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What is Pica (Eating Disorder)?
- 1. "Hungry, but I don't want food!" PICA EATING DISORDER By: Fullon, Garcia, Hombrebueno, Van Cauwenberghe
- 2. Introduction and History of the Disorder 1. 2. Clinical Presentation About Pica Eating Disorder - Diagnostic Features - Diagnostic Criteria 3. Etiology - Nutritional Factors - Psychological Factors - Ethnic/Cultural Factors 4. Epidemiology 5. Suggested Treatment - Treating Complications - Vitamin or Mineral Supplements - Psychological Evaluation and Behavioral Interventions 6. Misconceptions About Pica
- 3. - an unusual condition where patients develop cravings for non-nutritive substances that can cause significant health risks - examples of these substances are paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal or coal, ash, clay, starch, or ice - sometimes linked with obsessive-compulsive disorder because individuals with Pica are conscious of their behavior even though it is unhealthy and illogical Pica Eating Disorder
- 4. American Academy of Pediatrics identified Pica as the medieval Latin name for a bird called the magpie, which supposedly, has a appetite for eating almost anything. The first recorded case of Pica Eating disorder was observed in a pregnant woman as she was ingesting an abnormal amount of ice. In DSM-5, Pica was formerly classified under the section of disorders with onset of childhood and adolescence, before it fell under the category of eating disorders. Brief History
- 5. Misconceptions about Pica addressing the elephant in the room
- 6. Pica is a childhood disorder. Myth Fact Although pica is more prevalent among children than among adults, it is an eating disorder that can develop at any stage of an individual’s life. Given that pica can develop for different reasons, it can affect all age groups: children, teenagers, adults, and elderly.
- 7. Consuming odd foods is an example of pica. Myth Fact Pica is the persistent consumption of nonfood items for at least one month which have no nutritional value and are consumed intentionally. It is also not part of a cultural or socially accepted practice such as geophagy in Africa. Geophagy, or eating dirt or clay, is common especially for pregnant or lactating African women because they believe that certain soils are considered to have medicinal benefits and are often mixed with herbs as remedies for various ailments (Holden, 2017). Economic factors may also play a role in this.
- 8. People with pica consume similar items. Myth Fact People diagnosed with pica disorder can consume many different kinds of items, as long as they are intentionally consuming nonfood items without nutritional value. The type of item a person consumes depends on the underlying cause of their disorder, like how a person with iron deficiency may develop a habit of chewing rubber bands (Mpondo, Mwasada & Nyundo, 2013).
- 9. Pica and pregnancy cravings are the same. Myth Fact It is normal for pregnant women to experience cravings during their pregnancy, and craving for nonfood items is not a category for diagnosing pica disorder. However, a diagnosis can be made when pregnant women eat nonfood items intentionally, usually related with nutritional deficiencies. Dirt, clay, and powdered laundry detergent are common items pregnant women with pica eating disorder ingest.
- 10. Pica isn't that serious. Myth Fact Eating nonfood items causes serious health issues and consequences. The most common types are intestinal obstructions, tearing and infection (Pica Myths, 2019). For example, eating feces may cause toxocariasis and toxoplasmosis, and eating peeling paint may cause heavy metal poisoning. Individuals may also habitually eat nonfood items that it interferes with them getting nutritional needs from edible food, which is concerning for the individual’s overall physical and mental wellness.
- 11. Eating disorders are a choice. Myth Fact Various factors are in play when diagnosing pica and other eating disorders – genetic predispositions, biological, sociocultural, and psychological factors. Although pica is characterized by the intentional eating of nonfood items, it is beyond just eating these items ‘by choice’. The disorder cannot be easily remedied by telling a person to ‘just eat healthier food’. There are underlying issues that explain the eating behaviors, and the root of it should be addressed when treating pica disorder.
- 12. It is impossible to recover from an eating disorder. Myth Fact This is a common misconception when it comes to eating disorders. In most cases, pica is successfully treated across different ages as long as proper treatment and rehabilitation is implemented and applied. Recovery may be from treating medical complications, prescribing vitamin or mineral supplements, and psychological evaluation or behavioral interventions.
