(See also Introduction to Eating Disorders Introduction to Eating Disorders Eating disorders involve a persistent disturbance of eating or of behavior related to eating that Alters consumption or absorption of food Significantly impairs physical health and/or psychosocial... read more .)
Patients tend to eat nontoxic materials (eg, paper, clay, dirt, hair, chalk, string, wool). For children < 2 years, this behavior is not considered developmentally inappropriate; children < 2 years frequently mouth and ingest a variety of objects. Pica is also common during pregnancy.
Usually, pica does not cause significant medical harm. However, some patients develop complications such as
Pica itself rarely impairs social functioning, but it often occurs in people with other mental disorders that do impair functioning (eg, autism Autism Spectrum Disorders Autism spectrum disorders are neurodevelopmental disorders characterized by impaired social interaction and communication, repetitive and stereotyped patterns of behavior, and uneven intellectual... read more , intellectual disability Intellectual Disability Intellectual disability is characterized by significantly subaverage intellectual functioning (often expressed as an intelligence quotient < 70 to 75) combined with limitations of adaptive... read more , schizophrenia Schizophrenia Schizophrenia is characterized by psychosis (loss of contact with reality), hallucinations (false perceptions), delusions (false beliefs), disorganized speech and behavior, flattened affect... read more ). Swallowing objects in an attempt to cause self-harm or to falsify illness (as occurs in factitious disorder Factitious Disorder Imposed on Self Factitious disorder is falsification of physical or psychologic symptoms without an obvious external incentive; the motivation for this behavior is to assume the sick role. Symptoms can be acute... read more ) is not considered pica.
Pica may last several months, then disappear on its own, particularly in children.
Diagnosis of Pica
Pica is diagnosed when
A patient persistently eats nonnutritive, nonfood material for ≥ 1 month.
Ingestion of these materials is inappropriate for the developmental level of the patient.
Ingestion of these materials is not part of a cultural tradition.
If ingestion occurs in a patient with another disorder, it is sufficiently persistent and severe to warrant specific treatment.
Pica is not diagnosed in children < 2 years because at that age, eating such materials is considered part of normal development.
If doctors suspect pica, they evaluate nutritional status to check for weight loss and nutritional deficiencies.
Sometimes pica is diagnosed when patients have symptoms of intestinal obstruction (eg, severe cramping, constipation), lead poisoning, or parasitic infestation that trigger a trip to the emergency department or a clinician.
Tests may be done based on the patient's symptoms and/or the substances ingested. They include blood tests to check for lead poisoning when paint chips have been eaten and stool tests to detect parasitic infestation when soil has been eaten.
Diagnosis reference
1. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision, DSM-5-TRTM, Feeding and eating disorders.
Treatment of Pica
Sometimes behavioral modification
Treatment of nutritional deficiencies and other complications
Behavioral modification techniques may help, but little is known about specific treatments for pica.
Nutritional deficiencies and other complications are treated. Intestinal obstruction may require surgery.
Key Points
Diagnose pica in patients who persistently eat nonnutritive, nonfood material for ≥ 1 month; pica is not diagnosed in children < 2 years.
Usually, pica does not cause significant medical harm, but check patients for weight loss and nutritional deficiencies and, if symptoms suggest it, for intestinal obstruction, lead poisoning, and parasitic infestation.
Behavioral modification techniques may help, but little is known about specific treatments for pica.
Treat nutritional deficiencies and other complications as needed.
