Pathophysiology Pica is a mysterious disorder because of the changing possibilities that make up the definition of Pica suitable for diagnosis

Pica is defined as an eating disorder in which the person consumes things that are not deemed edible. Kids with Pica, however, go beyond this innocent exploration of their surroundings. Between 10% and 30% of kids ages, 1 to 6 has the eating disorder pica, characterized by persistent and compulsive cravings (lasting one month or longer) to eat nonfood items(Pica, 2014). Although doctors do not fully understand the cause of Pica, there is a correlation of Pica with individuals with developmental problems, such as intellectual disabilities, Obsessive convulsive disorder, and malnutrition or hunger. Iron-deficiency anemia and malnutrition are two of the most common causes of Pica, followed by pregnancy. In these individuals, Pica is a sign that the body is trying to correct a significant nutrient deficiency(Pica, 2017). Additional causes of Pica can be a result of stress, cultural factors, low economic status, pregnancy, and learned behaviors.

Pica is a mysterious disorder because of the changing possibilities that make up the definition of Pica suitable for diagnosis. In the Diagnostic and Statistical Manual of Mental Disorders, DSM 4 pica is classified as a feeding and eating disorder considered in infancy or early childhood. According to DSM 4, a confirmed diagnosis would require that the patient meet the criteria, including the determination to eat nonnutritive substances for at least one month. The behavior is inappropriate for the developmental level. The behavior is not a culturally sanctioned practice.

In some cases, Pica can include a dislike of eating food items. However, the criteria have been changed a little for recent considerations regarding the nature of Pica. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) notes a critical word change from the previous edition. This change was the substitution of the word “nonnutritive” with the word “non-food.” This change was significant because individuals could consume products that did not contain nutrients but were still considered food items. A typical example of this situation is diet soda consumption, which does not have substantial amounts of nutrients but is still considered a food item. If the old criteria for a pica diagnosis were still applicable, there would be larger numbers of people with pica diagnoses, which would take time away from the people who needed treatment. Due to such confusion regarding diagnosis criteria changes, the importance of discussing etiological theories, assessment, prevention, and treatment recommendations for Pica is critical (Chalker, 2017).

DSM -5 Criteria:

Pica is categorized as a feeding disorder that must meet the following criteria.

Persistent eating of non-food substances over at least one month.

– Chalk, paint, clay, talcum powder, hair, soil, paper, ice, etc.

The eating of nonnutritive, non-food substances is inappropriate to the development level of the individual.

– Substances ingested usually tend to differ with age and accessibility.

– Pica is typical for an infant to put anything in the mouth; that is why diagnosis cannot be given before age 2years.

Pica eating disorder is not considered a culturally acceptable or regular practice.

– The patient’s culture should be reviewed before giving a diagnosis of Pica.

– Some culture, nonnutritive food is used due to the spiritual belief, as medical remedies, and other community accepted use.

If the eating behavior happened with another mental health disorder such as an intellectual disability or medical condition such as pregnancy, a further assessment would be required. Pica eating disorder can be a symptom of another mental health disorder such as autism spectrum disorder.

– Pica eating disorder can occur during pregnancy when pregnant women crave non-food substances for at least one month, such as soil (Sudduth et al., n.d.).

Pica is a compulsive eating disorder in which individuals eat non-food items (Leung & Hon, 2019). Pica affects adults, teens, and children. In children, it affects boys and girls equally (National Eating Disorders Association, 2020). Globally 20 percent of cases involve expectant mothers (Xiang et al., 2018).

The clinical presentation of Pica in children is highly variable and linked with the specific nature of the resulting medical conditions and ingested items. Physical findings may include stomach pain, stomach upset, blood in the stool, and bowel problems (Borgna-Pignatti & Zanella, 2016). These symptoms result from the poisonous, toxic, and bacterial content of the ingested non-food items. Repeated ingestion of non-food items for an extended period causes poisoning, intestinal blockage, teeth injury (tooth abrasion and surface tooth loss), and infections (National Eating Disorders Association, 2020).

Xiang et al. (2018) indicate that a child with Pica demonstrates repetitiveness and regularity of eating non-food substances consistently for more than a month. The child craves items such as crayons, paper, chalk, hair, dirt, and clay. Borgna-Pignatti & Zanella (2016) indicate that some children with Pica have nutrient deficits; for example, a child may have low iron, hemoglobin, or hematocrit. Leung & Hon (2019) suggest that Pica is the body’s way of replacing missing nutrients. Pica warning sign is consuming non-food items that are not part of cultural, religious, or social practice. Some cultures support eating clay as part of a medicinal course (Xiang et al., 2018). Another sign of Pica is eating non-food for children above the age of two years. Children below two years put objects in their mouths as part of the development and explore their senses. Mouthing at times result in ingestion (National Eating Disorders Association, 2020)

Acuphagia                           Sharp objects

Amylophagia                       Laundry starch

Cautopyreiophagia              Burnt matches

Coprophagia                        Human feces, animal dung

Foliophagia                         Leaves, grass, acorns, pinecones

Geomelophagia                    Raw potatoes

Geophagia                            Dirt, sand, clay

Lignophagia                         Wood, bark, twigs

Lithophagia                          Rocks, gravel, pebbles

Pagophagia                           Ice, freezer frost

Plumbophagia                       Paint chips (lead)

Tobaccophagia                      Cigarette butts

Trichophagia                         Hair  (Stiegler, 2005, Table 1)

Treatment of Pica

The first line of “treatment” for Pica is to test nutritional deficiencies as these are the most common culprits of the disorder (National Eating Disorders Association, n.d.). If a nutritional deficiency has been ruled out, behavioral therapy is initiated. There is no pharmacological treatment for Pica, though, on occasion, Zyprexa has been used for Pica that is resistant to behavioral interventions (Ellis & Pataki, 2016). This may be because it is hypothesized that Pica may be the result of too little dopamine (a neurotransmitter), and Zyprexa can increase dopamine levels in the brain (Ellis & Pataki, 2016). Most treatments, however, are behavioral.

Some common ways to help treat Pica from a behavioral standpoint include (Ellis & Pataki, 2016; Moline et al., 2020):

· Altering the environment,

· Family therapy,

· Discrimination training (teaching the difference between edible and inedible objects, often with rewards for desired behavior),

· Contingent reinforcement (using either rewards or penalties for desired or undesired behaviors),

· Use of “time outs.”

Brief physical restraint when necessary.