Pica

Pica ICD-10 F50.8 ICD-9 307.52 OMIM {{{OMIM}}} DiseasesDB {{{DiseasesDB}}} MedlinePlus {{{MedlinePlus}}} eMedicine {{{eMedicineSubj}}}/{{{eMedicineTopic}}} MeSH {{{MeshNumber}}}

Pica is an appetite for non-foods (e.g., coal, soil, chalk, etc.) or an abnormal appetite for some things that may be considered foods, such as food ingredients (e.g., flour, raw potato, starch). In order for these actions to be considered pica, they must persist for more than one month, at an age where eating dirt, clay, etc., is considered developmentally inappropriate.

The condition's name comes from the Latin word for the magpie, a bird which is reputed to eat almost anything. Pica is seen in all ages, particularly in pregnant women and small children, especially among children who are developmentally disabled where it is the most common eating disorder. It is often cigarette butts that are consumed, presumably for the Nicotine content. Most developmental centers have a no-smoking policy due to this fact, and developmentally disabled persons out in the community are often at risk of sickness and/or choking on the litter they find.

It is much more common in developing countries and rural areas than elsewhere. In extreme forms, pica is regarded as a medical disorder. Pregnant women have been known to develop strong cravings for gritty substances like soil or flour. Some theorize that these women may be craving trace minerals lacking in their system. There is a lack of major studies and research in this field.

Pica in children, while common, can be dangerous. Children eating painted plaster containing lead may suffer brain damage from lead poisoning. There is a similar risk from eating dirt near roads that existed prior to the phaseout of tetra-ethyl lead in gasoline or prior to the cessation of the use of contaminated oil (either used, or containing toxic PCBs) to settle dust.

In addition to poisoning, there is also a much greater risk of gastro-intestinal obstruction or tearing in the stomach. This is also true in animals.

Causes

The scant research that has been done on the root causes of pica suggest that the majority of those afflicted tend to suffer some biochemical deficiency and more often iron deficiency. The association between pica and iron deficiency anemia is so strong, that most patients with iron deficiency will admit to some form of pica. Often the substance eaten by those with the disorder does not contain the mineral of deficiency. If a mineral deficiency is not identified as the cause of pica, it often leads to a misdiagnosis as a mental disorder.

Treatment

Treatment emphasizes psychosocial, environmental, and family guidance approaches. Treatment options include: discrimination training between edible and nonedible items, self-protection devices that prohibit placement of objects in the mouth, sensory reinforcement involving screening (covering eyes briefly), contingent aversive oral taste (lemon), contingent aversive smell sensation (ammonia), contingent aversive physical sensation (water mist), brief physical restraint, and overcorrection (correct the environment, or practice appropriate alternative responses).

This involves associating negative consequences with eating non-food items and good consequences with normal behavior. Medications may be helpful in reducing the abnormal eating behavior, if pica occurs in the course of a developmental disorder, such as mental retardation, or pervasive developmental disorder. These conditions may be associated with severe behavioral disturbances, including pica. These medications enhance dopaminergic functioning, which is believed to be associated with the occurrence of pica.

Examples

• Acuphagia (ingestion of sharp objects)
• Amylophagia (consumption of starch)
• Bibliophagia (consumption of books)
• Coniophagia (consumption of dust)
• Coprophagia (consumption of excrement)
• Emetophagia (consumption of vomit)
• Geomelophagia (abnormal ingestion of raw potatoes)
• Geophagy (consumption of soil)
• Gooberphagia (pathological consumption of peanuts)
• Lithophagia (ingestion of stones)
• Mucophagy (consumption of mucus)
• Pagophagia (pathological consumption of ice)
• Tobaccophagia (consumption of tobacco)
• Trichophagia (consumption of hair or wool)
• Urophagia (consumption of urine)
• Velcroholism
• Xylophagia (consumption of wood)

see also

• Adjunctive behaviour
• Eating disorders
• Ingestion
• Toxicomania
• Xenorexia

Key texts

Books

• de Koning, N. D., Moreland, F., Valenti, R. J., & Dosen, A. (2007). Feeding and eating disorders. Kingston, NY: National Association for the Dually Diagnosed.
• Donovick, P. J., & Burright, R. G. (1992). Lead poisoning, toxocariasis, and pica: Links to neurobehavioral disorders. New York, NY: Plenum Press.
• Ellis, C. R., Singh, N. N., Crews, W. D., Jr., Bonaventura, S. H., & et al. (1997). Pica. Belmont, CA: Thomson Brooks/Cole Publishing Co.
• Fultz, S. A., & Rojahn, J. (1988). Pica. New York, NY: Plenum Press.
• LeBlanc, L. A., Feeney, B. J., & Bennett, C. M. (2006). Pica. New York, NY: Springer Science + Business Media.
• Molina, I. A., Theriot, M. T., & Dulmus, C. N. (2007). Pica. Hoboken, NJ: John Wiley & Sons Inc.
• Motta, R. W., & Basile, D. M. (1998). Pica. Washington, DC: American Psychological Association.
• Wren, F. J., & Tarbell, S. E. (1998). Feeding and growth disorders. Needham Heights, MA: Allyn & Bacon.

Literature reviews

• Lacey, E P (1990) Broadening the perspective of pica: literature review.Public Health Rep. Jan–Feb; 105(1): 29–35. PMCID: PMC1579989

Papers

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• Baheretibeb, Y., Law, S., & Pain, C. (2008). The girl who ate her house--Pica as an obsessive-compulsive disorder: A case report: Clinical Case Studies Vol 7(1) Feb 2008, 3-11.
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Additional material

Papers

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Dissertations

• Dolinsky, Z. S. (1982). The progression of behavioral and pathological effects of the parasite Toxocara canis in the mouse: Dissertation Abstracts International.
• Frazer, J. E. (1989). An experimental analysis of pica: FI schedule effects in three profoundly retarded men: Dissertation Abstracts International.
• Goh, H.-L. (1998). Multicomponent assessment and treatment of cigarette pica. Dissertation Abstracts International: Section B: The Sciences and Engineering.
• Hunt, T. J. (1978). Caretaker attitude as related to pica and lead poisoning: Dissertation Abstracts International.
• McCaffrey, R. J. (1980). Motion sickness-induced pica in the rat: A test of the sensory rearrangement theory: Dissertation Abstracts International.
• Witkowski, B. C. (1991). Pica behavior and treatment of institutionalized females with developmental disabilities: Dissertation Abstracts International.
• Young, S. L. (2008). A biocultural study of the relationship between pica and anemia. Dissertation Abstracts International: Section B: The Sciences and Engineering.

External links

• Eating Disorder: Pica