97 Pica (307.52)

DSM-IV-TR criteria

• A. Persistent eating of nonnutritive substances for a period of at least one month.
• B. The eating of nonnutritive substances is inappropriate to the developmental level.
• C. The eating behavior is not part of a culturally sanctioned practice.
• D. If the eating behavior occurs exclusively during the course of another mental disorder (e.g., Mental Retardation, Pervasive Developmental Disorder, Schizophrenia), it is sufficiently severe to warrant independent clinical attention.

Associated features

Pica is commonly Associated with Pervasive Developmental Disorders as well as Mental Retardation. Mineral and vitamin deficiencies have been reported in some cases though no specific biological abnormalities have been found. In some cases it is only after general medical complications that Pica comes into attention. Poverty, lack of parental supervision, developmental delay, and neglect can increase the risk for the condition. Pica is considered to be a serious eating disorder that could result in health problems such as lead poisoning, bowel problems, dental injury, and parasitic infections. In order for the action of ingesting these abnormal non-nutritive substances to be considered pica, the actions have to occur for more than one month at a cognitive level that recognizes the abnormality.

Child vs. adult presentation

Pica is more of a young child disorder and can occasionally be seen in pregnant females. This disorder is more commonly observed in children than adults. Pica in children occurs about the same in boys as in girls between the ages of 2 and 3. It can be found in ages younger, but eating items such as dirt, clay, paper, soap, mucus, cigarette butts, etc. are considered normal at a younger age. Pica is observed more in adults with mental retardation around the ages of 10-20 years. More common forms of Pica involve the ingestion of ice.

Gender and cultural differences in presentations

Although no specific data exist regarding racial predilection, the practice is reported to be more common among certain cultural and geographic populations. For example, geophagia (eating of soil) is accepted culturally among some families of African lineage and is reported to be problematic in 70% of the provinces in Turkey. People who live in the tropics, tribe-oriented societies, and in poverty are the places that geophagia is the most common form of pica. Pica is a widespread practice around different many places such as: western Kenya, southern Africa, India, Australia, Canada, Israel, Iran, Uganda, Wales, Turkey, and Jamaica. For instance, in Uganda, they purchase soil only for the purpose of ingestion. In the Unites States Pica is less common than international places; it is a disorder that is often unrecognized and not reported.

Epidemiology

It is estimated that Pica is seen in about 4-26% of institutionalized populations. The prevalence of Pica also increases with mental retardation, with it being high as15% for adults with severe mental retardation.

Etiology

The cause or etiology of Pica has been attributed to various cases, including nutritional, mental retardation or brain damage, cultural and economic, and emotional deprivation. Although specific causes of Pica are unknown, there are some certain conditions and situations that an increase a person’s risk for Pica: nutritional deficiencies, dieting, cultural factors, parental neglect, lack of supervision, food deprivation, developmental problems, mental health problems (OCD and Schizophrenia), and pregnancy increase that risk. http://www.pregnancy-info.net/pica.html

Empirically supported treatments

• Sources such as the Handbook for Clinical Child Psychology support general behavioral strategies as being the most effective treatment for Pica. This involves specific training for the child on edible versus non-edible foods and positive reinforcement. The primary prevention of Pica is the efforts to remove or alter factors involved in its etiology. It must be directed toward improving the mental health of children in infancy and early childhood.”
• The treatment of Pica can be very difficult to treat. Parents are told to encourage children to eat a healthy and balanced diet. Anything that is dangerous and can be ingested should be removed from your home, so they will be not be tempted to ingest those substances. Any nutritional deficiencies should be identified to help with the treatment. “Parents should consider consulting with a behaviorally-trained mental health clinician, as a comprehensive behavioral plan based squarely on principles of learning theory may be necessary to manage and ultimately eliminate Pica.”
• “Pica will unconsciously reappear in young children and pregnant women, but may never go away if it is left untreated.” Also, the doctor can educate the child on acceptable and unacceptable “food”. Child-safety locks and high shelving are also good options to get the items out of the child’s reach.
• Additional Information can be found at the KidsHealth website.
• The video below is a satirical view of Pica. It is not an actual portrayal of Pica