Understanding pica as an eating disorder
SOME people may, like addicts do, crave dirt, soap and other non-nutritional products for consumption, a condition known as pica.
Though for these people the cravings can lead to destructive habits and yearning for these products above all others, psychiatrist Dr Roger Roberts said pica is not an addiction, but an eating disorder. He explained that for the condition to be referred to as pica, the eating of non-nutritious food would have to go on over a period of at least one month, and the habit deemed inappropriate to the developmental level of the individual.
“It is not diagnosed in individuals younger than two years old since mouthing of objects is considered to be a normal developmental behaviour in individuals at that age, nor is it diagnosed in individuals who ingest non-nutritive or non-food substances in keeping with their culture or social norm,” he said.
The psychiatrist, however, explained that depending on the type of material ingested, the condition may be harmless or have life-threatening consequences.
He said some common items that are normally ingested include clay, dirt, sand, starch, coal, chalk, wood, cigarette butts, pencil erasers, needles, hair, string, paint, pebbles and ice. But the exact cause is unknown.
“A number of hypotheses have been suggested. These include nutritional deficiencies, for example iron deficiency, stress, cultural and familial factors and low socio-economic status,” he said.
“A number of risk factors have been identified over the years. Common ones include brain injury, epilepsy, pregnancy, intellectual disability, autism spectrum disorder and environmental deprivation.”
Of note, Dr Roberts said pica is only diagnosed in pregnancy if the craving results in the intake of non-nutritive, non-food substances to the extent that the eating of these substances poses potential medical risks.
With regard to diagnosis, he said it is usually made based on a detailed medical and psychiatric history and physical examination, though some individuals only present for medical attention when they develop complications from pica.
As for complications, the psychiatrist said these are usually based on the type of substance ingested and may include lead toxicity, parasitic infections, ulcers, constipation, bowel obstruction, intestinal bleeds and nutritional deficiencies such as iron and zinc.
“There may be dental complications including severe tooth abrasion and surface tooth loss. While there is no particular investigation indicated in the evaluation of pica, based on the substance ingested and complication developed or suspected, blood tests and imaging studies may be needed. It is important to note that the diagnosis may be delayed because patients and their relatives may deny or refuse to tell the doctor that particular substance is being ingested by the patient because of embarrassment.”
With reference to treatment options, Dr Roberts said behavioural strategies are considered the most effective treatment for pica.
“Management of individuals with the disorder is done, usually including a multidisciplinary approach involving psychiatrist or psychologist, social worker, dentist and other specialists depending on complication(s) developed,” he said.
Dr Roberts said pica often remits without treatment in pregnant women and young children. He added that in some individuals, for example, those with intellectual disability and other developmental disorders, the condition may persist for years or indefinitely without treatment.
