What is Pica?

Pica is defined as the eating of one or more substances that are not made to be eaten. Everyone has eaten something that is nonnutritive but for the classification of Pica to be considered this must be on a persistent basis for at least one month.

Pica disorderCredit: www.uthealthleader.org


A child that swallows a penny and must be taken to the emergency room for an examination would not be considered Pica.  A child that picks his nose and then eats that may or may not have the disorder.  The behavior must be developmentally inappropriate.  So the older child that continues this for some period of time may need to be looked at for this abnormal behavior. 


Infants and children who may be considered for the diagnosis of Pica will typically eat paint, plastic parts of toys or other various items, string from clothes or other places, cloth, or even their own hair.  Older children may eat dirt, insects, rocks, leaves, and even feces.  I have had numerous parents concerned with the eating of these substances.  The child is usually not concerned with the behaviors.  When a concerned parent sees their child eating feces or toilet paper with feces on it, they are alarmed and rightfully so.  This is when the child may be punished or redirected.  When the redirection does not work, the parents may seek treatment. 


There is some research to show that women who are lacking some vitamins during or after pregnancy will develop some symptoms of Pica.  The most common substance these women will eat is dirt.  There is evidence this is caused by iron or zinc deficiencies.  


The data on the amount of people that have Pica is hard to determined and limited.  It is more common in people with mental retardation and some developmental disorders, such as Autistic Disorder (Autism).  The diagnosis of Pica is usually not given with these diagnoses unless the problems need special attention that will not be provided with the other diagnosis.  For instance, most insurances and Medicaid will not pay for treatment of mental retardation and most will not pay for psychological interventions of the developmental disorders.  In these cases, the eating of these substances still needs to be addressed by a professional and then the diagnosis of Pica is given to treat the disorder. 


Symptoms of Pica

The symptoms of Pica are pretty straightforward as I have described above.  However, the Diagnostic and Statistical Manuel of Mental Disorder IV-TR (DSM)[1] criteria for Pica are listed for reference sake as follows:

  • Persistent eating of nonnutritive substances for a period of at least one month.
  • The eating or nonnutritive substances are inappropriate for the developmental level.
  • The eating behavior is not part of a culturally sanctioned practice.*
  • If the eating behavior occurs, exclusively during the course of another mental disorder (e.g., Mental Retardation, Pervasive Developmental Disorder, Schizophrenia), it is sufficiently severe to warrant independent clinical attention.

 xray of picaCredit: tovet.blogspot.com

* some cultures have it part of their religious or cultural practices to east sand, dirt, rocks, or other substances to fulfill the requirement of that culture.  It is common in Africa for pregnant and lactating women to eat clay made from the dirt there.  This is for spiritual reasons and can be due to the nutrients they feel the soil used to make clay can provide. 


This is also done in some American cultures.  Americans, such as the Pomo tribes, indigenous to Northern California used dirt in their diet.  These people will mix it with ground acorn to neutralize the acid. 


Treatment of Pica

The first thing that must be done when the diagnosis of Pica is applied is to have a thorough health screening.  This should include blood work to determine if there are any vitamin deficiencies. 


This health screening will also test to determine if there are any problems associated with the direct eating of the substance, such as lead poisoning or bowel clogging due to the substances. 


The typical psychological treatment is behavior modification associated with cognitive behavior therapy.  This will make use of mild aversive therapy, such as punishment for eating of the nonnutritive substances.  The person will also be rewarded when they eat things that are made to be eating.  The person will also be rewarded when they have gone a certain amount of time without the eating behaviors associated with this disorder. 


The treatment must contain a certain agreement from teachers, parents, and caregivers on the monitoring of the child to stop this behavior.  Some parents will be too embarrassed to talk with school personnel about this problem.  You must remember this is for the benefit of the child and your embarrassment should not stop you from doing so.  The disorder of Pica could lead to many other psychological and physiological problems. 


This mix of family education, behavioral modification, and removal of environmental temptations of the substances will add to the possible success of recovery from Pica. The successful treatment of Pica varies.  In some cases it last only a few months and in others it can last years. 


Other resources about Pica

Most of the time, children will outgrown this eating of substances.    Societal standards, behavior modification, maturation, and learning will all contribute to the child not wanting to eat these non edible things anymore. Child eating nonnutriative substance


The concern most mental health professional have is the replacement hypothesis.  This is where the child replaces the behaviors of one disorder, in this case Pica, with the behaviors associated with another disorder.  I have noticed, in my experience, anxiety seems to be associated with Pica either, before, during, or afterwards.  I cannot say this is a cause, but I can say there is a correlation in my experience. 


The University of Maryland in conjunction with their medical center is providing a lot of research and valuable information about the disorder of Pica.  I recommend if you or someone you care about has symptoms of Pica, check out some of their information.  However, their website and this article is in no way a replacement for the valuable resources and help you can get from your medical doctor or a good mental health professional.  They will know you and your situation best.  That should be your first place to start to look for information regarding Pica. 


Take care of yourself and those around you.  Make today and everyday a great day. 

Pica: A Childhood Symptom (IRMMH monograph ; 3)
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