- 14. Only licensed professionals can diagnose pica. These professionals include pediatricians, gastroenterologists, psychiatrists and/or clinical psychologists. Diagnostic Criteria
- 15. If you are concerned that your child or someone you know may be experiencing symptoms of pica, you must consult with a medical professional right away. Online resources and screenings are available, but they are not always reliable and cannot definitively diagnose any medical or mental health conditions. Diagnostic Criteria
- 16. Persistent eating of non-nutritive, nonfood substances for a period of at least one month. The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual. Diagnostic Criteria
- 17. The eating behavior is not part of a culturally supported or socially normative practice. If occurring with another mental disorder, or during a medical condition, it is severe enough to warrant independent clinical attention. Specify if: In remission: After full criteria for pica were previously met, the criteria have not been met for a sustained period of time. Diagnostic Criteria
- 18. P I C A Persistent eating of nonfood substances for at least one month Intentional consumption of nonnutritive substances that are inappropriate to individual's developmental level Culture and social norms are not bases of explanations for the behavior Another mental disorder is present
- 19. Typical substances ingested tend to vary with age and availability. A. Eating of one or more non-nutritive, non-food substances on a persistent basis over a period of at least 1 month that is severe enough to warrant clinical attention. Diagnostic Features
- 20. The term non-food is included because the diagnosis of Pica does not apply to ingestion of diet products that have minimal nutritional content B. The eating of non-nutritive, non-food substances must be developmentally inappropriate. Diagnostic Features
- 21. A minimum age of 2 years is suggested for a Pica diagnosis to exclude developmentally normal mouthing of objects by infants that results in ingestion. C. The behavior must not be part of a culturally supported or socially normative practice. Diagnostic Features
- 22. The eating of nonnutritive, nonfood substances can be an associated feature of other mental disorders (e.g., intellectual disability [intellectual developmental disorder], autism spectrum disorder, schizophrenia). D. If the eating behavior occurs exclusively in the context of another mental disorder, a separate diagnosis of Pica should be made only if the eating behavior is sufficiently severe to warrant additional clinical attention. Diagnostic Features
- 23. Etiology
- 24. Pica is considered a multifactorial phenomenon due to the fact that there is no known cause for it and that there are numerous possible etiologies. There have been several hypotheses put forward in an attempt to explain this behavior, including nutritional and dietary factors as well as psychological and biochemical disorders The cultural, ethnic, and family practices of people are among the other areas being investigated for possible causes. Etiology
- 25. Pica is associated with an insufficient diet and nutritional deficiencies in iron, calcium, zinc, and other vitamins, among other nutrients. Nutritional Factors
- 26. Pica is a learned behavior More prevalent in environments with less social interaction. Children who experience neglect are at higher risk of developing Pica disorder People with certain mental health conditions like Obsessive-Compulsive Disorder (OCD) and Schizophrenia may develop pica as a coping mechanism Psychological Factors
- 27. In some impoverished countries, eating dirt or clay is not done out of choice, but rather as a result of a lack of food supplies in the area. This is what the children and women of these countries consume in order to appear full enough to get them through the day without experiencing hunger pangs. Ethnic/ Cultural Factors
- 28. Can be categorized according to the type of substance ingested: clay ingestion ice ingestion excessive starch consumption may contain a wide variety of toxic contaminants such as lead, mercury, arsenic, fluoride, etc. Geophagia Pagophagia Amylophagia Other Substances Pica Complications Nasser, Y. A. (2021, July 29). Pica. StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532242/
- 29. Epidemiology
- 30. The actual number of those affected by pica is unclear due to under-reporting among affected subjects. However, it is most likely more prominent in developing countries. Prevalence of Pica Fawcett, E., Fawcett, J., & Mazmanian, D. (2016). A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. International Journal of Gynaecology and Obstetrics. 133 (3): 277–283. doi:10.1016/j.ijgo.2015.10.012. ISSN 1879-3479. PMID 26892693
- 31. 27.8% 68% Prevalence of Pica Fawcett, E., Fawcett, J., & Mazmanian, D. (2016). A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. International Journal of Gynaecology and Obstetrics. 133 (3): 277–283. doi:10.1016/j.ijgo.2015.10.012. ISSN 1879-3479. PMID 26892693 27.8–68% of pregnant women experience pica Pica is present in up to 50% of children aged 18–36 months Pica can be seen in 10% of people who are mentally challenged Pica is present in 10% of children older than age 12 There are some studies from the United States that shed light on pica prevalence:
- 33. The first line of treatment for individuals with pica eating disorder is addressing the illness from ingesting nonfood items, such as constipation, diarrhea, ulcer, intestinal tear, infection, or any combination of these. They are treated as advised by their physician or a medical professional. Lead poisoning can also be acquired from eating items with chemicals like paint chips, in which case chelation therapy is prescribed. Chelation therapy is a method for removing heavy metals, such as mercury or lead, from the blood (Cafasso, 2018). Together with medications, this allows the individual to excrete the lead in their urine. Treating complications from nonfood items
- 34. In some cases, pica is caused by malnutrition or nutritional deficits. The doctor would prescribe vitamin or mineral supplements to address this. For example, if the individual has iron or zinc deficiency, they will be given iron supplements or vitamins to treat the eating disorder (Holm, 2012). Usually, pica symptoms would disappear after nutritional treatment (Monroe, 2018). If pica symptoms persist despite addressing the illnesses and nutritional deficits, psychological intervention is done. Vitamin or mineral supplements
- 35. In collaboration with a mental health team, the eating behavior is addressed by identifying the underlying psychological factors leading to the disorder. The Handbook for Clinical Child Psychology currently supports general behavioral strategies as the most effective treatment approach for pica, with training in which foods are edible and which foods cannot be eaten through the use of positive reinforcement (WebMD, 2005). The doctor may also order psychological evaluation to determine if the individual has another underlying mental health condition, such as OCD or autism spectrum disorder (Holm, 2012). Treatment would vary depending on the diagnosis. Prescriptions may require therapy, medication, or both. Psychological evaluation and behavioral interventions
- 36. It is advised that individuals who exhibit symptoms of pica, or people who know of individuals who do, would consult physicians and medical professionals for treatment and recommendations on how to address the symptoms. Should psychological and behavioral intervention be sought, it would be as ordered by the medical professional. As such, the individual can consult a recommended mental health professional in such case. Who to consult?
