Written by Fariah Rahman, General Member
What is pica?
Pica is an eating disorder and involves eating non-food items and those that have no nutritious value. This behavior has to last at least one month and occur in individuals who are at least 2 years old for pica to be diagnosed. Many children, individuals with intellectual disabilities, and pregnant women are diagnosed with pica. The items ingested can vary widely, including substances like dirt, clay, paint, raw starches, soap, buttons, ice, hair, charcoal, string, ash, wool, paper, sand, soil, chalk, cloth, gum, glue, baby powder, pebbles, metal, ash, vomit, feces, uncooked rice, pet food, glass, grass, eggshells, and other non-food items (Al Nasser et al., 2023; Cleveland Clinic, 2022; Holm & O'Carroll, 2023; Leung & Hon, 2019; NEDIC, n.d.). Pica is compulsive, so patients can face difficulty controlling their behavior (Cleveland Clinic, 2022). “Pica pica” is the Latin name of a species of magpie that collects and eats various objects out of curiosity and this is where the condition gets its name from (Leung & Hon, 2019).
Factors that might be associated with pica
We are still not exactly sure what causes pica. Some research suggests there may be a link between pica and stress as well as childhood abuse or neglect. Some risk factors for pica may include nutritional deficiencies, pregnancy, epilepsy, underlying mental health issues, and poverty (Al Nasser et al.). Pica can also occur in immigrant and refugee children. There is also a greater risk of pica occurring in children with sickle cell anemia (Leung & Hon, 2019). Pica can also occur in patients with certain mental health conditions, such as schizophrenia and obsessive-compulsive disorder (OCD) (Al Nasser et al.; Holm & O'Carroll, 2023). Eating feces or vomit might occur in people with certain neuropsychiatric disorders (Leung & Hon, 2019).
Potential consequences of pica
Many dangerous risks can occur when non-food substances are ingested (Cleveland Clinic, 2022). For example, if a pica patient eats clay, there could be parasites in it that can infect them. Lead poisoning can occur when patients consume substances that contain lead, such as clay and some types of paint. This can be especially toxic to pregnant women and the developing child as lead poisoning can cause neurological problems. When pregnant women eat earth, known as geophagy, it may lead to the delayed development of motor skills in children. Eating ice, known as pagophagia, can lead to iron deficiencies, especially in pregnant women. It can also lead to tooth problems (Al Nasser et al.). Pica patients can also experience problems with their gums (Leung & Hon, 2019). Pica can also lead to choking (Holm & O'Carroll, 2023). Eating hair, known as trichophagia, can cause blockages in the digestive tract. It can also be dangerous when pica patients consume materials that are sharp-edged (Cleveland Clinic, 2022). Eating sharp objects can cause gastrointestinal bleeding. Death might occur due to poisoning, infections, intestinal blockages, and electrolyte imbalances (Leung & Hon, 2019).
Long-term pica can occur in individuals with intellectual disabilities. This can lead to problems such as toxic effects, blockages of the intestines, and bezoars (Al Nasser et al.). A bezoar is a mass of ingested foreign material. It can be made up of hair, fibre, or other indigestible materials. Surgery may be needed to extract the bezoar (Kaneshiro & Dugdale, 2023). Rapunzel syndrome is an unusual type of bezoar made of hair with a specific structure that accumulates in the gastrointestinal tract. It can happen in patients with psychiatric illnesses and those who have a habit of pulling out and eating their hair. Death can occur in severe, rare cases (Lopes et al., 2010).
Caring for pica patients
Healthcare providers should look for signs of poisoning or other complications that can result from pica (Al Nasser et al.). Pica can lead to constipation, iron deficiency, and irregular heart rhythms (Cleveland Clinic, 2022). Barium swallow x-rays can be done to identify the presence of bezoars in the body (Kaneshiro & Dugdale, 2023). An electrocardiogram can be done to detect heart problems (Cleveland Clinic, 2022). To see if the patient has been infected, poisoned, or has electrolyte imbalances, blood, urine, and stool tests can be performed (Cleveland Clinic, 2022). Blood tests can be done to test for zinc and iron levels to detect any deficiencies which may be associated with pica (Al Nasser et al.; Holm & O'Carroll, 2023). Tests can also be done to evaluate the amount of lead in the blood (Leung & Hon, 2019). Problems with the nervous system can occur due to lead poisoning. Parasitic infections can have effects on different parts of the body such as the heart, liver, and eyes. Doctors should talk to the patient and their caregivers to get all the important information. They need to find out what was eaten, how much, how long it’s been happening, where it usually happens, where the substance came from, if other things were eaten with it, and if the person has felt sick because of it (Al Nasser et al.). Patients with pica should be treated with respect as they might feel embarrassed because of their condition. Patients might feel ashamed that they have pica which can prevent them from seeking help. It is crucial that healthcare providers cultivate a safe environment where individuals with pica can seek the help they need (Cleveland Clinic, 2022).
Removing the craved non-food substance from the pica patient’s environment and reducing access to it can be helpful for treatment (Al Nasser et al.; Cleveland Clinic, 2022). It is important to pay attention to the person’s emotional needs and stressors they may be facing (Leung & Hon, 2019). Lead-based paint present in homes should be eliminated. Patients and their families should be educated regarding the harms of eating the non-food substance and the importance of reducing exposure to it (Al Nasser et al.). Urgent medical attention should be given when possibly toxic or dangerous substances are consumed. Pica can also be treated through different types of therapy. It can involve equipping pica patients with coping strategies to alter their behavior or helping them focus on other activities (Cleveland Clinic, 2022). Supervision of children who are struggling with pica is important to ensure they do not consume problematic items (Cleveland Clinic, 2022; Leung & Hon, 2019). Pica can also go away on its own in children and pregnant women (Cleveland Clinic, 2022).
References:
Al Nasser, Y., Muco, E., & Alsaad, A. J. (2023). Pica. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532242/
Holm, G. (2023, April 24). Everything you need to know about pica. Healthline. https://www.healthline.com/health/pica
Kaneshiro, N. K., & Dugdale, D. C. (2023, August 5). Bezoar: Medlineplus medical encyclopedia. MedlinePlus. https://medlineplus.gov/ency/article/001582.htm#:~:text=A%20bezoar%20is%20a%20ball,to%20pass%20through%20the%20intestines
Leung, A. K. C., & Hon, K. L. (2019). PICA: A common condition that is commonly missed - an update review. Current Pediatric Reviews, 15(3), 164–169. https://doi.org/10.2174/1573396315666190313163530
Lopes, L. R., Oliveira, P. S., Pracucho, E. M., Camargo, M. A., Coelho Neto, J. de, & Andreollo, N. A. (2010). The rapunzel syndrome: An unusual trichobezoar presentation. Case Reports in Medicine, 2010, 1–3. https://doi.org/10.1155/2010/841028
Pica: What it is, causes, symptoms & treatment. Cleveland Clinic. (2022, May 6). https://my.clevelandclinic.org/health/diseases/22944-pica
Other eating disorders. NEDIC. (n.d.). https://nedic.ca/eating-disorders-treatment/other-eating-disorders/