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Pica (disorder)
Classification and external resources

Stomach contents of a psychiatric inmate with pica
ICD-10 F50.8, F98.3
ICD-9 307.52
DiseasesDB 29704
eMedicine ped/1798
MeSH D010842

Pica is a medical disorder characterized by an appetite for substances largely non-nutritive (e.g. metal (coins, etc), clay, coal, soil, feces, chalk, paper, soap, mucus, ash, gum, etc.) or an abnormal appetite for some things that may be considered foods, such as food ingredients (e.g., flour, raw potato, raw rice, starch, ice cubes, salt).[1] In order for these actions to be considered pica, they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate. The condition's name comes from the Latin word for magpie, a bird which is reputed to eat almost anything.[2] Pica is seen in all ages, particularly in pregnant women, small children, and those with developmental disabilities.

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 (in some countries) or prior to the cessation of the use of contaminated oil (either used, or containing toxic PCBs or dioxin) to settle dust. In addition to poisoning, there is also a much greater risk of gastro-intestinal obstruction or tearing in the stomach.[citation needed] This is also true in animals. Another risk of dirt eating is the possible ingestion of animal feces and the accompanying parasites. Pica can also be found in animals, and is most commonly found in dogs.

Contents

Causes

The scant research that has been done on the causes of pica suggests that the disorder is caused by mineral deficiency in many cases, typically iron deficiency which is sometimes a result of celiac disease.[3] Often the substance eaten by someone with pica contains the mineral in which that individual is deficient. More recently, cases of pica have been tied to the obsessive–compulsive spectrum, and there is a move to consider OCD in the etiology of pica;[4] however, pica is not currently recognized by the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as being a mental disorder. Sensory, physiological, cultural, and psychosocial perspectives have also been used by some to explain the causation of pica.

Mental health conditions, such as obsessive-compulsive disorder (OCD) and schizophrenia can sometimes cause pica.[citation needed] It was suggested that stress associated with traumatic events is linked to pica disorder. Some of the traumatic events common in individuals with pica include maternal deprivation, parental separation or neglect, child abuse, disorganized family structure and poor parent-child interaction.[citation needed] Pica may also be a symptom of iron deficiency anemia secondary to hookworm infection.[citation needed] Symptoms may also include a bluish hue to the skin, particularly around the mouth.[citation needed]

However, pica can also be a cultural practice not associated with a deficiency or disorder. Investigation of kaolin (white dirt) ingestion among African-American women in the U.S. state Georgia shows the practice there to be a DSM-IV "culture-bound syndrome" and "not selectively associated with other psychopathology".[5] Similar kaolin ingestion is also widespread in parts of Africa.[6] Such practices might stem from health benefits such as clay's ability to absorb plant toxins and protect against toxic alkaloids and tannic acids.[7]

Unlike in humans, in dogs or cats, pica may be a sign of immune-mediated hemolytic anemia, especially when it involves eating substances such as tile grout, concrete dust, and sand. Dogs exhibiting this form of pica should be tested for anemia with a CBC or at least hematocrit levels.[8][9]

Prevalence

Few studies have been conducted to measure the prevalence of pica in various populations. Two prevalence studies conducted on pregnant women in the 1990s found rates of 8.1% for pregnant African American women in the U.S.[10] and 8.8% for pregnant women in Saudi Arabia.[11] Rates of pica among pregnant women in developing countries can be much higher, however, with estimates of 63.7%[12] and 74.0%[13] reported for two different African populations. This is due to different cultural norms as well as greater levels of malnutrition. Two studies of mentally retarded adults living in institutions found that 21.8%[14] and 25.8%[15] of these groups suffered from pica. Prevalence rates for children with and without developmental disabilities are unknown.

Treatment

Treatment for pica will vary based on the patient's category (child, developmentally disabled, pregnant, or psychopathic) and may emphasize psychosocial, environmental, and family guidance approaches. An initial approach often involves screening for and, if necessary, treating any mineral deficiencies or other comorbid conditions.[3] For pica that appears to be of psychotic etiology, therapy and medication such as SSRIs have been used successfully.[16] However, previous reports have cautioned against the use of medication until all non-psychotic etiologies have been ruled out.[17]

Some 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.[citation needed] These medications enhance dopaminergic functioning, which is believed to be associated with the occurrence of pica.[citation needed]

Behavior-based treatment options can be useful for developmentally disabled or mentally retarded individuals with pica. These may involve associating negative consequences with eating non-food items or good consequences with normal behavior, and may be contingent on pica being attempted or initiated regardless of a pica attempt. A recent study classified nine such classes of behavioral intervention:[18]

