Pica

What is Pica?

Pica is the Latin word for magpie, a bird that is famous for eating anything and everything. It is an eating disorder in which there is a constant craving for non-food items like ice, earth, dirt, clay, paint, plaster, chalk, wool, ashes, burnt match heads, charcoal, rust and other such items that are not usually considered food.

Why is it caused?

There is no identifiable cause for pica. In some cases, the following predisposing factors may be present.

• Nutritional deficiencies including iron and zinc, which may be fulfilled by consuming something that contains them. However, many believe that these deficiencies are secondary to pica.
  
• Pica is often associated with lead intoxication.
  
• Increased nutritional requirements especially during pregnancy, which if not met, may lead to abnormal eating.
  
• Excessive dieting: People who diet may become hungry and try to satiate their hunger with low-calorie, non-food substances.
  
• Mental retardation, lack of parental nurturing, maternal deprivation, family disorganization and lack of supervision.
  
• Psychological disturbances such as hysteria.
  
• Ethnic customs that include eating certain non-food substances.
  

What is the incidence of the disorder?

The age of onset is usually 1 to 2 years. Pica is seen in 25 to 30% of children between one and six years of age. It usually remits in childhood but can continue into adolescence and adulthood. It is more common in the low socio-economic classes. 70% of pregnant women have pica.

What are the associated complications?

Cravings for toxic or contaminated substances may lead to gastrointestinal infestations and blockage. There may be symptoms like pain, lack of bowel movements and abdominal bloating. This may suggest that the substance has formed an indigestible mass and may have blocked the gastrointestinal tract. In such cases immediate medical attention becomes necessary.

How is it diagnosed?

Pica is diagnosed by actual observation of repeated or chronic ingestion of non-nutritive foods. There is no test that confirms pica. However, since it is associated in some cases with malnutrition, several tests may be needed.

The degree and type of anaemia should be ascertained. Tests for iron and zinc deficiency and lead intoxication may be necessary. These children should be tested for parasitic infestations. Appropriate psychological assessment is necessary to detect mental subnormality, deviant behaviour and/or neurological deficits and to distinguish from autism and schizophrenia.

What is the treatment?

If pica is a lifestyle choice that does not harm the individual, it can go untreated. But if there is a craving for toxic or contaminated substances, treating the condition becomes important. Treatment emphasizes psychosocial, environmental and family guidance approaches. Positive reinforcement may help in most cases. Associated medical and surgical problems will need appropriate treatment.