Named for the Latin word magpie – a bird with a truly unfinicky appetite, pica is a dangerous eating disorder involving mild to severe compulsions to eat things that are not considered food. This can have serious health consequences when it goes unchecked, but the good news is that pica is a disease that responds well and sustainably to evidence-based treatment.
What Is Pica?
Pica is a term that describes a pattern of disordered eating characterised by a compulsive drive towards ingesting non-food items without known significant nutritional value. In the APA’s Fifth Diagnostic and Statistical Manual, it is classified as a “feeding and eating disorder.”
Culturally and regionally, definitions of what is and is not food fluctuate. It may not be considered pica if an individual consumes items with no nutritional value for cultural, spiritual, or medicinal reasons – think Hollywood trends in additive clays and charcoals. Pica often manifests as hard-to-control or uncontrollable cravings to consume a particular type(s) of non-food items, brought on by the scent, sight, or texture of said objects.
In adolescents and teens, pica often presents in connection with certain other mental health conditions, including different patterns of disordered eating, anxiety, and obsessive-compulsive disorder. While individual cases are unique and can differ significantly, evidence points to some people experiencing pica as a cluster of symptoms related to the OCD spectrum rather than body dysmorphia.
Pica also is a condition that frequently affects individuals who live with developmental and intellectual disabilities, such as ADHD and autism spectrum disorder. Studies have found that 10 and 15% of people with these conditions show signs of pica.
Examples of Pica
The phrase “eating non-food items” may seem slightly abstract, but the fact is that pica sufferers have been observed eating a great range of types of objects. A few pica groups have been identified with terminology, such as “geophagia” – associated with eating dirt, clay, stones, etc., or “amylophagia” – associated with eating raw starches and starchlike substances, from plain flour to raw potatoes to laundry starch.
While not a comprehensive list, people with pica may experience cravings for:
- Dirt
- Sand
- Clay
- Stones and pebbles
- Hair
- Faeces
- Cloth
- String
- Wood pieces and fibre
- Gum
- Ice
- Charcoal and ash
- Cigarette butts
- Coffee grounds
- Chalk
- Soap
- Laundry starch
- Pencil erasers
- Sharp objects
- Paint chips
A few common oral compulsive habits, including chronic nail biting, or onychophagia, are generally not connected to pica, even if they may be a cause for concern. Both nail biting and skin picking (excoriation disorder), even if they involve the consumption of material, are typically considered “body-focused repetitive behaviours” and are associated with nervous disorders.
What Isn’t Pica?
When looking into treatment options for something causing concern, it is important not to misattribute the cause of the out-of-place behaviour.
Infants
It is not uncommon to see young infants place the occasional non-food item into their mouths as a part of their sensory exploration of the world and mental development. While this behaviour can be cause for concern – if the child can access or eat dangerous things or is doing so unsupervised – it is not considered developmentally inappropriate or pica.
Should the consumption of non-food items persist after the age of two, the behaviour may be attributed and diagnosed as pica for treatment. It is also appropriate to assess for other developmental conditions affecting the child’s learning timeline at this point.
Pica and Cultural Practice
Around the world and even to a limited extent, within broader communities, there may be other, diverse motivations for eating substances that are considered non-food items elsewhere. In these cases, a healthcare provider would not consider the consumption a sign of an eating disorder.
- Non-food items
- Eating soil or clay
- Pica behaviour
- Not limited to developing countries
- Eating substances
Symptoms of Pica
Pica, like many eating disorders, is frequently masked and overlooked by the people around the affected individual until the behaviour has reached a sufficiently severe level.
When clinically diagnosing this condition, a mental health professional will be looking out for the following pica behaviours, outlined in the DSM-5:
- Persistent eating of non-food items without nutritional value lasted for at least one month
- This consumption pattern occurs in someone for whom it is not developmentally appropriate (under the age of 2)
- The motivation to eat non-food items is not supported by socially or culturally normative practices or beliefs.
- If the eating disorder co-occurs and is related to other illnesses or medical conditions, the behaviour causes enough concern to demand specific treatment.