  • Presentation of attention, food, or toys, not contingent on pica being attempted
  • Differential reinforcement, with positive reinforcement if pica is not attempted and negative reinforcement if pica is attempted
  • Discrimination training between edible and inedible items, with negative consequences if pica is attempted
  • Visual screening, with eyes briefly for a short time after pica is attempted
  • Aversive presentation, contingent on pica being attempted:
    • oral taste (e.g., lemon)
    • smell sensation (e.g., ammonia)
    • physical sensation (e.g., water mist in face)
  • Physical restraint:
    • self-protection devices that prohibit placement of objects in the mouth
    • brief restraint contingent on pica being attempted
  • Time-out contingent on pica being attempted
  • Overcorrection, with attempted pica resulting in required washing of self, disposal of nonedible objects, and chore-based punishment
  • Negative practice (nonedible object held against patient's mouth without allowing ingestion)

Examples

Chalky stone composed of kaolinite with traces of quartz ingested by a patient with pica.

Notes

  1. ^ emedince.com article on "Eating Disorder: Pica"
  2. ^ http://www.wenwen.ws/bird/Birds/crows-and-magpies-whats-their-favourite-food-f5wg02698.htm
  3. ^ a b Rose, E.A., Porcerelli, J.H., & Neale, A.V. (2000). "Pica: Common but commonly missed". The Journal of the American Board of Family Practice 13 (5): 353–358.  PMID 11001006
  4. ^ Hergüner, S., Ozyildirim, I., & Tanidir, C. (2008). "Is Pica an eating disorder or an obsessive-compulsive spectrum disorder?". Progress in Neuro-Psychopharmacology & Biological Psychiatry 32 (8): 2010–2011.  PMID 18848964
  5. ^ R. Kevin Grigsby, et al. "Chalk Eating in Middle Georgia: a Culture-Bound Syndrome of Pica?" Southern Medical Journal. 92.2 (February 1999). pp.190-192.
  6. ^ Franklin Kamtche. "Balengou : autour des mines." (Balengou : around the mines) Le Jour. 12 January 2010. Retrieved 1 March 2010. (French)
  7. ^ Marc Lallanilla. "Eating Dirt: It Might Be Good for You." ABC News. 3 October 2005. Retrieved 1 March 2010.
  8. ^ Plunkett, Signe J. (2000). Emergency Procedures for the Small Animal Veterinarian. Elsevier Health Sciences. pp. 11. ISBN 0702024872. 
  9. ^ Feldman, Bernard F.; Joseph G. Zinkl, Nemi Chand Jain, Oscar William Schalm (2000). Schalm's Veterinary Hematology. Blackwell Publishing. pp. 506. ISBN 0683306928. 
  10. ^ Edwards, C.H., Johnson, A.A., Knight, E.M., Oyemade, U.J., Cole, O.J., Westney, O.E., et al. (1994). "Pica in an urban environment". The Journal of Nutrition 124 (6 Suppl): 954S-962S.  PMID 8201446
  11. ^ al-Kanhal, M.A., & Bani, I.A. (1995). "Food habits during pregnancy among Saudi women". International Journal for Vitamin and Nutrition Research 65 (3): 206–210.  PMID 8830001
  12. ^ Nyaruhucha, C.N. (2009). "Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania". Tanzania Journal of Health Research 11 (1): 29–34.  PMID 19445102
  13. ^ Ngozi, P.O. (2008). "Pica practices of pregnant women in Nairobi, Kenya". East African Medical Journal 85 (2): 72–79.  PMID 18557250
  14. ^ Ashworth, M., Hirdes, J.P., & Martin, L. (2009). "The social and recreational characteristics of adults with intellectual disability and pica living in institutions". Research in Developmental Disabilities 30 (3): 512–520.  PMID 18789647
  15. ^ Danford, D.E., & Huber, A.M. (1982). "Pica among mentally retarded adults". American Journal of Mental Deficiency 87 (2): 141–146.  PMID 7124824
  16. ^ Bhatia, M.S., & Gupta, R. (2007-05-11). "Pica responding to SSRI: An OCD spectrum disorder?". The World Journal of Biological Psychiatry.  Online publication ahead of print. PMID 17853279
  17. ^ Fotoulaki, M., Panagopoulou, P., Efstratiou, I., & Nousia-Arvanitakis, S. (2007). "Pitfalls in the approach to pica". European Journal of Pediatrics 166 (6): 623–624.  PMID 17008997
  18. ^ McAdam, D.B., Sherman, J.A., Sheldon, J.B., & Napolitano, D.A. (2004). "Behavioral interventions to reduce the pica of persons with developmental disabilities". Behavior Modification 28 (1): 45–72.  PMID 14710707
  19. ^ Why Kenyan women crave stones BBC News

External links


Simple English

Pica is an eating disorder where a person wants to eat things that are not normal to eat, for example nails, rocks or feces. A person with Pica may also have a strong want to eat unusual things that are normally considered food but not in the normal way, for example, uncooked potatoes, flour or starch.








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