The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders as a guidebook for mental health professionals, that details all of the diagnostic criteria for various mental disorders, including feeding and eating disorders. It is now in its fifth edition. One disorder included under feeding and eating disorders is a diagnosis known as pica, an issue that occurs when someone continues to eat nonfood or non-nutritive substances
In order to meet the criteria for a diagnosis of pica, a person must meet all of the following:
- The eating of nonfood (or nonnutritive) substances for at least one month. These substances may be almost anything but some more common examples are the eating of things such as dirt, rocks, clay, hair, metal, chalk, soap, powder, charcoal, ash, starch, ice, paint, feces (also known as coprophagia) or paper.
- This eating of nonfood substances is inappropriate for the developmental level of the person – thus excluding the normal issues surrounding small children who put many nonfood objects in their mouth.
- This behavior is not part of a culturally supported or social practice.
- If this behavior occurs alongside another mental disorder or medical condition, it is severe enough to warrant attention by a professional – meaning that even if the person is suffering from a nutritional deficit, developmental delay, pregnancy, or some other issue – the diagnosis of pica may still be appropriate.
Occasionally, people suffering from pica will have some type of nutritional deficit that seems to trigger the craving for specific nonfood items. However, for the majority of cases no such deficit exists. Pica is seen both in men and women although is often reported as a symptom specific to pregnancy. It is more common among children and people than adults.
Unfortunately, many cases of pica come to the attention of medical professionals only when the person experiences some physical complication from eating nonfood substances. These issues can include, but are not limited to, intestinal or bowel obstruction by the nonfood substance, intestinal perforation (if the substance is sharp), or infections. In rare cases, pica can be fatal, depending on the substances that the person ingests.
Pica is often seen alongside other mental disorders and among people struggling with intellectual disabilities and developmental delays, including autism. Among people with anorexia nervosa, pica is sometimes seen as a method to control appetite, as sufferers will eat non-nutritive objects in order to ‘feel full’ rather than eating actual food. Other people who struggle with self-injury and/or cutting may also purposefully swallow harmful objects such as pins or needles as part of a pattern of hurting themselves.
The treatment of pica varies based on if there is a triggering or primary diagnosis and the developmental stage of the person being treated. For instance, if there is a nutritional deficit that has led to the pica, the treatment would be focused on correcting that deficit. For people with anorexia nervosa as a primary diagnosis, treatment would focus on the eating disorder rather than simply focusing on the symptom of pica. However, the primary treatment of pica itself includes behavioral therapies including positive reinforcement when the person eats only food. For those people who also have developmental disabilities, applied behavioral analysis (behavior modification) shows the most promise for successful treatment.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Ing, A.D., Roane, H.S., Veenstra, R.A. (2011). Functional analysis and treatment of coprophagia. Journal of Applied Behavioral Analysis, 44(1), 151-155.
Matson, J.L., Hattier, M.A., Belva, B., Matson, M.L. (2013). Pica in persons with developmental disabilities: Approaches to treatment. Research in Developmental Disabilities, 34(9), 2564-2571.