Pica: Symptoms, Causes, and Treatment

Pica is an eating disorder that causes someone to crave and compulsively eat things that are not food, such as paint chips, dirt, paper, or hair. The disorder can lead to intestinal blockages, toxic side effects, and other health issues.

Pica is usually temporary and can affect pregnant people and others with iron-deficiency anemia or other nutrient deficiencies who may crave certain minerals found in dirt, or eat earthy material like clay. Pica disorder is also seen in people living with an autism spectrum disorder.

Pica in kids is not uncommon and is more prevalent in autistic kids and those with developmental or intellectual disabilities (pica is not diagnosed in those under age 2).

This article explains pica symptoms and health issues that may follow the ingestion of non-food material. It explains common types of pica and their causes, as well as pica treatment.

What Do People With Pica Eat?

Pica types have different names, based on describing the type of non-food items that people eat. Pica disorder examples include pagophagia, which refers to eating ice, and geophagia, which refers to eating dirt and clay.

Common items ingested by people (children and adults) with pica include:

• Dirt
• Paper
• Clay
• Animal feces
• Ice
• Paint chips
• Sand
• Hair
• Chalk
• Plants or grass
• Cigarette butts
• Rocks
• Toys (such as Lego bricks)
• Rubber bands
• Shampoo
• Cloth
• String
• Wool
• Talcum powder
• Gum
  

What Are the Causes of Pica?

Although the exact cause of pica is unknown, experts know that some conditions cause a person to be more at risk for developing pica. These include:

• Developmental disorders
• Intellectual disabilities
• Autism spectrum disorder
• Mental health conditions, such as schizophrenia or obsessive-compulsive disorder
• Those with malnutrition or who suffer from hunger, resulting in low levels of nutrients such as iron and zinc, which can trigger specific types of cravings
• Stress, such as in kids who have been abused or neglected or those living in severe poverty
• During pregnancy when, rarely, people crave dirt (which may be related to an iron deficiency)

Other Risk Factors

Pica can be linked with several other conditions, including:

• Hair pulling (a disorder called trichotillomania)
• Skin picking (a disorder called excoriation)

The overall number of people with pica is not clear, but it is thought to be more prevalent in developing countries than in the United States.

Pica in Autistic Children

Several factors have been linked with pica in autistic kids. The reasons these kids often crave nonfoods may include the following.

• Sensory feedback (also referred to as automatic reinforcement): This is the desire to eat nonfoods for a pleasurable feeling.
• An inability to decipher between foods and nonfoods: Some children eat nonfood items because they believe they are edible foods.
• Nutrient deficiency: This includes a lack of adequate levels of iron or zinc.

How Is Pica Diagnosed?

Pica is not diagnosed based on specific lab tests. A healthcare provider begins the diagnosis by taking a person's medical history and the reports from family members, particularly for children.

Other tests may then follow based on symptoms and what the person may be eating.

Diagnostic Tests

Pica disorders may be diagnosed based on tests that include:

• Blood tests to evaluate the possibility of anemia or low zinc or iron levels
• Stool samples to test for intestinal bleeding
• X-rays or other imaging tests to check for intestinal blockage
• Lead levels, to evaluate for lead poisoning if paint chips are ingested
• Tests to check for parasites or bacteria from eating dirt or other items
• Weight loss evaluation
• Testing for nutritional deficiencies

Qualifying Factors for a Pica Diagnosis

The criteria of symptoms that qualify a person to be diagnosed with pica include:

• Persistent eating of nonfood substances for one month or longer, even if the foods cause illness or discomfort such as nausea
• Ingesting a nonfood substance when it's not part of a culturally or socially supported practice, as is true in cultures that commonly eat clay for medicinal purposes.
• Eating nonfood items when it is developmentally inappropriate. For example, children ages 2 years and under commonly put items in their mouths and would not yet be diagnosed with pica.

The type of nonfood substances that are ingested often change according to a person's age and the availability of nonfood items.

What Are the Complications of Pica?

Most people with pica eat regular nutrient-filled foods in addition to ingesting nonfood items. But in many instances, those who are affected by pica are nutritionally malnourished. Pica disorders lead to symptoms that have a broad range, but they are all linked with the impact of nonfood items that are ingested.

