PICA

The name “pica” comes from the Latin word for magpie, a bird known for its tendency to eat almost anything. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), pica is an eating disorder that involves consuming non-food items or substances that have no nutritional value for at least one month. Crucially, for a diagnosis of pica to be made, the DSM-5 recommends that the subject be over two because younger children naturally tend to experiment with objects by putting them in their mouths.

Prevalence and demographics

PICA is far less common than eating disorders like bulimia and anorexia nervosa, but accurately determining its prevalence is difficult due to underreporting and the varied demographic groups it affects. It is most commonly observed in children between the ages of two and three, with one study finding that 12.3% of children had engaged in pica at some point. It has been noted to occur among pregnant women, possibly driven by changes in nutrient levels or hormonal fluctuations during pregnancy.

PICA is also observed in individuals with mental health disorders or developmental disabilities, with many reported cases in people with autism. The link between PICA and autism isn’t clearly defined, but it is theorised that it may be related to sensory-seeking behaviours or dietary deficiencies sometimes present in autistic individuals.

Recognising the symptoms and behaviours associated with PICA is crucial in safeguarding the individual’s health and facilitating early intervention. Here are the typical signs and symptoms to be aware of:

Persistent consumption of non-food items

Individuals with PICA consistently consume non-nutritive substances for more than one month. Common substances include:

• Soil or clay (Geophagy)
• Ice (Pagophagia)
• Hair (Trichophagia)
• Paper
• Laundry detergent
• Paint chips
• Metal objects
• Stones

Dental issues

Regular consumption of non-food items can lead to dental problems, including wear and tear on the teeth, injuries to the teeth and gums and increased risk of cavities.

Digestive issues

Digestive complications, such as constipation, abdominal pain and bowel problems, can occur due to ingesting non-digestible substances. It can obstruct the digestive tract in severe cases, resulting in surgical emergencies.

Infections, parasites and intoxication

Consuming contaminated substances like soil can expose individuals to infections and parasites, putting their health at significant risk. The ingestion of harmful substances can also lead to intoxication in children, resulting in physical and mental impairment.

Nutritional deficiencies

Pica can also cause nutritional deficiencies such as iron deficiency anaemia as the individual consumes non-nutritive items at the expense of a balanced diet.

Choking hazards

Consuming non-food items presents a significant choking hazard, particularly in young children.

Social implications

Individuals with pica can also face social implications, including isolation and stigma due to their unconventional eating habits. They may also go to great lengths to hide their condition due to the fear of being judged or misunderstood, which can prevent recognition and treatment.

Individuals with developmental disorders, including those with intellectual disabilities, may exhibit pica behaviour. It is commonly observed in children with a stunted developmental age of around 18 to 24 months. The reasons are unclear, but it is potentially tied to the exploratory behaviours typical for this developmental stage.

Pregnancy

Pica is sometimes observed in pregnant women. While the exact causes are unknown, changes in hormonal levels, which affect appetite and taste preferences, are suspected to be a contributing factor.

Cultural factors

In some cultures, consuming certain non-food substances is a normalised practice, sometimes grounded in traditional or ritualistic behaviours. However, it should be underscored that even in these contexts, engaging in pica can entail serious health risks.

Childhood

Children between the ages of 2 and 3 are more commonly affected by pica. This is connected to the phase of exploratory behaviour in childhood, where they use their mouth as a sensory organ to learn about their surroundings.

The diagnostic process for PICA is comprehensive and generally initiated based on the observed behaviours and reported symptoms. This process usually involves:

Medical history and physical examination

A thorough medical history and a physical examination form the cornerstone of diagnosing pica. Healthcare providers may particularly look for any signs of complications that have arisen from consuming non-food items such as gastrointestinal issues or dental problems.

Laboratory tests

To assess nutritional deficiencies which could be instigating pica, doctors may also recommend laboratory tests. These tests help pinpoint any deficiencies in iron, zinc or other nutrients influencing the behaviour.

Psychological evaluation

A comprehensive psychological evaluation can help identify any underlying mental health or developmental issues causing pica. This includes assessments to gauge cognitive development and to identify any other psychiatric conditions that might be present.

Observational reports

Reports from family members, caregivers or teachers can provide valuable information regarding the individual’s eating habits and preferences, which can assist in the diagnostic process.

According to various studies, children with autism are significantly more likely to exhibit pica behaviour than those without the disorder. However, it is important to note that having pica does not mean one has autism, as pica can occur in the absence of autism. It is seen across various conditions, including intellectual disabilities and schizophrenia and can also be a standalone condition.

Proper diagnosis of pica syndrome, especially when it co-occurs with other disorders like autism, necessitates a detailed and multidisciplinary approach to effectively manage and treat the individual’s unique presentation of symptoms.

Treating PICA often involves a multifaceted approach, combining medical intervention with behavioural therapies to effectively manage the condition. Some of the prominent strategies employed in the treatment of pica can include:

Medical interventions

First and foremost, addressing the physical health issues arising from PICA is paramount. This might involve surgery or medication to treat the repercussions of ingesting non-food items.

Nutritional counselling

Nutritional counselling is often required to address deficiencies and guide individuals towards a balanced diet, assisting in reducing cravings for non-food items.

Occupational therapy

Engaging in occupational therapy can be instrumental in helping individuals cultivate the skills necessary for daily life activities, steering clear of the maladaptive coping mechanism of consuming non-edible objects.

Cognitive behavioural therapy (CBT)

CBT is leveraged to navigate the emotional and psychological drivers behind pica, facilitating the development of healthier coping strategies and reshaping unhelpful thought patterns.

Dialectical behavioural therapy (DBT)

DBT assists individuals in gaining control over intense emotions and mitigating self-harming behaviours tied to PICA. DBT encourages effective impulse management through behavioural therapy and mindfulness strategies.

Psychoeducation

Implementing psychoeducation educates individuals and their families about the disorder, shedding light on the diverse treatment pathways, actively battling the stigma tied to the condition and fostering collaborative involvement in the treatment regimen.

Art and music therapy

These therapies aim to reduce anxiety and promote emotional expression, potentially addressing triggers for pica through creative and non-verbal approaches.

Mindfulness and meditation

Meditation and mindfulness techniques can be beneficial in helping individuals remain grounded, encouraging a deeper understanding of personal triggers, and fostering self-control.

UKAT London Clinic has vast experience helping individuals with various eating disorders, including pica. We tailor flexible treatment plans to each client’s unique needs, working closely with medical and therapy experts who approach recovery with compassion. We aim to create a healing environment that empowers individuals to regain control over their lives; contact us today for more information.