Pica: The Compulsion to Eat Non-food Items

Pica is an eating disorder characterized by the compulsive consumption of non-food items. This condition occurs across different demographics, most notably in children and pregnant mothers. Apart from its negative health impact it also has dangerous implications on the well-being of a person.

Definition and Overview

It is a term associated with the Latin word ‘magpie’ which means a bird that tends to eat anything. As it can be found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), pica can be classified as an ‘eating disorder’ lasting for more than one month in people who are at an age where eating such objects is developmentally inappropriate. It is not culturally sanctioned and carries various health risks which brings about the need for clinical intervention for it.

It is not simply a funny idiosyncrasy; it can escalate into chronic health conditions of deficit in nutrients, blockage of the gastrointestinal tracts or poisoning. The condition is often linked to underlying mental health issues, developmental disorders, and nutritional deficiencies, making it a multifaceted challenge for healthcare providers.

Prevalence and Demographics

It is observed in several population sub-groups, and the prevalence of its occurrence may vary greatly within demographic factors. Studies indicate that cravings relating to pica may be reported by as many as 68% of pregnant women, most commonly for ice and clay. About 18.5 per cent of children are reported to engage in pica, particularly common in children aged 18 to 36 months, where rates can reach up to 50%. Such behaviours also occur in people with developmental disabilities with estimates suggesting that 10% of this population may engage in pica. This disorder is most dangerously observed in areas where there are nutritional deficiencies like in some regions of Africa where it can go as high as 44.8% with pregnant women.

Causes of Pica

Though several causes have been put forward to explain pica, the exact cause of pica is still unknown. Many of such common causes include nutritional deficiencies that are indicative of a lack of minerals in diets such as zinc and iron. For this reason, the body may seek even non-food elements to cover up for this deficiency and thus compensate. For example, geophagia, or the consumption of soil, may stem from iron deficiency, as the soil can bind iron in the gastrointestinal tract, exacerbating the deficiency.

it is often also associated with certain psychiatric conditions such as schizophrenia or obsessive-compulsive disorder (OCD). Apart from these, even Prenatal and postnatal stress events, trauma and neglect may also produce pica behaviours in people, particularly in vulnerable populations such as children and pregnant women. Even children, especially those under six years of age like to place everything and anything in their mouths in the process of exploration.

While many outgrow this behaviour, some may continue to eat non-food items, indicating a potential underlying issue if the behaviour persists beyond typical developmental stages. Lastly, in certain cultures consumption of non-food items may be seen as appropriate, normalized or ritualized, and it may bear some cultural significance making it harder and more complicated to diagnose this.

Symptoms of Pica

The primary symptom of pica is the compulsive eating of non-food items. Individuals may consume a wide range of substances, including; chalk, clay, dirt or soil, paper, fabric, metal, paint chips and laundry detergent The specific items consumed can vary widely, with individuals often fixating on one or two types of substances. This compulsive behaviour can lead to a range of secondary symptoms including health issues such as constipation, electrolyte imbalances, intestinal blockages or perforations, lead poisoning, anaemia due to iron deficiency and parasitic infections.

Pica Terms Non-food material ingested

• Acuphagia: Sharp objects
• Amylophagia: Starch
• Cautopyreiophagia: Burnt matchsticks
• Coprophagia: Faeces
• Geomelophagia: Raw potatoes
• Geophagia: Dirt, clay, soil, or chalk
• Hyalophagia: Glass
• Lithophagia: Stone or gravel
• Mucophagia: Mucous
• Odowa: Soft stones
• Osteophagia: Bones
• Pagophagia: Ice
• Plumbophagia: Lead
• Polypica: More than one substance
• Tobaccophagia: Tobacco products
• Trichophagia: Hairs and wool
• Urophagia: Urine
• Xylophagia: Wood log stems

Health Implications

Pica and associated disorders do have severe health risks and sometimes it could be worsened by associated problems. Ingesting non-food items can lead to gastrointestinal where metal and large pieces of fabrics and adsorbents when ingested can give rise to intestinal obstruction, can cause blockages or tears in the digestive tract and holes that require emergency surgeries.

Similarly, the intake of non-nutritive substances may cause other nutritional deficiencies leading to further health complications such as anaemia and weakened immune function. Lastly, eating paint chips or soil contaminated with heavy metals poses significant risks of poisoning. For instance, lead poisoning is a well-documented consequence of consuming lead-based materials, which can lead to neurological damage, particularly in children.

Treatment Options

Addressing pica requires a multidisciplinary approach, often involving medical professionals, mental health specialists, and nutritionists. Treatment strategies may include:

• Behavioural Interventions: Employing behavioural therapies, which may include positive reinforcement and exposure therapy, may lessen the intensity of pica within the population of people with a developmental disability. These methods focus on creating new behaviours that are positive towards food and discourage the eating of non-edibles.
• Nutritional Support: It is important to note that prevention and treatment of such problems involves discovering and remedying the specific underlying nutritional problem. Healthcare practitioners will assert diet and/or supplementation in a bid to meet the required nutrition which may calm dwelling on no satisfactory items.
• Psychological Support: For individuals with underlying mental health issues, therapy and counselling can be beneficial. Specialized treatment of psychological issues connected with pica helps reduce the urge and find better and positive ways to deal with situations.
• Medical Monitoring: Individuals with pica must undergo frequent checkups to determine complications from lead ingestion or gastrointestinal complications. Early timeliness can save a person from more serious harm that will worsen the situation.

It is a complex eating disorder with severe health implications understanding its causes, prevalence, and treatment options is crucial for effective management. As healthcare providers systematically diagnose pica, they must recognize and address this condition with empathy and appropriate interventions, ensuring that individuals receive the support they need to overcome this challenging disorder.

Further Readings

1. Matson, J. L., Hattier, M. A., Belva, B., & Matson, M. L. (2013). Pica in persons with developmental disabilities: treatment approaches. Research in Developmental Disabilities, 34(9), 2564-2571.
2. Roy, A., Fuentes-Afflick, E., Fernald, L. C., & Young, S. L. (2020). Pica is prevalent and strongly associated with iron deficiency among Hispanic pregnant women living in the United States. Appetite, 144, 104456.
3. Khosravi, M. (2021). Pica behaviours in schizophrenia: a call for further research. Journal of Eating Disorders, 9(1), 1-4.
4. Call, N. A., Simmons, C. A., Meyers, J. E., & Alvarez, J. P. (2015). Clinical outcomes of behavioural treatments for pica in children with developmental disabilities. Journal of Autism and Developmental Disorders, 45(7), 2105-2114.
5. Hartmann, A. S., Zenger, M., Glaesmer, H., Strauß, B., Brähler, E., de Zwaan, M., & Hilbert, A. (2022). Prevalence of pica and rumination behaviours in adults and associations with an eating disorder and general psychopathology: findings from a population-based sample. Journal of Eating Disorders, 10(1), 1-10