What is Pica?

Pica is a type of eating disorder that involves persistent eating of non-food substances/objects which have no nutrition.

Signs and Symptoms of Pica

Pica is characterised by the following

• Persistent eating of non-nutritive,
  non-food substances over a period
  of at least 1 month.
• The eating of non-nutritive, non-food
  substances is inappropriate to the
  developmental level of the individual
• The eating behaviour is not part of a
  culturally supported or socially
  normative practice.
• If the eating behaviour occurs in the
  context of another mental disorder
  (e.g., intellectual developmental
  disorder, autism spectrum disorder,
  schizophrenia) or medical condition
  (including pregnancy), it is sufficiently severe to warrant additional clinical attention.

The types of substances ingested by individuals with Pica vary. They commonly include soil, raw starch and ice, but may include a range of objects such as hair, plastic, rocks, gum etc.

Pica can be associated with a range of serious physical complications sometimes requiring surgery or resulting in death (Matson, Hattier et al. 2013).

Typically, individuals with Pica are not averse to eating food (i.e. the behaviour is not due to an alternative eating disorder diagnosis such as eating ice or cotton to prevent hunger in Anorexia Nervosa) and will generally also eat normal foods.

Prevalence of Pica

"Limited data suggest that the prevalence of Pica is approximately 5% among school-age children. Roughly one-third of pregnant women, especially those with food insecurity (i.e., without reliable access to affordable and nutritious food), engage in Pica." (American Psychiatric Association, 2022)

In Australia, the rate is largely unknown, and
research is needed in this area.

The Causes of Pica

The exact causes of Pica are not well known, and a range of factors may play a role.

Available research suggests Pica more commonly occurs in certain population groups:

1. Pica typically develops in childhood
2. Pica is more common in pregnant women
3. Individuals in developing countries are more likely to experience Pica.
4. Individuals who are institutionalised particularly due to an intellectual disability have an increased risk of developing Pica.
5. Pica commonly presents in individuals suffering from malnutrition, specifically anaemia (iron deficiency) and/or zinc deficiency.

These studies are limited and there is a need for further research into the prevalence and causes of Pica.

Treatment options

Treatment varies depending on Pica severity and the existence of any comorbid disorders.

Research on Pica interventions is limited, and studies present mixed results. However it is clear that proper screening is required to appropriately diagnose the specific medical and psychiatric conditions involved for the individual.

The consumption of non-food substances may result in a range of medical conditions including infection, poisoning (lead), abdominal pain, gastrointestinal complications, dental enamel erosion, metal toxicities and various nutritional deficiencies.

Medical treatment may be required even in the first instances and in extreme cases surgical intervention may be required (e.g. to remove objects from digestive system) prior to the focusing on behavioural change (Hartmann, Becker et al. 2012). Nutrition may also need to be restored through dietetic interventions.

Psychological treatment in the form of behavioural interventions may also be appropriate for individuals with Pica – e.g. positive reinforcement training into edible vs. nonedible foods. Emerging research suggests that when applied appropriately behavioural interventions are effective at significantly reducing Pica (Hong and Dixon 2017).

There is no current evidence suggesting psychopharmaceuticals are of benefit in treating Pica.

For any person with Pica, it is important to seek care from an empathetic and skilled GP who can remained involved in care throughout treatment and can monitor physical health.