When someone thinks of an eating disorder, the “big three” – Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder – most often come to mind. What many don’t realize is that there are several other clinically recognized feeding and eating disorders. One of these diagnoses is a complex and lesser understood condition called Pica.
Pica is defined as the persistent and compulsive eating, over a period of at least one month, of non-food substances (such as paint or string) that are not developmentally appropriate for that age. It usually develops in childhood and often only persists for a few months.
Pica is common among children with developmental disabilities which can make the condition more difficult to treat or manage. An appropriate diagnosis of Pica does not include the consumption of non-food items that are ingested as part of a culturally supported and/or socially normative practice, such as eating clay for medicinal purposes.
Yes, most young infants put non-food items into their mouth. This is a developmentally normal approach for babies to explore and understand the world around them. Additionally, it is not uncommon for toddlers and some young children to ingest things like dirt or sand. It is when the behavior becomes repetitive, despite attempts to redirect or restrict it, when a Pica diagnosis may be considered.
Some important and interesting facts about Pica:
The name: “Pica” comes from the Latin word for magpie, a bird known for its large and random appetite.
Pica Risk factors: Can include pregnancy, malnutrition or other nutritional deficiencies; a family history of Pica; poverty, trauma and/or neglect; a co-occurring mental disorder such as schizophrenia, autism spectrum disorder; or an intellectual disability. It has also been associated with trichotillomania and excoriation (hair-pulling disorder and skin-picking disorder), and more recently to the obsessive-compulsive continuum.
Complications of Pica: Complications can include poisoning–which can potentially lead to brain damage, developmental disabilities or other issues. Nutritional deficiencies can occur when the consumption of non-food items interferes with regular eating. Non-digestible objects, hard or sharp items and bacteria or parasites can lead to constipation/blockages, esophageal or intestinal tears and/or various other infections.
Pica Treatment: A behavioral approach is generally the most effective intervention for treating Pica, typically involving the use of Cognitive Behavioral Therapy (CBT) to help build skills around distinguishing edible foods from non-edible ones. Family therapy is also utilized in the treatment and management of Pica, and applied behavior therapy is commonly used for those with intellectual disabilities.
Pica often goes unreported, and the prevalence of this disorder is unknown. However, due to the risks to both the physical and mental well-being of the individuals who engage in this behavior, the consumption of non-food items should be taken very seriously when reported or observed.
Fiona LaRosa-Waters is Community Relations Specialist for Walden Behavioral Care. She earned her Bachelor of Science degree in Human Services at Lesley University, and is currently pursuing an M.Ed in Health Education through the Eating Disorders Institute at Plymouth State University. Prior to coming to Walden, Fiona held positions as a professional outreach representative for eating disorder, substance use, and trauma treatment facilities, was a counselor in a treatment center for adult women with eating disorders and provided outpatient case management for clients struggling with addictions and eating disorders. She is passionate about helping people locate resources to support treatment and recovery, advancing education about eating disorders and addiction and about connecting with the mental health community.