Pica (disorder)

Pica is an appetite for non-nutritive substances (e.g., coal, soil, chalk, paper etc.) or an abnormal appetite for some things that may be considered foods, such as food ingredients (e.g., flour, raw potato, starch).^[1] In order for these actions to be considered pica, they must persist for more than one month, at an age where eating such objects is considered developmentally inappropriate. The condition's name comes from the Latin word for the magpie, a bird which is reputed to eat almost anything. Pica is seen in all ages, particularly in pregnant women and small children, especially among children who are developmentally disabled, where it is the most common eating disorder.

Pica in children, while common, can be dangerous. Children eating painted plaster containing lead may suffer brain damage from lead poisoning. There is a similar risk from eating dirt near roads that existed prior to the phaseout of tetra-ethyl lead in gasoline or prior to the cessation of the use of contaminated oil (either used, or containing toxic PCBs or dioxin) to settle dust. In addition to poisoning, there is also a much greater risk of gastro-intestinal obstruction or tearing in the stomach. This is also true in animals. Another risk of dirt eating is the possible ingestion of animal feces and the accompanying parasites.

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Extreme Cases

On display at the Glore Psychiatric Museum in Saint Joseph, Missouri is a very disturbing example of Pica. A female inmate at the then Lunatic Asylum #2 had swallowed a total of 1,446 items including nails, screws, safety pins, spoon tops, and salt and pepper shaker tops. She died during the surgery to remove the items.^[2][3][4]

Causes

The scant research that has been done on the root causes of pica suggests that the majority of those afflicted tend to suffer some biochemical deficiency and more often iron deficiency. The association between pica and iron deficiency anemia is so strong, that most patients with iron deficiency will admit to some form of pica.^{[citation needed]} Often the substance eaten by those with the disorder does not contain the mineral of deficiency. If a mineral deficiency is not identified as the cause of pica, it often leads to a misdiagnosis as a mental disorder.

Pica may also be a symptom of a hookworm infection. Symptoms may also include a pinkish hue to the skin, particularly around the mouth. The metallic, rattling sound of swallowed objects inside a patient's abdomen can also signify a pica disorder.

Unlike in humans, in dogs or cats, pica may be a sign of immune-mediated hemolytic anemia, especially when it involves eating substances such as tile grout, concrete dust, and sand. Dogs exhibiting this form of pica should be tested for anemia with a CBC or at least hematocrit levels. ^[5][6]

Treatment

Treatment emphasizes psychosocial, environmental, and family guidance approaches. Treatment options include: discrimination training between edible and nonedible items, self-protection devices that prohibit placement of objects in the mouth, sensory reinforcement involving screening (covering eyes briefly), contingent aversive oral taste (lemon), contingent aversive smell sensation (ammonia), contingent aversive physical sensation (water mist), brief physical restraint, and overcorrection (correct the environment, or practice appropriate or alternative responses).

This involves associating negative consequences with eating non-food items and good consequences with normal behavior. Medications may be helpful in reducing the abnormal eating behavior, if pica occurs in the course of a developmental disorder, such as mental retardation, or pervasive developmental disorder. These conditions may be associated with severe behavioral disturbances, including pica. These medications enhance dopaminergic functioning, which is believed to be associated with the occurrence of pica.

Examples

• Amylophagia (consumption of starch)
• Coprophagia (consumption of excrement)
• Geophagy (consumption of soil, clay, or chalk)
  • Consumption of dust or sand has been reported among iron deficient patients.
• Hematophagy (ingestion of blood)
• Hyalophagia (consumption of glass)
• Pagophagia (pathological consumption of ice)
• Self-cannibalism (rare condition where body parts may be consumed; see also Lesch-Nyhan syndrome)
• Trichophagia (consumption of hair or wool)
• Urophagia (consumption of urine)
• Xylophagia (consumption of wood)

In popular culture

• Michel Lotito has made a career in entertainment of eating chopped "inedibles" like a Cessna 150 small airplane.
• A patient suffering from Pica was featured in a Season One episode of Grey's Anatomy where the patient had ingested numerous doll heads. Another Pica patient was featured in the Season Four premiere of Grey's Anatomy.

See also

References

1. ^ * emedince.com article on "Eating Disorder: Pica"
2. ^ roadsideamerica.com article on Glore Museum
3. ^ [1]
4. ^ [2]
5. ^ Plunkett, Signe J. (2000). Emergency Procedures for the Small Animal Veterinarian. Elsevier Health Sciences, 11. ISBN 0702024872. 
6. ^ Feldman, Bernard F.; Joseph G. Zinkl, Nemi Chand Jain, Oscar William Schalm (2000). Schalm's Veterinary Hematology. Blackwell Publishing, 506. ISBN 0683306928.