- 37. Where to seek help? National Eating Disorders Association (NEDA) Philippine Mental Health Association (PMHA) National Center for Mental Health (NCMH) National Association of Anorexia Nervosa and Associated Disorders (ANAD) If you are in a crisis and need help immediately, text “NEDA” to 741741 to be connected with a trained volunteer at Crisis Text Line. For counseling, you may get in touch with them via Facebook Messenger, through pmhacds@gmail.com, or contact them at (02) 8921-4958 0917-565-2036. For free psychosocial support, mcc@ncmh.gov.ph/pro@ncmh.gov.ph, landline (02) 531 9001, or you may reach your regional DOH helpline through bit.ly/DOHhelplines ANAD is a professionally supported and peer- run support group for people with eating disorders. You may join ANAD's support group through https://bit.ly/ANADSupport or contact them through their helpline at 1 (888)-375- 7767.
- 39. A. Keep a look out for potentially dangerous pica items. B. Tell others (guidance counselor, health professionals) about pica. C. Request support, for example from learning disability/autism or mental health services. D. Provide safe alternatives to chew/bite and eat. E. Distract away from pica and increase engagement in other activities. For parents/carers: National Autistic Society. (2022). Understanding and managing pica. Autism.org.uk. https://www.autism.org.uk/advice-and-guidance/professional-practice/managing-pica
- 40. A. Work together to manage risk and share information. B. Provide access to regular physical health checks. C. Provide services to assess and diagnose pica. D. Include information about pica in medical records, care plans and education and health care plans (EHCPs). E. Seek additional training/resources on pica. For professionals: National Autistic Society. (2022). Understanding and managing pica. Autism.org.uk. https://www.autism.org.uk/advice-and-guidance/professional-practice/managing-pica
- 41. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Cafasso, J. (2018). What Does Chelation Therapy Treat? Healthline; Healthline Media. https://www.healthline.com/health/chelation-therapy Fawcett, E., Fawcett, J., & Mazmanian, D. (2016). A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. International Journal of Gynaecology and Obstetrics. 133 (3): 277–283. doi:10.1016/j.ijgo.2015.10.012. ISSN 1879-3479. PMID 26892693 Holden, J. (2017). Eat dirt? Why on earth would you do that? The Irish Times; The Irish Times. https://www.irishtimes.com/life-and-style/health-family/eat-dirt-why-on-earth-would-you-do-that-1.2934821 Holm, G. (2012). Everything You Need to Know About Pica. Healthline; Healthline Media. https://www.healthline.com/health/pica#treatment Khan, Y. & Tisman, G (2010). Pica in iron deficiency: a case series. Journal of Medical Case Reports. https://doi.org/10.1186/1752-1947-4-86 Mental Health and Pica. (2005). WebMD; WebMD. https://www.webmd.com/mental-health/mental-health-pica Monroe, J. (2018). Pica Disorder and How to Treat It. Newport Academy; Newport Academy. https://www.newportacademy.com/resources/mental-health/pica-eating-disorder/ Mpondo, B., Mwasada, G., & Nyundo, A. (2013). Pica as a persistent eating disorder associated with iron deficiency anaemia: two case reports. South Sudan Medical Journal. http://www.southsudanmedicaljournal.com/archive/august-2018/pica-as-a-persistent-eating-disorder- associated-with-iron-deficiency-anaemia-two-case-reports.html Pica Myths. (2019). The Recovery Village Drug and Alcohol Rehab; The Recovery Village Drug and Alcohol Rehab. https://www.therecoveryvillage.com/mental-health/pica/pica-myths/ Rice, A. (2021). What Is Pica? - Pica Eating Disorder. Familydoctor.org. https://familydoctor.org/condition/pica/ References:
- 42. What's your favorite takeaway? What can we do to raise more awareness about Pica? Why is it important to learn about Pica? How can we be more sensitive towards people with eating disorders?
- 43. end