Written by Dr. John Carosso
First, what is it, and what’s with the name?
Pica is an unusual compulsion to eat nonfood items. It goes beyond ‘mouthing’ objects to actually swallowing; most common items include dirt, clay, paint chips, chalk, baking soda, feces, hair, glue, toothpaste , and soap. However, the list of potential items is endless. The condition most often occurs in two to three year old children with developmental delays, autism, people with epilepsy, pregnant women, and those with brain injuries. The condition must persist for more than a month to be diagnosable. The name is Latin from the Magpie, that bird with an indiscriminate appetite.
What causes it?
Some suggest that the child or individual is attempting to compensate for lacking minerals, but this is inconclusive and, besides, the ingested substance does not always contain that lacking mineral. The condition may also carry-over from the developmentally appropriate tendency to mouth objects. There are also secondary gains that may sustain the behavior (attention-seeking or avoidance of an unfavored task) but these likely do not originally cause the disorder but can be helpful to consider in treatment. Pica is also being considered as a complexity within the spectrum of Obsessive-Compulsive Disorder, and there are also sensory factors that have been implicated. Moreover, ingesting nonfood items is also a cultural practice in some regions.
Is it common?
Yes, it’s surprisingly common. Among mentally and developmentally disabled people, especially those ages 10 to 20, pica is the most common eating disorder and is found in 20 percent of children treated at mental health clinics. Between ages one and six, this non-food craving disorder can be found at rates of 10-20%. The exact rate for children with autism is unclear but studies of mentally challenged adults found rates of upwards of 25%. In developing countries, the rates can be as high as 74% for pregnant women. The condition dates back to Roman times but was not clinically chronicled till 1563.
What do we do about it?
The treatment depends on whatever identifiable cause can be ascertained. We first screen for any mineral deficiencies and accommodate accordingly. Treatment protocols also assess for any toxic levels. Behavioral interventions are considered through principles of applied behavioral analysis (ABA) to determine triggers and anything potentially reinforcing. For example, if the behavior is sustained via the inadvertent provision of extra attention, or by enabling avoidance a non-preferred task, we treat by providing minimal attention and ensuring that the child cannot avoid the task. The youngster is also highly reinforced for appropriate food choices, and sensory issues are targeted by finding similar oral-sensory options. A “Pica Box” can also be helpful: a container of edible items for the child to mouth. Of course, during this process, close physical monitoring is vital to redirect the behavior. Various medications can be helpful, especially if the condition has an anxiety-related (OCDish) undertone. Aversive techniques have been used in more extreme situations but this obviously is absolute last resort.
Outcome?
Pica tends to wax and wane in severity, and subside as the child ages. However, once the condition surfaces, there is an increased chance it will resurface again later. Nevertheless, I’ve seen quite positive outcomes with behavioral approaches; keeping the condition in check and quite contained, if not extinguished entirely.
I hope that helps to understand the basics of Pica. By all means, contact me at jcarosso@cpcwecare.com with any questions or thoughts on the matter. God bless.
