According to the US Agency for Healthcare Research and Quality, the number of people admitted to hospital for treatment of the eating disorder bulimia nervosa has decreased in recent years. At the same time, however, admissions for a less well known condition called “pica” have almost doubled.
What is Pica?
Pica is an eating disorder in which people consume normally inedible substances such as soil, chalk, sand, ice, paint or even faeces. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders defines pica as “the persistent eating of non-nutritive substances for a period of at least 1 month” that is:
- inappropriate to the person’s developmental level (for instance, young children may experiment with eating dirt, earthworms and other nasties, but this is not classed as pica)
- not part of a culturally sanctioned practice (for example, kaolin is eaten widely in parts of Africa and may have health benefits in such instances, but this is also not considered pica)
- if occurring in a person with another mental disorder, the consumption is sufficiently severe to warrant independent clinical attention.
Other than 1–6-year-olds and people with developmental disabilities such as autism, pregnant women are most likely to crave non-food substances. However, the condition has also been reported in men, and in people of all ages and ethnicities. It tends to be more common in lower socioeconomic groups.
What Causes Pica?
There has been little research on the causes of pica. It is thought that, in some cases at least, cravings for inedible substances stem from deficiencies of certain nutrients in the diet. In a study reported in the Journal of Medical Case Reports, two patients who consumed large amounts of ice daily, and a third who ate elastic bands, were all found to have iron deficiency. Low zinc levels have also been associated with pica.
In other cases, the problem is psychological in nature. For example, people may eat substances such as soil or chalk because they crave the sensation of a particular texture in their mouth.
Is There a Cure for Pica?
Eating non-foods can have serious complications, depending on the amount and type of substance consumed. For example, micro-organisms and parasites in soil or faeces can cause infections, while people who consume lead-based paints or painted objects may develop lead poisoning. Large amounts of indigestible material in the stomach or intestine may cause an obstruction, and people who eat inedible substances in place of food can also become malnourished.
Given these health risks, it is worth contacting a doctor if any child or adult is consuming large amounts of non-food. He or she will be able to test for nutritional deficiencies, infections or lead poisoning as appropriate, and if necessary can refer the patient for treatment of the eating disorder. Psychological approaches include behavioural therapy, aversion therapy and positive reinforcement, while medications may help when pica is part of a developmental disorder.
Pica Cases Increasing
From 1999 to 2009, the number of US hospital admissions for pica increased from 964 to 1862 per year, a rise of 93%. The prognosis of this eating disorder varies widely. In many cases, it lasts for a few months then disappears without any need for treatment; in others, especially those associated with a developmental disorder, it may continue for years or longer.
Sources
DSM-IV DSM-IV-TR: Pica. Accessed 28-12-11
Hospitalizations for Eating Disorders Declined, But Big Increase Seen in Pica Disorder. Accessed 28-12-11
Pica. Accessed 28-12-11
Pica in Iron Deficiency: A Case Series. Accessed 28-12-11
Disclaimer
The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
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