Pica Involves Eating Everything but Food: DSM-5, Causes, and Treatment
This article is cited and quoted in the Journal of the International Society of Preventative and Community Dentistry: 2014 Jan-Apr; 4(1): 1–4.
PICA: Diagnosis and Symptoms
America's psychiatric diagnoses manual, the DSM-5, published in 2013 and updated approximately once very two decades, shows eight types of eating disorders:
- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating Disorder
- Rumination Disorder
- Avoidant/Restrictive Food Intake Disorder
- Other Specified Feeding or Disorder (disorders that do not fit into the first seven)
I have worked largely with the diagnoses presented in the previous manuals (DSM IV and DSM IV-TR), but pica remains much the same, and I have seen a few cases of the disorder. The DSM-5 states that it often manifests itself in the presence of other mental disorder, and I have found that to be true thus far.
Source: Diagnostic and Style Manual of the American Psychiatric Association, DSM 5; 2013.
The criteria for a diagnosis of pica are listed below; however, if you or someone you know exhibits any of these symptoms, ask a doctor about them and possible treatments needed. We cannot actually make a diagnosis by matching a list of symptoms with a patient's behavior without the examination required for the condition.
- Strongly continuing to eat of non-food items for at least one month.
- This eating in No. 1 above is inappropriate to the developmental level of the individual.
- The eating in No. 1 above is not part of a culturally or socially usual/customary practice.
- If the eating in No. 1 occurs in the presence of another mental disorder (autistic spectrum disorder), or during a medical condition (pregnancy), and severe enough to warrant independent clinical attention, then it is diagnoses as pica.
Some of these unwanted behaviors accompanying pica can includes syndromes of behaviors that include:
- Abnormal language,
- Strange methods of play not used before, and
- Strange relationships with friends of the child's own age (peer group).
Look for these things to occur and call your pediatrician or family doctor (general practitioner or internist) and discuss them with him or her. The child may also pull out his or her own hair and eyelashes, and that is part of another syndrome. If this happens, call the doctor right away.
Also, keep a diary or a daily log of the times when your child chews on paper and other nonfood items and when he/she does not. Make a note of what happened just before the behavior occurred and how soon it is after a meal or before the next meal. Write down anything that you think is important about each particular instance of pica behavior. The log or diary would be helpful to your doctor. Like so many puzzling situations, if you start writing things down, you begin seeing patterns.
Pica Means "Magpie" in Latin
Pica comes from the Latin word that means magpie, which is a bird that is known for a big appetite to eat anything and everything.
Here are some of the things that children and adults sometimes eat, if they have been diagnosed with or show signs of pica, or have yet been un-diagnosed with any mental illness:
- Dirt / clay / mud; clay pottery shards
- Rubber erasers
- Pencil wood
- Play Doh
- Paint chips
- Baking soda
- Coffee grounds
- Cigarette ashes / Burnt match heads / Cigarette butts
- White Glue / White paste
- Hair, from head or hair brushes. Cat hair is a newer item
- Paper / cardboard
- Soap bars
- News favorites among non-food eaters are the melamine sponge and foam pillow stuffing.
Note: Eating some non-food items, as is done in cases of pica, can result in bladder cancer.
Melamine, a Non-Food Protein
Scientific American Magazine researchers found that melamine, a high-nitrogen containing, non-food protein is added to food illegally to boost protein content for the nutritional label. It was used as protein for cattle to eat from 1958 through 1978, when it was found that it does not metabolize efficiently enough to be as effective as desired.
When eaten by humans in quantity, the end results of this melamine can be bladder cancer.
Source: Alison Snyder. "Protein Pretense." Scientific American Magazine. August 2007.
Materials like glass, plastic and metal are not changed in their passage through the bowel and might, in theory at least, be more hazardous than natural substances. Occasionally children or people in disturbed mental states swallow these sorts of things deliberately and it is remarkable how rarely they develop problems.— Core Charity
Sponge Material Is a Big Non-Food Item In Pica
Possible Causes of Pica
The act or habit of eating things that are not food is called "pica" in medical and psychological textbooks. For children, who learn about the world by putting things into their mouths, pica is really fairly common. I remember kids in elementary school eating pencils, erasers, paste... and a few crayons.
Some of the children were bored and some did not realize they were chewing on nonfood items, because they were thinking hard about a test question or a math problem. There were a lot of pencils with teeth marks on them elementary school. I see them in libraries and college classrooms on occasion even today and they make me laugh.
Unfortunately, some children do not have breakfast at home and they eat paper and other items, just because they are hungry and need to survive. Hopefully, subsidized school and summer breakfast and lunch programs are reaching most of them and they are receiving at least one or two meals a day in school. This initiative has helped a lot in the past 20 years.
One other serious possibility to consider is that pica can be—but not always is—associated with Obsessive-Compulsive Disorder (OCD), but a licensed doctor or other qualified practitioner needs to determine that, with the input of the patient.
Developmentally, babies—more than elementary school kids—have a period of growth in which they put just about everything they find into their mouths, even their own feet. They usually go on to something more exciting that catches their attention and forget what they had in their mouths. When a child that has passed this developmental point and is older, but who suddenly begins to eat nonfood items once again, there may be a problem of some kind. In this case, there is likely some cause for it that can be found and eliminated, however.
The Autism Connection
Stress and Developmental Causes
Think about, and ask your child about, any new or recurring stresses in his life—a new baby at home, changing schools, a new job for a parent, a bully at school, etc. Remember that every time you move before the child is 5 years old will generally make him/her regress in maturity a bit for a while, but this will usually remedy itself. An example of this is bedwetting that begins with a move and ends when the child is more steeled in a routine.
If you suspect emotional or developmental problems, talk with your doctor ASAP. If everything seems fine and the blood tests are normal, ask your doctor if it is just a habit. If so, then try to keep paper and other nonfood items away from your child, if he/she is very young.
Fortunately, two very likely causes can be examined through a simple blood test. The first cause is easy to cure and if either cause is found to be at fault, steps can be taken to correct both problems. These causes are curable, including:
- low iron in the blood (anemia) and
- high blood level of lead.
Lead exposure is a problem for many children that live or visit for extended periods of time in older houses that have lead-based paint in them. These houses were built mainly before the 1970s and lead paint was outlawed in 1978). However, other sources of lead include certain types of medications, some kinds of pottery, and several other sources. The blood test for lead and anemia will help you to begin to narrow down the cause of eating paper and plastic and such.
There are other possibilities for the manifestation of pica in children. Some kids develop pica as a symptom of emotional distress. Some others experience developmental disorders that lead to longer periods of time eating nonfood items, or to returning to the behavior. Many of these problems would most likely not manifest only as pica, however. Other behaviors and symptoms would likely begin to appear.
Treatment may not even be required, but talk to your doctor to be sure.
Pica treatment can involve several kinds of licensed professionals, depending on the reasons for the disorder and the various symptoms and related syndromes.
A medical doctor must first look for for physical problems causing the pica—and then also look for physical problems that are being caused by it. It is vital that a medical practitioner be first to enter the case.
If there are socioeconomic matters involved, a social worker will become involved to provide education and guidance to remedy underlying problems such as poverty and the factors that are associated with it.
If psychological conditions are present, a licensed therapist or psychiatrist will become involved.
Questions & Answers
© 2007 Patty Inglish MS