When diagnosing pica, the medical professional will assess symptoms by reviewing the individual’s personal and medical history. Medical testing is not necessary for a diagnosis, although other blood and imaging tests are often recommended so that we can check for digestive blockages and physiological causes.
Risk Factors and Potential Causes
Pica is not necessarily “caused” by any other mental or physical health conditions, but there are trends among whom this eating disorder presents.
Often, pica cravings are connected to nutrient deficiencies, such as iron deficiency (anemia) or zinc deficiencies. Treatment can be as simple as supplementing the client’s diet with key vitamins and minerals, although behavioural intervention and gastronomic education can help ensure that remission stays sustainable.
As mentioned previously, however, developmental disabilities may also play a role in adolescents developing pica. Residential treatment can help individuals who experience pica as a coping mechanism for symptoms of autism spectrum disorder and as a side effect for an associated mental health condition.
Pregnancy is also a significant risk factor associated with pica – likely due to the increased dietary needs and nutritional deficiencies present during this period. A 2016 meta-analysis of 70 studies investigating the illness around the world found that 27.8% of women who had gone through pregnancy experienced pica either during gestation or postpartum. That said, pica cravings tend to end in pregnant women soon after giving birth and without treatment.
Medical Complications
Consuming non-food items is not harmless and can quickly become destructive. As with all eating disorders, pica can bring about a range of alarming and life-threatening health problems, especially in vulnerable populations such as developing children, adolescents, and pregnant women.
Nutritional Loss
If consuming nonnutritive products begins to take over someone’s diet, it can rapidly bring about drastic nutritional imbalances that result in extreme weight loss, anemia, and physiological deterioration.
Poisoning and Infection
Food safety regulations exist for a reason, and things that are not sold as sustenance do not go through manufacturing processes that expect them to be even partially digested. Consuming artificial but not food-safe materials such as paints and plastics can easily result in heavy metal accumulations and life-threatening conditions like copper and lead poisoning.
People with pica are also exposed to many pathogens and are at significant risk of infection. Many objects of pica cravings (think soil, pebbles, animal droppings, hair) are explicitly unsanitary. This behaviour is a known vector for parasitic infections that can infect the digestive tract, cardiovascular system, and muscle tissue.
Digestive Tract Obstructions
Many people with pica experience regular GI complaints that stem from intestinal obstruction. While the body has some remarkable systems for breaking down and passing insoluble materials, we are not designed to digest things like hair, stone, paper, and glass. These can collect and compact at various stages in the stomach and colon, creating blockages that can grow to require more invasive interventions and surgery to return to a normal quality of life.
Dental Decay
Some people’s pica cravings are motivated by texture, and chewing the objects consumed is a part of the compulsion. While this may be less of an issue for pica focused on soft materials, chewing harsher substances like brick, wood, or glass can rapidly cause irreparable dental damage and invite oral infections.
Social and Emotional Health
Finally, pica is an eating disorder that can bring about painful consequences for the emotional and social health of people with it. It forces many into a life of shame and secrecy and, like many compulsive behaviours, can become connected to painful negative thought processes and guilt. Failing to hide pica behaviours, on the other hand, can result in social rejection and isolation for people in school and beyond, creating a constant source of stress when it goes untreated.
Treating Pica
As an eating disorder, pica is diagnosed and treated primarily as a mental illness, although it often has a physiological side. Effective treatment should be personalised according to medical evaluation and usually involves a combination of supplementary and behavioural interventions, as well as a focus on structuring healthy coping skills and lifestyle changes designed to beat cravings. In short, sustainable remission calls for holistic treatment and may involve:
- Managing behavioural problems
- Vitamin supplements for mineral deficiency
- Aversion therapy/positive reinforcement
- CBT
- Dietary and gastronomic education
- Treatment for co-occurring mental health conditions
The Wave
At The Wave, we specialise in providing personalised holistic mental and physical healthcare tailored to the needs of adolescents and young people. Youth is a time of potential and chaos. We care about seeing pica treated but also supporting developing people in managing, coping with, and ultimately healing beyond the many factors that produce and reproduce mental illness and eating disorders.
If you’ve noticed signs of pica in a young person you’re close to and would like to hear more about our approach or assessment, reach out to us today.
