Understanding Pica: What You Need To Know

Ever heard of a reality television show called, 'My Strange Addiction?' Although a majority of us may believe it is scripted, many individuals appeared on the show were addicted to eating mattresses, hair, and other non-edible items. Believe it or not, this is not a 'fake' condition, but those individuals have a psychological disorder known as pica. Curious about this strange but fascinating condition? Continue reading to learn what causes this disorder and how it’s treated now.

What Is Pica?

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Pica is a psychological disorder characterized as the persistent eating of substances with no nutritional value, such as dirt, hair, ice, paper, metal, stones, glass, chalk, drywall or paint, and even feces. According to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-4) criteria, for a person’s eating habits to be considered pica, it must persist for more than one month at an age where eating non-edible substances is considered developmentally inappropriate and is not a cultural practice. 

The condition also needs to be severe enough that it requires medical attention. Pica has also been linked to other mental and emotional disorders as well, including obsessive-compulsive disorder, and can lead to a plethora of complications such as intoxication, physical and mental impairment, nutritional deficiencies, and emergency surgeries due to an intestinal obstruction.

Signs & Symptoms

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There are no specific symptoms that an individual can have when it comes to pica, as each case varies, but the most significant sign a person may have pica is if they are ingesting items not considered food and with no nutritional value. Rather, the symptoms associated with pica are broken down into subcategories based on the substance eaten. 

These subcategories include acuphagia (sharp objects), amylophagia (starch), cautopyreiophagia (burnt matches), coniophagia (dust), coprophagia (feces), emetophagia (vomit), geomelophagia (raw potatoes), geophagia (dirt, soil, clay), hyalophagia (glass), and lithophagia (stones). Mucophagia (mucus), pagophagia (ice), plumbophagia (lead), trichophagia (hair, wool, other fibers), urophagia (urine), hematophagia (blood) which is also known as vampirism, and xylophagia (wood, paper).

What Causes Pica?

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First, there is no direct cause of pica, as each individual and their case is unique and different from another person who consumes inedible objects. However, stressors such as emotional trauma, maternal deprivation, family problems, parental neglect, pregnancy, and a disorganized family structure are deeply connected to pica as a form of comfort. Mineral deficiencies are also commonly linked to pica; however, in most cases, biological abnormalities are rarely found in patients diagnosed with pica. Patients who practice different forms of pica, such as amylophagy, geophagy, and pagophagy, are more likely to be anemic, have a low hemoglobin concentration in their blood, lower levels of red blood cells, or lower plasma zinc levels.

Additionally, pregnant women and children who practice pica were associated with having a higher chance of being anemic or having lower hemoglobin in their blood compared to the general population. Recently, pica has been linked to the obsessive-compulsive spectrum. However, pica is still recognized as a separate mental disorder, and recent studies have found a connection between OCD and schizophrenia as a possible cause of pica in some cases. Pica can also be a cultural practice not associated with a disorder or deficiency, and cultural rituals can be the cause of it in some individuals.

Treatment Options

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Given the numerous medical complications associated with pica, close supervised medical monitoring is necessary when an individual is receiving treatment for their eating behavior. Close collaboration with a mental health team skilled in treating pica is ideal for optimal treatment when it comes to complicated cases. Treatment for pica depends on the patient, their severity and suspected cause and can focus on psychosocial, environmental, and family-guidance approaches. The initial approach involves screening for and treating any mineral deficiencies, if necessary, and behavior-based treatments can be incredibly helpful for developmentally disabled and mentally ill patients with pica.

Fortunately, behavioral treatments for pica have been shown to reduce the severity of pica symptoms by eighty percent in patients with intellectual disabilities. Behavioral treatments may involve using positive reinforcement tactics, such as aversion therapy, where the patient learns through positive reinforcement what foods are good and bad for them. Treatment can be similar to how OCD or addictive disorders are treated, such as exposure therapy.

Complications Associated With Pica

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Depending on what the individual is consuming, those who suffer from pica could be at risk for developing a multitude of complications. Certain items, such as paint chips can contain lead and other toxic substances, and when consumed, can lead to poisoning, which for a child increases their chances of developing learning disabilities and brain damage. Poisoning is considered the most lethal and concerning side effect of pica. Also, eating inedible objects can interfere with an individual developing healthy eating habits, which can lead to nutritional deficiencies, as well as emergency surgery due to obstruction in the digestive tract, intestines, and bowels. 

Eating hard or sharp objects can also cause tears in the lining of the intestines and esophagus. Another complication includes bacteria or parasites from dirt, fecal matter, and other objects can cause serious infections, which could damage the kidneys or liver. Co-existing developmental disabilities can also make treatment quite difficult for the patient. With the right treatment and a proper diagnosis, patients with pica can go on to live somewhat healthy and normal lives once they overcome this psychological disorder.