Cooper (2010) state that “it is estimated to affect 10 percent to 32 percent of children from ages 1 to 6 years; approximately one in five patients on dialysis: and 20 percent of pregnant women” (p. 39). The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) describes Pica as,
Persistent eating of nonnutritive, nonfood substances over a period of at least one month. The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual. The eating disorder behavior is not part of a culturally supported or socially normative practice. If the eating behavior occurs in the context of another mental disorder (e.g., intellectual disability [intellectual development disorder], autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is sufficiently severe to warrant additional clinical attention. (American Psychiatric Association, 2013, p 329)
There are a lot of substances and objects that can be consumed by individuals who have pica. They can include wood, paint chips, feces, lead, paper, coal, dirt, sand, light bulbs, plaster, needles, string, hair, dirt, pebbles, fingernails, wood, cigarette butts, burnt matches, clay, stones, and laundry starch (Cooper, 2010). Pica got its name from the Latin word for magpie, which is a type of bird that will consume just about everything (Mansbacher, 2009). This paper will explain the possible reasons why this disorder can occur, the consequences that the disorder has on physical, mental, and social well-being, and possible treatment plans.
Theories of Occurrence
Pica has been identified as not having an exact cause to why it can occur. Pica is considered normal behavior in infants before 18-24 months, since the stages of human development consists of infants exploring objects with their mouth. There has been many theories that has been anticipated to have a better understanding of why Pica occurs and the many factors that are associated to this eating disorder (Cooper, 2010).
According to many studies iron is the most common deficiency associated with pica, but calcium, zinc and other vitamins can also contribute to this eating disorder. Iron deficiency has been frequently found in patients who consume clay. But, it is still unsure if an iron deficiency caused the patient to consume clay or if the clay resorted to this deficiency. Lack of iron can also be linked to sponge-eating and even ice and freezer frost (Cooper, 2010).
A lot of scientists looked at Pica as a cause of behavior that was learned specifically in the developmental stages of life. This could be due to a form of hostility, or perhaps just thought it existed a lot in surroundings of these who didn’t have much social interaction (Cooper, 2010).
Cultural, ethic and family practice
Many countries that practice Pica, refers to it as cultural pica. In numerous cultures, the intake of mud, clay and charcoal is very regularly found in pregnant women. This eating disorder has also been practiced in fertility rituals. Females would consume soil before, during and after pregnancy because it was taught to be a belief to promise future offspring. Treatment of morning sickness was also another reason why pregnant women would eat clay and starch. Therefore, it was not unusual behavior for children to consume the same substances, since it helped with abdominal pain, nausea or even vomiting. In some underprivileged countries, eating dirt/clay is not by choice, it’s because the lack of food supply (Cooper, 2010).
Pica is sometimes detected and can be classified as a behavior that is learned in individuals who have developmental disorders such as autism or even severe intellectual disability (Cooper, 2010).
External factors such as stress can contribute to developing Pica. Parental separation, abuse, and neglect or insufficient parent/child interaction can trigger Pica in children. Children who have autism are very defenseless to stress. In addition, neurochemical and neuropathological issues can cause a change in eating habits in patients with dementia (Cooper, 2010).
Physical, Mental, Social Consequences
Cooper (2010) warns that depending on what an individual may eat, the physical consequence of Pica varies and can be mild to life threating. Pica can cause serious medical and dental problems. The most common medical problem in Pica is lead poisoning, which is very uncommon in adults and is caused by eating soil, lead-based paint, and anything that includes lead. Lead poisoning is the most common and can result in headaches, vomiting, seizures and respiratory failure. It can also cause permanent neurological damage in children. There are other potential toxins that are related to Pica. These toxins include hyperkalemia, and is caused by eating burnt match heads and clay, as well as mercury poisoning from eating paper. The ingestion of eating clay, soil and feces has been linked to parasitic infection, including toxoplasmosis and toxocariasis. Persons with developmental disabilities that engage in Pica and that are institutionalized, parasitic infections are generally found in these individuals. Cooper (2010) state that “almost 70 percent of a sample of institutionalized patients who engage in pica had pinworms.”
Pica can also cause mechanical bowel problems, perforations, intestinal obstructions, ulcerations and even constipation. This is very common when consuming sharp objects such as glass. When it comes to the dental problems that can be caused by pica, they include severe tooth abrasion, infractions, and surface tooth loss (Cooper, 2010).
Depending on what is consumed, pica is well known to cause lead poisoning which can cause serious brain damage such as severe intellectual impairment. High amounts of lead in the blood stream can have many effects on cognition thinking, which include learning impairment and impulsive behavior problems, and reduced attention span. (Blinder, & Salama, 2008).
