What is ‘pica’?
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines pica as eating non-nutritive, non-food substances over a period of at least one month. Additionally, the behaviour must not be in keeping with the child's developmental stage and must not be socially normative or culturally acceptable behaviour. The nature of ingested items is variable, including but not limited to earth (geophagy), raw starches (amylophagy), ice (pagophagia), charcoal, ash, paper, chalk, cloth, baby powder, coffee grounds, and eggshells. The term is derived from "pica-pica," the Latin word for the magpie bird, because of the bird's indiscriminate gathering and eating a variety of objects for the sake of curiosity.
Although pica is seen in children, it is also a common eating disorder in patients who are intellectually impaired. In women, it is most often seen during pregnancy. In some parts of the world, the consumption of non-nutritive substances is culturally accepted. Pica usually occurs as an isolated disorder but there are instances when it may co-exist with schizophrenia, OCD, or trichotillomania.
Signs
It can sometimes be difficult to know if a person is struggling with pica, and others may not witness the potential signs. People with pica often feel embarrassed or ashamed about this condition. Because of this, people with this condition often don’t seek treatment or are afraid to open up about it to their healthcare provider. Those with pica may still eat regular foods and drinks, without issue, or they may also struggle with another eating disorder or physical or mental health condition. Possible signs of pica include: craving to consume substances that aren’t supposed to be eaten; eating substances that aren’t supposed to be eaten; and/or physical illness as a result of eating harmful substances.
Causes
Many factors have been implicated in the etiology of pica; however, no direct causality has been established. Studies of psychological factors have reported an association between pica and stress, child neglect and abuse, and maternal deprivation. Iron deficiency anemia has also been implicated. Some may experience Pica as a form of coping mechanism.
While the causes of Pica remain unknown, some of the risk factors for developing the disorder include the following:
- Stress
- Cultural factors
- Learned behaviour
- Low socioeconomic status
- Underlying mental health disorder
- Intellectual disability
- Nutritional deficiency
- Child neglect
- Pregnancy
- Epilepsy
- Familial psychopathology
Consequences/risk/impact
People with pica don’t usually avoid regular food, meaning they may still be getting all the nutrients they need. However, some non-food items that they consume can be very dangerous, especially if eaten in large quantities. Often, pica is not revealed until medical consequences occur, such as metal toxicity, cracked teeth, or infections. Some of the items that people may feel an urge to eat because of pica can be extremely harmful. For example, it can cause poisoning, nutritional deficiencies, infection, and intestinal obstruction.
Treatment/support
If you or someone you know has eaten something that isn’t supposed to be eaten, you should seek medical help immediately. It may be necessary to contact the emergency services. It is important to get as early a diagnosis as possible especially of the substances are hazardous to health. If you become aware of potential signs of pica, it is advisable to contact your GP without delay.
Treatment depends on the severity and underlying cause of the behaviour. It may include addressing nutritional deficiencies (i.e. through supplementation), behavioural therapies, and medical intervention in instances where the behaviour has led to physical health problems. In some instances, therapy can provide manageability, and a change of lifestyle and environment can also be beneficial in reducing access to the substance where possible. Behavioural therapy with the aim of unlearning the behaviour could also help. This may involve a focus on promoting self-soothing behaviour, redirecting attention, managing anxieties, and replacing pica items with similar, but safe, alternatives. In some instances though, medication and more intrusive medical intervention (such a surgery) might be required.
Treatment of any eating disorder should take a multidisciplinary and tailored approach.
The National Pica Advisory Service (TNPAS) UK - National Pica Advisory Service UK
TNPAS provide support and resources to families (including housing assistance), and training to organisations, whilst engaging with governmental and agency bodies to ensure the best outcomes for those affected by Pica.
BEAT Eating Disorders charity - https://www.beateatingdisorders.org.uk/get-information-and-support/
BEAT offer support (including a helpline and chatroom) and resources for anyone affected by an eating disorder. Information about pica is available on the BEAT website.
Guidance: In an education setting
Pica and the role of educators in safeguarding young children