Pica – More Understanding and Less Judgment

What is pica and who is most likely to develop the disorder? Are you aware of the signs and health risks of pica? If you don’t know, then you’re amongst the majority. Although rare, symptoms associated with pica syndrome have been documented by medical professionals for centuries. In the 21 st Century, however, there is still widespread stigma and sensationalism of the illness.

In this blog, we’ll explain what pica is. Drawing from some of the available research, we’ll look at who pica affects, as well as possible causes and health risks of the disease. At UKAT, we’d also like to see more compassion towards people with pica, so they feel supported to seek professional help and recover.

What Is Pica?

Pica is a rare eating disorder (or feeding disorder) where people develop cravings for and swallow inedible items. These can include soil, clay, paint chips, plaster, soap, detergent, shampoo, paper, chalk, stone, coins, bricks, cigarette ends, hair, clothing, toothpaste or any other non-food objects. Pica sufferers may have one particular item that they consume or many different things. In serious cases, pica can lead to severe or fatal medical consequences, including poisoning, gastrointestinal obstruction or disease, dental and oral problems, parasites and other infections, problems in pregnancy and more. Although there’s limited research into the causes and most effective treatments, studies have shown the ways in which pica affects children and adults. Certain population groups are much more susceptible to the disease than others.

Who Does Pica Affect?

Pica can affect people of all ages but it’s most common for pica to start in childhood.

Pica in children over the age of 2: In children under 2 years old, pica is not usually diagnosed. This is because young children go through a developmental stage of putting non-edible objects into their mouth. It’s part of exploring their world and learning through sensory input. During this phase, some babies and toddlers accidentally swallow non-food items.

In children over the age of 2, a diagnosis of pica is made when a regular pattern emerges of seeking out and swallowing non-food items – usually for a period of at least one month.

Research suggests that psychosocial stress may be an important factor in why some children develop pica – including where a child experiences maternal deprivation, parental separation, neglect, abuse or lack of parental interaction.

Pica in children and adults with learning disabilities: Children and adults with learning disabilities are between 4% and 26% more likely to develop pica, than people without a learning disability. The prevalence of pica increases, the more severe the disability.

Pica and autism: The National Autistic Society says there can be medical, dietary, sensory or behavioural reasons why people with autism develop pica. These include not understanding the difference between edible and non-edible items, seeking sensory input, relieving anxiety or avoiding a demand.

Pica and malnourishment: Some scientists point to malnourishment, including mineral deficiency, as a factor in why people develop pica. Lack of iron, zinc or calcium, for example, may lead to people craving and eating non-food items. It’s unclear exactly what processes within the body result in the symptoms of the disease, however. Additionally, eating items such as clay may actually exacerbate iron deficiency, as clay binds to iron in the gastrointestinal tract.

Pica in pregnancy and postpartum: Eating non-food items has long been associated with pregnant women. Vitamin or mineral deficiency may be a cause, but nutritional problems are as likely to happen as a result of pica. There are also other theories around why pregnant women develop pica, including increased sensory sensitivity to certain smells, tastes and textures. There are also sometimes cultural explanations, as to why certain populations practise pica.

A 2016 meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period estimated that 27.8% of women developed the condition while pregnant or after giving birth. Amongst this group, researchers found that pica occurred more in Africa than elsewhere in the world. Pica increased as the
prevalence of anaemia increased. The disorder decreased with higher levels of education.

Pica in people with common and severe mental health illnesses: The Eating Disorder charity, BEAT, say that pica may be more likely to occur alongside other mental illnesses, including depression, obsessive-compulsive disorder (OCD), trichotillomania (hair pulling), excoriation disorder (skin picking) and schizophrenia.

What Are the Health Risks of Pica?

The health risks of pica vary greatly, depending on the substance(s) or object(s) ingested, for how long and whether there are co-existing mental illnesses or

Injuries to teeth: Regularly ingesting items such as bricks, coins or stones can cause extensive damage to teeth. A report, published in 2014 in the Journal of International Society of Preventative and Community Dentistry, a detailed case history of a 7-year old girl who had consumed brick pieces for several years. On examination, many of her teeth showed severe attrition and she had multiple dental caries. Iron, zinc and calcium deficiency were found to be factors in why she developed pica.

Choking, blockages or damage to the gastrointestinal tract: Young children who develop pica are most at risk of choking, blockages and gastrointestinal damage, especially if they consume hard, sharp or large objects or caustic and toxic substances. Adults are also at risk of these complications. Equally, damage can be done to the mouth, throat, oesophagus, stomach, intestines, rectum or anus, as indigestible items pass along the gastrointestinal tract. Some non-food items can get stuck inside the body and they can be very difficult to detect and extract unless there is localised pain. Non-metallic foreign bodies such as
plastics, for example, would not show up on X-ray examinations (whereas coins would).

Vomiting: Ingesting poisonous non-food items can cause vomiting, as can harmful bacteria that cause infection.

Parasitic and other infections: Eating non-food items such as soil or clay risks introducing parasites and other infections to the body. Parasitic infections from animal faeces, such as toxoplasmosis, may be present in the soil. If you’re infected with toxoplasmosis in pregnancy, there is a risk of serious
harm to your baby and miscarriage. There are also soil-related bacterial and fungal infections.

Poisoning: Lead poisoning is the most common poisoning associated with pica. [8] This can occur when people with pica eat paint chips in older houses, where lead-based paints have been used.

Poor absorption of minerals and malnourishment: Some non-food items bind to and prevent the absorption of vital minerals such as iron. Although malnutrition may be a factor in pica developing, the disease tends to exacerbate malnourishment over time rather than relieving it.

Problems for pregnant women and foetuses: Pregnant women with pica risk all of the above health problems. Additionally, preeclampsia, eclampsia and dysfunctional labour due to faecal impaction may present serious problems, including risks to the mother’s life. The risks to the foetus(es) include premature birth, perinatal mortality, low birth weight, malnutrition, exposure to toxic chemicals/ heavy metals and decreased head circumference.

Compassionate Treatment for People with Pica

Due to the nature of the illness, there are times when individual cases about pica make the news with very sensational headlines. These stories tend to focus on the items people crave and consume, with an emphasis on shocking or extreme behaviours. As with all mental illnesses and/or addictive disorders, there is always a person beneath the specific symptoms of illness, who needs specialist treatment and support to recover.

At UKAT, we take a non-judgmental approach to all addictive disorders, including where there’s a dual diagnosis of mental illness and addiction. Pica may be present alongside another addiction, such as alcohol abuse, drug dependence, gaming disorder or sex addiction. There may also be significant unresolved trauma, which is the driving factor behind this rare eating disorder.

In cases where people with pica are severely malnourished, physically injured or mentally unwell, spending time in the hospital may be necessary to stabilise, before
residential rehabilitation can start. The UKAT Admissions team can advise on your treatment options including admissions criteria. Please get in touch to talk about your situation today.