Recent research has been done to show that pica is associated to low amounts of dopamine in the brain. Dopamine is a transmitter that is created when we do or eat things that are pleasurable and is responsible for significant number of roles in humans. Some of the functions of dopamine includes personality, improves working memory, movement, sleep, learning, attention span, behavior and cognition. Therefore since practicing pica is associated in eating non-food items that are not pleasing to the human body. This can cause low amounts of dopamine in our brains which can affect the role that dopamine plays in humans (Mansbacher, 2009).
Behaviors of individuals with pica that have a developmental disorder are often linked to self-abuse, hyperactivity, stereotypical behavior, and non-food related that are unusual actions such as eating from the ground and chomping on objects. It can also make patients who practice pica to become more anti-social since they do not want to be looked at as different in society and unaware that there is a name for this type of eating disorder. There is also a social stigma associated with pica because individuals who practice pica are most likely to hide their habits and most likely to hide this eating disorder from others which can effect relationships, school, or even work (Blinder, & Salama, 2008).
Blinder and Salama (2008)state that “reduction in exposure is the cornerstone of any treatment program. Treatment approaches are primarily preventive, educational, and directed toward modification of pica behavior” (p. 72). Treatment of pica depends and also varies by the suspected cause (i.e., developmentally disabled, children, pregnancy or psychotic patients. The success of treatment associated with pica usually fades with age and is usually generally high, but it also depends on the reason why pica occurred especially if the individual has developmental or mental disorders, which can be a long term concern. This is why treating pica as early as possible is the best route to go, since there is not a certain way to stop pica from existing. Though, if awareness to proper eating habits and close supervision of children who are known to place things in their mouths can sometimes help catch the disorder before serious or mild consequences can happen. There has been many treatment interventions to help with pica, some include nutritional, psychological, pharmacological, and behavioral (Stiegler, 2005).
Counseling and psychotherapy is mostly used to treat individuals without developmental disorders, who practice in Pica due to emotional or psychological problems. The treatment of depression, anxiety and some personality disorders can be helped with prescribed medications such as antidepressants and serotonin specific reuptake inhibitors (SSRIs). Psychological treatment is also used to help pica patients who do not have a developmental disorder. Medicines can also be used to treat pica in individuals who may or may not have a developmental disorder (Stiegler, 2005).
Modification in behavior has been almost entirely applied to those who have developmental disorders and might include using a positive reinforcement normal behavior techniques, many interventionists use a therapy called aversion therapy and this can be where the patients learns about distinguishing between which foods to eat and not to eat. There are many behavioral approaches but again these are all linked to persons with developmental disorders that practice pica (Stiegler, 2005).
Cognitive behavior therapy
Cognitive behavior therapy helps individuals to learn about the illness itself and the symptoms that can be associated with pica. This therapy can also help with the patient’s perspective about their symptoms which will reduce the power that the pica symptoms can have over their body. Cognitive behavior therapy can also teach pica patients different ways of handling daily problems they may face due to this eating disorder (Blinder, & Salama, C. (2008).
In conclusion, pica is not a well-known eating disorder and rarely is talked about. Many people who practice pica do not even know that there is a name for this kind of disorder or that it even exists in society today. It’s a disorder that everyone should be informed about, just like the other eating disorders that exists, since it can lead to very severe or even life threating consequences depending on what is consumed in practicing pica. Pica is well known in patients who have developmental and mental disorders and should be taken very seriously when it comes to treatment. It is very important to be educated about healthy eating practices, the danger in eating non-nutritive substances, and the severe to mild consequences that pica can have on your body.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Blinder, B. J, Salama, C. (2008). An update on pica: Prevalence, contributing causes, and treatment. Psychiatric Times, 25(6), 66, 72-73. Retrieved from ProQuest Nursing & Allied Source database.
Cooper, M. D. (2010). Pica. Access: The Newsmagazine of the American Dental Hygienists’ Association, 24, (5), 39-41. Retrieved from ProQuest Nursing & Allied Health Source database.
Mansbacher, J. (2009). Pica: What it is, how you can recognize it, and how can you treat it. Exceptional Parent, 39(2), 32-34. Retrieved from ProQuest Nursing & Allied Health Source.
Stiegler, L. N. (2005). Understanding pica behavior: A review for clinical and education professionals. Focus on Autism and Other Development Disabilities, 20(1), 27-38. Retrieved from ProQuest Science Journals database.