What is Pica?

Pica is a mental condition characterised as the compulsive ingestion of non-nutritive, non-food substances. To meet the DSM criteria for a diagnosis, this must occur over a period of at least one month and be severe enough to warrant medical attention.

The name pica comes from the Latin name for magpies (pica pica), as magpies were associated with eating a huge variety of substances when the term pica was coined in the 1500s.

Is pica an eating disorder?

Pica is widely referred to both as an eating disorder and a feeding disorder, and both descriptions are accurate. Feeding disorders fall under the category of eating disorders, but they are a little different.

It is extremely common for eating disorders to be strongly associated with weight for the person experiencing them. Eating disorders are often associated with a preoccupation with weight, leading to the compulsive weighing of both the person’s own body and the food being consumed, negative body image, and frequently checking themselves in the mirror. Pica is not associated with these things and has more in common with another feeding disorder, ARFID (avoidant/restrictive food intake disorder), where the type of substance ingested is more important. ARFID is characterised by a strong aversion to certain tastes, smells, textures and types of food. Pica is characterised by powerful cravings for substances that are not considered food – but differs from ARFID in that it can be considered an addiction.

Regardless of which category it falls into, pica can cause feelings of strong shame and powerlessness in the sufferer and can also lead to dangerous medical complications, meaning a compassionate, supportive treatment regimen is crucial for recovery.

How it is diagnosed

Diagnosis of pica often excludes people where the behaviour is not ‘culturally bound.’ This is because the consumption of substances that aren’t food is accepted, encouraged or serves a genuine purpose for some groups of people, and as a result, would not meet the criteria of a mental condition.

For instance, some indigenous people in Peru and Bolivia will eat clay to counteract the toxicity of the potatoes that grow in the region, which form the bulk of their diet. In other cultures, eating non-food items for pregnancy cravings is not seen as unusual, and is socially accepted.

Pica is a composite mental conditional with several potential causes. This means diagnosis does not require a cause – it is enough to simply meet the DSM criteria of consuming non-nutritive substances for over a month and be severe enough to need medical attention.

Pica can affect anyone, but most cases are found in young children and pregnant women. No accurate data exists on the exact prevalence of pica, but it’s estimated to affect anywhere between 8 and 65% of pregnant women, the most widely studied cohort of people susceptible to pica.

The types of items commonly craved

Non-nutritive substance means anything that isn’t food. Some substances that sufferers of pica ingest are more dangerous than others – for instance, gasoline. However, all substances can be dangerous.

Some substances associated with pica are more common than others. These include dirt and clay (geophagia), hair (trichophagia) or paper (xylophagia). Items with a chalky texture are commonly craved, as are ice and soap.

Underlying causes and contributing factors for pica cravings

No one cause has been identified for pica, and causes can be roughly broken down into three categories.

Physiological conditions such as nutritional deficiencies can play a role – this is one explanation for why pregnant women represent a large cohort of those diagnosed with pica. People experiencing pica can crave non-food substances containing minerals they are deficient in. For this reason, medical professionals will screen for nutritional deficiencies and anaemia when considering a diagnosis of pica.

Environmental factors can play a role. These can be a lack of supervision, particularly amongst children, and also exposure to dangerous contaminants that are commonly consumed by sufferers of pica, such as lead paint.

Finally, other mental conditions play an important role, with co-morbidities observed with autistic spectrum disorder, obsessive-compulsive disorder and schizophrenia.8

Potential health risks

The health risks of pica can vary depending on the substance ingested and can be serious. It can cause gastrointestinal problems, choking, infections and poisoning.

 

Recognising the signs/symptoms

People experiencing eating disorders will often feel shame, and in the case of pica, this can be exacerbated by the fact that they are compulsively eating things that are not considered food. Young children may know they shouldn’t be eating these substances but not really know why.

This means sufferers can go to great lengths to hide their behaviour, which can make diagnosis difficult. There are external signs – weight loss, dental damage, stomach issues and unusual items in their surroundings – but these do not necessarily mean the person suffers from pica alone. As a result, getting to the root of the eating disorder is even more challenging for children, and for adults, approaching specialists to get help for the condition is crucial.

Approaches to treatment and management

Treatment for pica often requires a multidisciplinary approach. Underlying medical or psychological conditions need to be detected and addressed. If pica arises from a deficiency, nutritional supplementation will help.

To cope with the cravings, behavioural interventions and support are crucial. Therapy also plays an important role in helping the individual to cope and break the cravings.

Fortunately, comprehensive help is available for sufferers of pica.

Talk to UKAT

If you or a loved one is struggling with pica, support is available. We offer comprehensive, empathetic and confidential advice that can get you started on the road to recovery.

To start your journey, contact our dedicated team today.