Pica Disorder: Cravings for Non-food items

Lilly Scholz
4 days ago
4 min read

What is Pica?

Pica is an eating disorder where a person compulsively eats things that aren’t usually considered food, and don't have any nutritional value. Pica is different from a young kid going outside and putting grass into their mouths since they’re curious about the world around them, Pica goes beyond that. For some who eat things such as ice, pica can be harmless, for others it can be deadly. It is commonly seen in:

Young children (especially under the age of 6)
Pregnant women
People with certain mental health issues (some examples are autism or schizophrenia)

Pica is technically considered as a life long condition due to no direct cure being available, therefore those who stop their pattern of behaviour are often considered to be “in remission” for as long as they don’t resume any pica behavioural patterns.

What causes Pica?

There is limited understanding of what causes pica, however some of the most common causes are thought to be iron-deficiency anemia, malnutrition and pregnancy. In these instances, pica is thought to be a sign that the body is trying to correct a deficiency of a certain nutrient. However, due to pica only being recognized as an eating disorder in 2013 in the fifth edition of the Statistical Manual of Mental Disorders (DSM-5), there is limited research and understanding around the disorder. Pica is seen to be higher in developing countries, likely due to the increased food insecurity. The main reason for this is the lack of consistent food supply to rural areas contributing significantly to high rates of malnutrition, which is thought to be one of the key contributing factors to the development of pica. Additionally, pica is often seen in kids living in poverty and facing abusive conditions, with possible explanations being a coping mechanism for dealing with negative situations or attention-seeking behaviour, especially in circumstances where parents are quite absent.

What are the signs and symptoms of pica?

People with pica often crave and eat non-food items such as:

Clay, dirt or soil
Ice
Paint chips
Paper
Pet food
Crayons
Feces

Stomach contents of a psychiatric patient with pica containing over 1446 items.

However, people with pica often develop various health problems depending on what they eat. Some examples can include:

Constipation/diarrhea from eating things the body can’t digest
Lead poisoning (paint chips)
Anemia
Damage to your teeth
Choking
Intestinal infections
Tears in the digestive lining

Additionally, not only are there health risks with pica, individuals may also suffer from significant mental and emotional health impacts. Individuals with pica often feel ashamed or embarrassed of something beyond their control, leading them to hide it and avoid seeking medical attention. This reluctance can cause further complications often associated with the non-food item they ingest. Moreover, not only can this secretive nature lead to isolation and distancing from others, some pica behaviors may serve as a coping mechanism for individuals that struggle with significant loads of stress or anxiety.

How is Pica diagnosed?

As there are no clinic laboratory tests for the disorder itself, pica is often diagnosed through various evaluations to meet the diagnostic criteria. There are four main criteria doctors may use to evaluate patients:

Time - pica requires persistent consumption for a period of at least 1 month.
Mental development - meaning a person has developed past a certain point mentally.
Zero social or cultural factors - no social or cultural background reasons to back up the behavior.
No other medal/mental health conditions - meaning pica isn’t a side effect of other conditions.

Furthermore, doctors may also check for the following:

Anemia or other nutritional deficiencies
Test lead levels
Stool tests to check for parasites
X-rays or other imaging tests

How is Pica treated, and is there a cure?

Pica in pregnant women usually resolves on its own, while children similarly usually simply grow out of the disorder. Pica unfortunately does not have a direct cure, however it can be treated through different therapy methods. There are very few medications that are likely to aid pica treatment, due to the possible side effects that maintain prevention of widespread use. Listed below are the possible treatments patients of various ages may undergo:

Supplements - if a nutritional deficiency is considered to be the leading cause in a case of pica, doctors may recommend supplements or a change in diet.
Environmental modifications - Doctors may recommend childproof locks or keeping non-food items out of reach for families with children.
Substitutes - Some children with pica seek specific textures or sensations, therefore some families offer substitutes. While they do not treat pica directly, they offer alternatives to drive away the oral satisfaction. For instance offering carrots or apples instead of crunchy non-food items such as chalk or rocks.
Behavioral therapy - Teaching patients coping mechanisms and strategies to alter their behaviour. This can also be done by using mild aversions (consequences) or positive reinforcement (rewards).