Pica is the eating or craving of things that are not food.
It can be a disorder in itself or medical phenomena.
The ingested or craved substance may be biological, natural or manmade.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), pica as a standalone eating disorder must persist for more than one month at an age when eating such objects is considered developmentally inappropriate, not part of culturally sanctioned practice, and sufficiently severe to warrant clinical attention.
Its prevalence of pica is difficult to establish because of differences in definition and the reluctance of patients to admit to abnormal cravings and ingestion.
Prevalence of pica among at-risk groups being in the range of 8% to 65% depending on the study.
Pica is the consumption of substances with no significant nutritional value such as soap, drywall, or paint.
Pica may lead to intoxication in children, which can result in an impairment of both physical and mental development.
Pica can cause surgical emergencies to address intestinal obstructions, as well as more subtle symptoms such as nutritional deficiencies and parasitosis.
Pica has been linked to other mental disorders.
Risk factors for pica: Stressors such as psychological trauma, maternal deprivation, family issues, parental neglect, pregnancy, and a disorganized family structure.
Pica is most commonly seen in pregnant women, small children, and people who may have developmental disabilities such as autism.
Children eating painted plaster containing lead may develop brain damage from lead poisoning, or from eating soil near roads that existed before the phase-out of tetraethyllead or that were sprayed with oil contaminated by toxic PCBs or dioxin.
A much greater risk exists of gastrointestinal obstruction or tearing in the stomach.
The risk of eating soil includes the ingestion of animal feces and accompanying parasites.
Pica can also be found in animals such as dogs and cats.
Subtypes are characterized by the substance eaten:
Acuphagia (sharp objects)
Amylophagia (purified starch, as from corn)
Cautopyreiophagia (burnt matches)
Coniophagia (dust)
Coprophagia (feces)
Emetophagia (vomit)
Geomelophagia (raw potatoes)
Geophagia (earth, soil, sand, clay, chalk)
Hyalophagia (glass)
Lignophagia (wood)
Lithophagia (stones)
Metallophagia (metal)
Mucophagia (mucus)
Pagophagia (ice)
Plumbophagia (lead)
Trichophagia (hair, wool, and other fibers)
Urophagia (urine)
Hematophagia (vampirism) (blood)
Xylophagia (wood, or wood products such as paper)
This pattern of eating should last at least one month to meet the time diagnostic criterion of pica.
There is a positive correlation between pica in pregnancy with pregnancy complications, lower educational attainment, and use of iron supplementation.
A meta-analysis of the prevalence of pica in German children found that 12.3% of German children have engaged with a pica behavior at some point in their lives.
Pica also a common eating disorder among those who are intellectually impaired.
In children, pica is usually short term, disappearing spontaneously
In a study of American children receiving chronic hemodialysis therapy found that 34.5% of the children studied engaged in pagophagy compared to 12.6% of children who engaged in other forms of pica.
Complications may occur due to the substance consumed: lead poisoning may result from the ingestion of paint or paint-soaked plaster, hairballs may cause intestinal obstruction and Toxoplasma or Toxocara infections may follow ingestion of feces or soil.
Pica is currently recognized as a mental disorder by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Mineral deficiencies are occasionally associated with pica, but biological abnormalities are rarely found.
People practicing forms of pica, such as geophagy, pagophagy, and amylophagy, are more likely to be anemic or to have low hemoglobin concentration in their blood, lower or lower plasma zinc levels.
Mental health conditions such as obsessive–compulsive disorder (OCD) and schizophrenia have been suggested to be causes of pica.
Sensory, physiological, cultural, and psychosocial perspectives also are used to explain the cause of pica.
Pica may be a cultural practice not associated with a deficiency or disorder.
Ingestion of kaolin, white clay,among African American women is a culture-related process not associated with other psychopathology.
Diagnosis
No single test confirms pica.
Pica can occur in people who have lower than normal nutrient levels and poor nutrition.
Testing blood levels of iron, zinc and
hemoglobin should be checked.
Lead levels should always be checked in children who may have eaten paint or objects covered in lead-paint dust.
The DSM-5 has four criteria that must be met for a person to be diagnosed with pica:
Eating non-nutritive nonfoods for at least one month.
This eating must be considered abnormal for the person’s stage of development.
Eating these substances cannot be associated with a cultural practice that is considered normal in the social context.
For people with a medical condition or a mental disorder, the action of eating non-nutritive nonfoods should only be considered pica if it is dangerous and requires extra medical investigation or treatment.
Differential diagnosis:
With autism, schizophrenia, and certain physical disorders non-nutritive substances may be eaten.
Treatment:
Varies by patient and suspected cause.
May require psychosocial, environmental and family-guidance approaches.
Iron deficiency may be treatable through iron supplements or through dietary changes.
Treating any mineral deficiencies or other comorbid conditions.
For pica that appears to be of psychogenic cause, therapy and medication such as SSRIs have been used successfully.
Nonmedication techniques may include other ways for oral stimulation such as gum, and popcorn.
Behavioral treatments have been shown to reduce pica severity by 80% in people with intellectual disabilities.
Pica is most prevalent geographically in Africa, with an estimated prevalence of 44.8%, followed by North and South America (23.0%) and Eurasia (17.5%).
Studies of adults with intellectual disabilities living in institutions found that 21.8% and 25.8% of these groups had pica.
Prevalence rates for children are unknown, as young children commonly place non-nutritious material into their mouths.
This activity occurs in 75% of 12-month-old infants, and 15% of two- to three-year-old children.
In institutionalized children with mental disabilities, pica occurs in 10–33%.
Eating disorder of non-food substances usually associated with iron deficiency anemia.
Pica is most often seen during pregnancy: estimated 27.8% of pregnant women experience pica.
Zinc deficiency may be associated with pica.