Pica (disorder)

Pica ( ) is the psychologically compulsive craving or consumption of objects that are not normally intended to be consumed. It is classified as an eating disorder but can also be the result of an existing mental disorder. The ingested or craved substance may be biological, natural, or manmade. The term was drawn directly from the Latin word for the Eurasian magpie, a bird subject to much folklore regarding its opportunistic feeding behaviors.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), pica as a standalone eating disorder must persist for more than one month at an age when eating such objects is considered developmentally inappropriate, not part of culturally sanctioned practice, and sufficiently severe to warrant clinical attention. Pica may lead to intoxication in children, which can result in an impairment of both physical and mental development. In addition, it can cause surgical emergencies to address intestinal obstructions, as well as more subtle symptoms such as nutritional deficiencies, particularly iron deficiency, as well as parasitosis.

Pica is most commonly seen in pregnant women, small children, and people who may have developmental disorders such as autism. Children eating painted plaster containing lead may develop brain damage from lead poisoning. A similar risk exists from eating soil near roads that existed before the phase-out of tetraethyllead or that were sprayed with oil (to settle dust) contaminated by toxic PCBs or dioxin. In addition to poisoning, a much greater risk exists of gastrointestinal obstruction or tearing in the stomach. Another risk of eating soil is the ingestion of animal feces and accompanying parasites. Cases of severe bacterial infections occurrence (leptospirosis) in patients diagnosed with pica have also been reported. Pica can also be found in animals such as dogs and cats.

Signs and symptoms

thumb|Chalky stone composed of [[kaolinite with traces of quartz, small pieces of which were sucked on by a person with pica]]

Pica is the consumption of substances with no significant nutritional value such as soap, plaster, plastic or paint. Subtypes are characterized by the substance eaten:

This eating pattern should last at least one month to meet the time diagnostic criteria of pica.

Complications

Complications may occur due to the substance consumed. For example, lead poisoning may result from the ingestion of paint or paint-soaked plaster, hairballs may cause intestinal obstruction, and Toxoplasma or Toxocara infections may follow ingestion of feces or soil.

Causes

Pica is currently recognized as a mental disorder by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). According to the DSM-5, mineral deficiencies are occasionally associated with pica, but biological abnormalities are rarely found. Specifically, practicing geophagy is more likely to be associated with anemia or low hemoglobin. More recently, cases of pica have been tied to the obsessive–compulsive spectrum, and a move has arisen to consider OCD in the cause of pica. Sensory, physiological, cultural, and psychosocial perspectives have also been used to explain the causation of pica.

Pica may be a cultural practice not associated with a deficiency or disorder. Ingestion of kaolin (white clay) among African American women in the US state of Georgia shows the practice to be a DSM-4 "culture-bound syndrome" and "not selectively associated with other psychopathology". Similar kaolin ingestion is also widespread in parts of Africa. Such practices may stem from purported health benefits, such as the ability of clay to absorb plant toxins and protect against toxic alkaloids and tannic acids.

Diagnosis

No single test confirms pica, but because pica can occur in people who have lower than normal nutrient levels and poor nutrition (malnutrition), the health care provider should test blood levels of iron and zinc.

Hemoglobin can also be checked to test for anemia. Lead levels should always be checked in children who may have eaten paint or objects covered in lead-paint dust. The healthcare provider should test and monitor for infection if the person has been eating contaminated soil or animal waste. It is recommended that treatment options for pica vary by patient and suspected causes. though treatment and routine evaluation are advised due to potentially serious consequences. Iron deficiencies or other nutrient deficiencies should be treated using dietary supplements and through dietary changes.

Certain psychotherapeutic approaches have been found helpful for pica. Behavior-based treatment options can be useful for people who have a developmental disability or mental illness. Aversion therapy is another option, wherein the person learns through positive reinforcement and mild aversions which foods are good and which ones they should not eat. A case-report found that asenapine resulted in significant improvement on a woman with several mental health conditions after bariatric surgery, whereas another found use in venlafaxine for pica associated with depression. Reports prior to these publications have cautioned against the use of medication until all non-psychogenic causes have been ruled out.

Epidemiology

The prevalence of pica is difficult to establish because of differences in definition and the reluctance of patients to admit to abnormal cravings and ingestion, Factors associated with Pica in this population were determined to be anemia and low levels of education, both of which are associated with low socioeconomic backgrounds. and 25.8% of these groups had pica.

Prevalence rates for children are unknown. Young children commonly place non-nutritious material into their mouths. This activity occurs in 75% of 12-month-old infants, and 15% of two- to three-year-old children.

The term pica originates in the Latin word for magpie, pīca, a bird famed for its unusual eating behaviors and believed to eat almost anything. The Latin may have been a translation of a Greek word meaning both 'magpie, jay' and 'pregnancy craving, craving for strange food'. In 13th-century Latin work, pica was referenced by the Greeks and Romans; however, it was not addressed in medical texts until 1563. Kaolin was consumed by slaves from West African in the Southeastern United States, particularly the Georgia belt, due to the antidiarrheal qualities in the treatment of dysentery and other abdominal ailments. The practice of consuming kaolin rocks was thereafter studied scientifically, the results of which led to the subsequent pharmaceutical commercialization of kaolinite, the clay mineral contained in kaolin. Kaolinite became the active ingredient in antidiarrheal drugs such as Kaopectate, although it was replaced by attapulgite in the 1980s and by bismuth subsalicylate starting in 2004.

Research on eating disorders from the 16th to the 20th centuries suggests that during that time in history, pica was regarded more as a symptom of other disorders rather than its own specific disorder. Even today, what could be classified as pica behavior is a normative practice in some cultures as part of their beliefs, healing methods, or religious ceremonies.

Animals

Unlike in humans, pica in dogs or cats may be a sign of immune-mediated hemolytic anemia, especially when it involves eating substances such as tile grout, concrete dust, and sand. Dogs exhibiting this form of pica should be tested for anemia with a complete blood count or at least hematocrit levels. Although several hypotheses have been proposed by experts to explain pica in animals, insufficient evidence exists to prove or disprove any of them.

Experimental studies have also explored treatment responses. One study found that pica-like behavior in rats caused by chemotherapy drugs was reduced after specific vagotomies, showing a biological connection between the brain, stomach, and eating behavior. These findings help explain how pica and related eating behaviors can be both physical and psychological. All bodies are interconnected, all functions and processes in a body of any animal are affected by one another, through these experiments and observation we can infer how any eating disorder or specifically pica has a noticeable affect in all aspects of life.

Cultural and real-life perspectives

Cultural research continues to show that pica is not only medical but also social. For example, a study in North-Central Nigeria found that pica among women is often shaped by cultural beliefs and community practices, rather than just psychological or nutritional causes. Real-life cases, such as a 10-year-old boy who felt a strong, uncontrollable urge to eat fibers and described relief after doing so, demonstrate how pica can overlap with obsessive-compulsive behaviors.