Pica is related to persistent eating of dirt, paint, and similar substances which have no nutritional value in them. Research suggests the prevalence rate of the condition be about 4 to 26 percent in different institutionalized groups. In other populations, the prevalence is not discreetly estimated.
If the individual is undergoing persistent eating of such substances over a period of 30 days, they are much likely to have pica. This also includes ingesting non-edible items that are considered to be socially acceptable in practice or culturally supported—for example, eating clay in eastern medicine.
The symptoms of pica in a patient present as the following:
- GI upset
- Stomach pain
- Blood in feces that might point to the development of a peptic ulcer
- Bowel issues like diarrhea or constipation
The symptoms arise because of the microbes, toxins, and poisons present in the non-edible items that are ingested.
If there is a significantly prolonged ingestion of the items, it can result in symptoms such as:
- Lead poisoning through consuming paint chips or lead
- Dental injuries from consuming harmful substances
- Blockage in the intestines can lead to tears
- Infections in the GI tract from the accumulation of microbes in the stomach.
There are some basic causes behind pica, the eating disorder. In a general sense, the eating disorder originated from either biochemical or behavioral sources. However, it is very important to consider all factors associated with the causation of the disease before coming to a final diagnosis.
A person who is mentally compromised might be feeling like to impulsively ingest any object being available to them and therefore bear the effects that occur as a result. People having obsessive personality disorder might obsess over ingesting activities and therefore find it hard to stop themselves. Such individuals come with abnormalities in their behavior in which pica – the ingestion activity – comes as a choice of disorientation of the mind rather than a reaction to a biochemical deficiency in the body.
The mouthing activity is another perspective that needs to be considered while finding the cause of the disease. This is highlighted in pediatric patients who are undergoing this physiological change, and therefore, it may be regarded as pica as a misdiagnosis. Children learn about different objects through their sensory organs, and in this process, mouthing can play a big role. However, it may call for problematic conditions such as lead poisoning, which can lead to a misinterpretation.
Geophagia, or ingestion of clay or dirt, is another perspective to be considered in the eating disorder. It is more common in rural areas and has an ethnic-cultural background to it. People might be using clay for traditional medications, which is another causative factor for pica.
In the developed countries, pica is majorly seen to be arising from a biochemical background, suggesting an iron deficiency in the body. This deficiency may present with or without anemia, so an absence of anemia in the individual, the causative factor, cannot be ruled out. Around half of the patients affected with pica have iron deficiency in them. Therefore, it leads to the hypothesis that pica may be a manifestation of deficient iron stores in the body and not the anemic condition itself.
Mental health disorders play a role in the development of pica in the body, and it is relevant to impair cognitive function. This includes autism spectrum disorder, intellectual disability, and schizophrenia.
The two most common pica causes include malnutrition and iron deficiency anemia in the body. Pregnancy comes third. In such individuals, the eating disorder comes as a sign that the body is trying to overcome the nutrient deficiency. By treating this nutritional deficiency, the eating disorder will subside on its own.
A healthcare professional should also be checking the behavioral aspect of the patient to rule out any other condition needing specific medical attention. For example, some individuals might consume nonedible items in pregnancy, but their healthcare professional might indicate their actions don’t require any independent clinical attention.
- Paint chips and certain items can cause acute poisoning, which can disable the patient in different ways; for example, it may cause brain damage. It is one of the most lethal complications associated with pica.
- It can also lead to malnutrition as the patient picks non-nutritional items over edible ones.
- It can lead to intestinal obstruction and constipation, which can cause abrasions and tears in the mucosal lining of the GI tract. Ingesting sharp objects can also lead to tears in the intestines.
- Microbes from inanimate objects, especially clay, can lead to serious infections which may affect the liver and kidneys.
Diagnosis and Test
Upon a provisional diagnosis of the eating disorder, a detailed medical evaluation is considered necessary for assessing possible iron deficiency anemia, blockage in the intestines, and potential poisoning or toxicity from the ingestion of the nonedible items. If there are any symptoms present, the healthcare professional will start evaluating through performing a medical history as well as a physical examination. The doctor might suggest tests such as blood tests, X-rays, etc., for checking possible complications such as anemia and toxins found in the body. Also, the health of the GI tract might be noted through endoscopies as well. Possible testing for microbial infection might also be put to note.
Treatment and Drugs
Treatment of the condition is mainly targeted towards pointing out acute medical conditions like lead poisoning and resolving any underlying nutrient deficiencies.
Vitamins and supplements fortified with iron are suggested to patients of pica having biochemical causation involved in their disease. On the other hand, antibiotics and antifungals might be given to the patient to address any underlying infection in the GI tract. Moreover, if the person has some kind of mental health disorder, then medications to treat psychiatric behaviors may be suggested to the patient. This may involve SSRIs or Selective Serotonin Reuptake Inhibitors and Methylphenidate.
Coping and support
Patients of pica with a mental health disorder background need additional coping and support from caregivers and family. For this, the support starts with a complete behavioral assessment for the patient. It is found that early interventions which are based on a detailed assessment are much likely to give a significant reduction in the pica; this also includes autism spectrum disorder. Primary health physicians should be referring the pica patient to a certified behavioral analyst or a psychiatrist.
For coping and support, the pica patient might be needing several interventions, including:
- Positive reinforcement when the affected individual does not engage in persistent eating. Give rewards in the form of nutritionally dense foods.
- Training of the individual for differentiating well against edible and nonedible foods and raising awareness of the harms associated with non-edible foods.
- Aversive therapy whenever pica occurs. For example, you can give the patient something bitter to taste to discourage the activity.
Lifestyle, And Home Remedies
Caregivers and patients need to be educated about eating disorders, as there are a lot of ways through which the patients can be empowered to solve and manage their conditions.
It might be a challenge to deal with the condition at first, but educating around the underlying factors associated with the condition at an individual level may come as an effective strategy to deal with the stress caused by the condition. These include the following:
- Making sure your child eats well-balanced food – malnutrition and anemia are some of the most prevalent conditions related to the development of pica. In such people, pica is an indication that the body is deprived of the nutrient and thriving to compensate for that lack. Encouraging the child to eat a well-balanced diet can ease the symptoms.
- Pica-proofing the home – Consider the non-edible item ingested by the patient and see the possibilities of getting rid of the item. In some cases, it might not be possible to do so. So, it is best to minimize the exposure of the child to the item in such a case.
- Small, frequent meals – Providing small, frequent meals help the child engage in eating the actual nutritional items rather than the other items harmful for them. It may also help in addressing problems such as malnutrition.
- Enriching environment – It is especially important if the pica is related to the child’s sensory involvement or even for an adult’s sensory stimulation. Make sure of the provision of activities that keep the person engaged to avoid attraction related to pica.
Preparing for your appointment
Before making an appointment, it is important to have a detailed history of the affected individual. The healthcare team will be asking questions like the length of persistent eating in time, the severity of the symptoms, any changes in behavior or cognitive function during that period, and specific items consumed by the individual. Having knowledge of these questions beforehand will help the team quickly diagnose the condition and the ways to resolve the problem.
Pica is more than a nutritional deficiency and an eating disorder related to mental health. With timely evaluation and right coping, the complications of the condition can be prevented.