Pica

What is pica?

Pica is a feeding disorder in which someone eats non-food substances that have no nutritional value, such as paper, soap, paint, chalk, or ice.

For a diagnosis of pica, the behaviour must:

• Be present for at least one month
• Not part of a cultural practice, and
• Be developmentally inappropriate e.g., it’s not generally diagnosed in children under the age of two, as it is common for babies to “mouth” objects, which can lead to them accidentally eating substances that aren’t meant to be eaten.

Often, pica is not revealed until medical consequences occur, such as metal toxicity, cracked teeth, or infections.

Pica affects people of all genders and ages, though it is more likely to first appear among children. It can occur alongside other illnesses, including other eating disorders. In cases where it is this other illness that has caused the behaviour related to pica, a separate diagnosis of pica would be made only if it is serious enough to need clinical attention beyond that already being provided for the other illness.

People with pica don’t usually avoid regular food, meaning they may still be getting all the nutrients they need. However, some non-food items eaten can be very dangerous, especially if eaten in large amounts.

If you’re concerned about yourself or someone else, you should visit your doctor as soon as possible so that you can get the right treatment and support you deserve..

What causes pica?

The exact reasons that people develop pica are not yet clear, and the percentage of people who have it is not yet known, as different researchers may use different definitions of pica, leading to some confusion. Although, research suggests multiple contributing factors, including genes, the environment, and psychology.

Some explanations include:

• Sensory or emotional regulation – For example, to manage difficult emotions or to provide sensory feedback. Recent research suggests that it may be linked to impulsivity and stress.
• Mineral or vitamin deficiencies – For example, pica has been linked with iron or ferritin deficiency. In some people, pica behaviours improve once these deficiencies are corrected. However, not everyone with pica is deficient in minerals and vitamins, and it’s unclear whether it causes the behaviour or the other way around.
• It may be more likely to occur alongside:
  • Pregnancy
  • Iron deficiency anaemia
  • Autism
  • Intellectual developmental disorders
  • Depression
  • Obsessive-compulsive disorder and related disorders such as trichotillomania (hair-pulling) and excoriation disorder (skin-picking)
  • Schizophrenia or other mental health conditions

Signs of pica

• Craving to consume substances that aren’t supposed to be eaten.
• Eating substances that aren’t supposed to be eaten.
• Physical illness as a result of eating harmful substances e.g., Poisoning, nutritional deficiencies, infection, poor oral health, and intestinal obstruction

If you or someone you know has eaten something that isn’t supposed to be eaten, you should seek medical help immediately. It may be necessary to contact the emergency services.

How is pica treated?

Treatment depends on the individual needs, the severity, and the underlying cause of the behaviour. A multidisciplinary and tailored approach should be taken to treat any eating disorder. This may include:

• Addressing nutritional deficiencies i.e. through supplementation
• Behavioural therapies – this can include promoting self-soothing behaviour, redirecting attention, managing anxieties, and replacing pica items with similar, but safe, alternatives
• Medical intervention e.g., in instances where the behaviour has led to physical health problems
• Medication may also be offered
• Addressing underlying conditions e.g., OCD, depression, schizophrenia

There are currently no widely used screening tools designed specifically for pica. However, newer questionnaires such as the Pica, ARFID, and Rumination Disorder Interview (PARDI), are being explored for use.

Research is needed to better understand:

• How pica develops and why
• What kind of treatment works best for individuals and why
• How to measure symptoms and treatment outcomes

If you recognise pica in yourself, find out how you can support yourself or someone you know here: Get Help for Myself.