common pica is, especially in the United States.
Pica Causes and Risk Factors
The cause of pica can vary, as the eating disorder tends to affect various groups of people for different reasons. Young children, pregnant women, and individuals with certain mental illnesses or intellectual disabilities often are most likely to develop the condition.
Biological Factors
Research does not indicate that pica is caused by genetic predisposition. However, certain mental illnesses that may include pica behaviors can be passed through genes.
Pica may occur in pregnant women. Uncommon cravings are quite common during pregnancy, especially in the first trimester, and these cravings can sometimes include non-food items. Craving ice (pagophagia) is one of the most common and thankfully harmless cravings.
However, pica can indicate poor nutrition or health imbalances during pregnancy. If non-food cravings include things like paint chips, paper, dirt, or clay, this may hurt your child.
Check with your healthcare provider to ensure you don’t have any nutritional imbalances that need addressing.
Aside from pregnancy, another common biological factor for pica is nutritional deficiencies or malnutrition. Sometimes, pica can be caused by strict dieting. Pica is also closely tied to other medical conditions such as iron deficiency anemia, zinc deficiencies, and sickle cell anemia.
Psychological Factors
Pica often occurs in young children. Babies and toddlers may attempt to eat non-food items because they enjoy the texture or taste. However, if this behavior persists or worsens as they age into young children, speak with your pediatric physician.
Pica can also develop in people with certain mental illnesses or developmental disabilities as a coping mechanism to deal with stress or intense emotions.
Not all individuals with these conditions will develop pica, but the risk is higher for the following conditions:
- Obsessive-compulsive disorder (OCD)
- Schizophrenia
- Autism spectrum disorder
- Anxiety disorders
- Post-traumatic stress disorder (PTSD)
- Intellectual and/or cognitive impairments
Environmental Influences
As mentioned earlier, malnutrition can lead to the development of pica, especially in environments where food is not available or attainable. In these situations, eating dirt, bark, grass, or other plant matter may be their only option.
Many cultures, even in the US, practice certain traditions that involve the ingestion of non-food items for healing purposes.
Some significant examples include:
- A chalky white clay substance called kaolin (aluminum silicate hydroxide) can be purchased across the southern US and is used as a folk remedy for pregnancy cravings. Kaolin is also eaten in Africa to suppress hunger or for feelings of pleasure.
- In India, pica cravings are used to predict the sex of an unborn child: dust cravings indicate a boy and ash cravings indicate a girl. Eating dust, ash, or mud is therefore common in these communities.
- Certain communities in Africa, specifically “Chagga” women of Tanzania, are expected to eat dirt for fertility and are regarded negatively should they choose not to participate.
Pica Signs and Symptoms
Although some non-food items may be harmless, others could be harmful or fatal if ingested. Therefore, recognizing the symptoms of pica in yourself or a loved one can be life-saving.
Behavioral Signs of Pica
The primary symptom of pica is the eating of non-food items. However, pica can cause some eating behaviors and behavioral problems you should also look out for.
Common behavioral signs of pica include:
- Eating non-food items with no nutritional value for more than one month
- Eating of non-food items not supported by cultural practices
- Hiding or lying about eating non-food items
- Hiding evidence of side effects like dental damage and stomach issues
- Becoming angry or defensive when questioned about eating non-food items
Physical Symptoms of Pica
Certain non-food items may contain toxic elements such as poisons or high lead levels. These types of toxins can lead to serious side effects and health complications if left unaddressed.
- Nutritional deficiencies
- Broken or damaged teeth
- Stomach pain
- Nausea and vomiting
- Diarrhea
- Bloody stool
- Constipation
Pica Health Risks and Complications
Depending on the non-food item, pica may not cause the patient any harm. However, in cases where the non-food item has high toxicity or can cause intestinal blockages, there may be serious or fatal health risks.
Immediate Health Risks
The short-term health risks of pica behaviors may include:
- Electrolyte imbalance
- Dehydration
- Intestinal obstruction/blockage
- Anemia
- Roundworm infection
- Ulcers
Long-Term Risks
The long-term health risks of pica behaviors may include:
- Irregular heart rhythms (arrhythmias)
- Infections
- Parasitic infestations
- Permanent gastrointestinal issues
- Lead poisoning
- Seizures
- Cranial nerve paralysis
- Coma
- Death
Pica Diagnosis and Treatment
Regardless of what form of pica you have, the diagnosis and treatment of pica are generally the same.
How Is Pica Diagnosed?
Diagnosis of pica typically begins with an interview and discussion of the patient’s family history, mental health, and experience with pica.
Your mental health professional will then compare your symptoms to those outlined in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition).
In certain cases, a patient may not receive a pica diagnosis. If the patient consumes non-food items due to nutritional deficiencies or cultural practices, it is not considered pica or an eating disorder.
Treatment Options for Pica
If the ingestion of non-food items is due to nutritional deficiencies, supplements are typically prescribed to help address the deficiencies.
Once a pica diagnosis is obtained, your doctor or healthcare professional will typically create a treatment plan that includes medication and behavioral therapy. If there are concerns of intestinal obstructions or poisoning, X-rays and blood tests may be ordered.
Behavioral therapy and mild aversive treatments are commonly used to treat pica. Mild aversive therapies use a mixture of unpleasant consequences and positive reinforcement to encourage pica patients to avoid eating non-food items.
Behavioral therapies, such as cognitive behavioral therapy (CBT), can help patients learn to better manage the stress that causes their pica and change their eating behaviors.
Find Treatment for Pica
Pica can be embarrassing for the patient and alarming for their loved ones. However, treatment options are available to help patients and their loved ones find solutions and combat shame. Start by talking to your healthcare provider about your non-food eating habits.
You can try the National Alliance for Eating Disorders Helpline if you don’t have a physician. You can also try SAMHSA’s online treatment locator to find eating disorder treatment options in your area.
FAQs About Pica
How common is pica?
There are currently no official statistics regarding how common pica is. However, research does indicate that young children, pregnant women, and people with certain mental illnesses or intellectual disabilities may be more likely to develop pica.
Is pica a form of OCD?
No. Pica is an eating disorder characterized by the compulsive eating of non-food items. However, individuals with OCD are more likely to develop pica as a coping method for their anxiety.
How is pica treated?
Pica is typically treated through therapy and, if applicable, medication. If mental health conditions are the underlying cause of pica, medication may help curb the compulsion to eat non-food items.
Behavioral therapy is often effective in helping patients develop healthier coping skills for their stress.
Can a child grow out of pica?
Yes. Children typically grow out of pica as they age. However, some children do not, especially if they have developmental and mental health disorders. Speak with your pediatrician if pica symptoms continue to persist.
What are the risks of pica?
Some non-food items consumed may be toxic, cause dental damage, introduce parasitic infections in the body, or cause blockages in the GI tract. In these instances, pica can be dangerous and even life-threatening.
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