“She can’t stop eating rubber, paper and plastic!”
Pica disorder is an eating disorder in which people develop a craving to consume non-food items or food ingredients which are inappropriate for consumption or have zero nutritional value. The medical term comes from a Latin word “Pica pica”, which is a bird described in folklore that gathers unnecessary objects for satisfaction.
The prevalence of the disorder is quite rare and is most commonly found in children, pregnant women and people suffering from mental illnesses and intellectual disabilities.
Some mental health conditions associated with Pica include the Autism Spectrum disorder, Schizophrenia and OCD (Obsessive Compulsive Disorder). It is also associated with conditions such as Trichotillomania (hair pulling disorder) and Excoriation (skin pulling disorder).
Symptoms are often temporary but are found to be long lasting in people with intellectual and developmental disabilities.
The severity of the condition varies depending on the type and amount of consumption (hazardous or non-hazardous substances). The most common types of non-hazardous substances include ice, paper, dirt and sand. The hazardous substances which can be potentially life threatening include soap, paint, clay, glue, parts of the cigarette, hair, chalk and glass. Other rare substances include feces, vomit, urine, mucous and blood.
What causes Pica to occur?
Pica is most frequently found to occur in children. The prevalence of Pica is considered to be normal in infants between 18 to 36 months but this is supposed to decrease with age. Pica is likely to develop in children between 2 to 12 years.
The most common cause for Pica occurring in adults is low nutrient levels in the body. The uncontrollable cravings can be a reaction to your body trying to replenish the low nutrient levels.
In some cases, a deficiency in nutritive substances such as iron, zinc can result in anemia and behavioral abnormalities that causes Pica. Iron deficiency decreases the CNS neurotransmission of Dopamine.
Malnourishment and poverty also leads to consumption of non-food items in order to curb the hunger pangs.
Sociocultural factors and societal norms are also significant in determining Pica. In certain cultures it is widely accepted to consume non-food items. For example in Australian aboriginal regions, clay is consumed as a fertility food. This condition later spread to various countries like the United States, Turkey and Africa to enhance child bearing.
Pica is also observed in pregnant women. Research suggests that this behavior often occurs during pregnancy due to fluctuating hormonal levels causing unusual cravings, anemia and iron deficiency.
Signs and Symptoms
The symptoms of the pica disorder occur due to the consumption of non-food items. The severity of the symptoms varies according to the type and amount of consumption.
Some common symptoms include –
- Behavior such as constant chewing of non-food items.
- Stomach upset (diarrhea or constipation)
- Suffering from ulcers
- Abdominal pain
- Blood in the stool
Sometimes the consumption of inappropriate food items can lead to some serious clinical complications such as-
- Food poisoning
- Lead poisoning due to items such as paint which can further progress and cause brain damage. Elevated blood levels of lead can also have diverse effects on cognition including behavioral impairment and reduced attention spans.
- Intestinal blockage
- Bezoar (the accumulation of a mass of indigestible substances trapped inside the stomach) which may need surgical emergency.
- Tear in the lining of the digestive tract due to sharp objects.
- The bacteria entering the body along with the dirt can cause serious infections that can damage the kidneys and the liver in the long run.
- The consumption of soil can lead to soil borne parasitic infections.
- The consumption of paper can lead to mercury poisoning.
According to the DSM 5 criteria, Pica is diagnosed only if the symptoms persist for more than one month at an age when the consumption of such objects is considered to be inappropriate and if the action is not associated with some cultural practice.
There is no test available to identify Pica. It is diagnosed on the basis of patient history. One can also look for deficiencies in the body which may be an underlying cause of Pica. If symptoms are present, it is recommended to perform a complete medical check-up.
Close medical monitoring is necessary to observe any abnormalities.
How to manage and treat Pica?
According to the Handbook of Clinical Child Psychology, behavioral strategies for prevention are considered to be the most effective approach to treat Pica. The end goal of these strategies is to take necessary preventive measures to treat Pica.
Providing psycho-education and creating awareness about the disorder helps the victims to be more alert and cautious regarding their consumption.
SSRI and neuroleptic treatments are also effective to increase dopamine transmission.
Modifying and creating a safer environment free from triggers also helps to get the condition under control.
Pica is a complex disorder that is still widely under research and hence can be very challenging to treat successfully. Making a proper diagnosis due to lack of testing can be extremely strenuous. Once Pica is diagnosed successfully, many victims may also experience feelings of embarrassment.
The right treatment approach can help you with both physical and psychological aspects of Pica. Relapse is very unlikely but a deficiency in nutrient levels can cause the patient to go back to craving the harmful substance all over again. Therefore it is of utmost importance to maintain a dietary regime.