Pica is part of a cluster of diagnoses called the feeding and eating disorders. Feeding and eating disorders are a group of psychiatric conditions that include:
Feeding and eating disorders are characterized by a persistent disturbance in eating behaviors. These disorders are linked to alterations in the consumption of food or absorption of nutrients, and can result in severe distress, physical health problems, and psychosocial impairment. People with anorexia nervosa are significantly underweight because they eat very little food in an effort to lose weight or prevent weight gain. People with binge eating disorder and bulimia nervosa eat large quantities of food in a short period of time (called a "binge"); people with bulimia nervosa also attempt to prevent weight gain by compensating for these binges in an inappropriate way, usually by vomiting, excessively exercising, fasting, or misusing laxatives or other medications. People with pica regularly eat non-nutritious, non-food substances. People with avoidant/restrictive food intake disorder have little interest in food or avoid many types of foods, which results in nutrition deficits.
Several of these disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, are characterized by serious disturbances in body image and a preoccupation with weight and shape. Other disorders, including pica and avoidant/restrictive food intake disorder, are characterized by atypical eating behaviors but are not prominently associated with body image disturbances. Some feeding and eating disorders, including anorexia nervosa and avoidant/restrictive food intake disorder, cause the individual to be significantly underweight or malnourished as a result of their eating behaviors. Other disorders, including bulimia nervosa and binge eating disorder, do not produce marked weight loss and are typically associated with normal or higher than expected weight.
Pica is a relatively rare psychiatric disorder that is more common in children than in adults, although the exact prevalence in children is unknown. Pica is characterized by persistent consumption of nonnutritive, nonfood substances (e.g., dirt, paint, gum, chalk, string, ice, or pebbles).
This eating behavior must be developmentally inappropriate; for example, an infant or toddler who occasionally swallows nonfood items as a result of developmentally normal mouthing of those items would not typically qualify for a diagnosis of pica. For a diagnosis to be warranted, the eating behaviors must occur on a regular basis for a period of at least a month and must not be part of a culturally supported practice.
Pica severity can range from mild to very severe. In severe cases, pica can lead to serious medical complications, including gastrointestinal injury or obstruction, acute weight loss, malnutrition, or poisoning.
Pica can occur in typically developing children or as part of an intellectual or developmental disorder. If pica persists into adolescence it is usually secondary to another psychiatric condition such as intellectual disability, autism spectrum disorder, and to a lesser extent, schizophrenia and avoidant/restrictive food intake disorder.
Due to the low prevalence and high comorbidity of pica with other psychiatric disorders, little is known about the neurobiology of pica per se. However, an increased incidence of pica is observed in individuals with congenital abnormalities of the central nervous system. Pica has also been associated with iron deficiency; however, the causal direction of this relationship is unclear. Pica has been proposed to serve as a self-soothing behavior, particularly in children with developmental or intellectual disabilities.
Currently there are no published guidelines on the best way to treat pica. However, clinical research suggests the following treatments are effective:
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments described above, might be considered.
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments described above, might be considered.