Symptoms of pica occur as a result of the toxic or poisonous content as well as the bacteria in nonfood items that are ingested. The symptoms may include:

• Nausea
• Pain or abdominal cramping in the stomach
• Constipation
• Diarrhea
• Fatigue
• Behavior problems
• School problems
  

Because pica symptoms are linked to the substances ingested, some of these symptoms may lead to more serious complications.

These symptoms and conditions need to be evaluated more urgently by a healthcare provider. They include:

• Intestinal blockage, when stomach pain does not resolve
• Stomach ulcers, which may cause blood in the stools
• Symptoms of lead poisoning if paint chips that contain lead are ingested
• Electrolyte imbalances, in rare cases leading to seizure
• Injuries to teeth, such as broken or fractured teeth from chewing on hard nonfood items
• Infections caused by germs, and/or parasites that enter the body from the nonfood item that is swallowed
  

How Is Pica Treated?

Pica disorder treatment varies depending on the underlying factors linked with the condition. It's important for healthcare providers to address the symptoms that often result from pica.

These symptoms differ depending on which nonfood items are ingested. Common pica treatments include:

• Medications for constipation or diarrhea
• Treatment of stomach ulcers
• Antibiotic treatment for infections
• Nutritional supplements for nutrient deficiencies
• Addressing other medical problems, such as lead poisoning

Behavioral Treatment for Pica

Pica disorder behaviors have similar features to symptoms and patterns of other conditions, such as bulimia or obsessive-compulsive disorder. It's been seen in people with bipolar disorder.

Treatments that address the pica behavior itself may include:

• A referral to a mental health/behavioral health specialist
• Behavior modification programs to redirect a person's attention away from the nonfood object and reward the choice of appropriate food items
• Medication to help reduce the urges and impulses to eat nonfood items

Professionals

Professionals trained in treating pica may include:

• A behavior analyst, with experience in functional behavioral assessment and implementation of behavioral intervention
• A psychologist with experience in applied behavior analysis, which is a type of therapy aimed at improving specific behaviors
• A pediatrician who specializes in the treatment of behavioral issues

Outlook (Prognosis)

Pica disorder treatment may be successful, but it varies quite a bit depending on the underlying causes and any related factors. In kids, pica usually improves as they grow up. But for those with mental illness or developmental disorders, it commonly continues into the teenage years or even into adulthood.

Pica treatment has been found to be more successful in children who have undergone a medical assessment and behavioral evaluation by a mental health or medical professional. Behavioral assessments help to identify and treat associated problem behaviors, such as aggression.

A thorough medical evaluation can result in the effective treatment of underlying problems, such as nutritional deficiencies, which may end up resolving pica.  

Pregnant people with pica will often experience a resolution of symptoms when the pregnancy ends. Many kids with pica outgrow it, however, autistic kids or those with developmental or intellectual disabilities might experience pica symptoms for most or all of their lives.

Coping With Pica

Pica disorder can be very challenging. It’s important to reach out and find experienced local professionals trained in treating compulsive behavior conditions such as pica.

There are many strategies to help empower people with pica and, in turn, lower stress and build positive coping skills while dealing with specific issues. Specific strategies, such as chewing gum, avoiding non-food items that you crave, and keeping stress at bay can all be helpful coping strategies.

Some examples for parents of autistic children include the following:

• Blocking, or placing your hand on top of the child’s hand can prevent the child from putting the nonfood item into their mouth. This strategy helps to reduce pica for some kids.
• Snacking at frequent, regular time intervals (such as every 30 or 60 minutes) can provide options to the child other than eating nonfood items.
• Rewards, such as stickers, can be given when children refrain from pica behaviors. Positive reinforcement is a proven strategy to help parents change a child's unwanted behaviors.

Summary

Pica is a condition in which people consume non-food items, such as dirt, clay, paint chips, cloth, string, cigarette butts, or rubber bands. It occurs more commonly in autistic kids or with developmental or intellectual disabilities, pregnant people, as well as some non-pregnant adults. Nutritional deficiencies may be at the root of some types of pica. Treatment includes supplementing deficient nutrients, behavioral therapy, and medication. If you are concerned about yourself or a loved one consuming non-food items, speak to a healthcare professional to get help.