Definitions

Pica_(disorder)

Pica (disorder)

Pica is a medical disorder characterized by an appetite for largely non-nutritive substances (e.g., coal, soil, feces, chalk, paper, soap, ash, etc.) or an abnormal appetite for some things that may be considered foods, such as food ingredients (e.g., flour, raw potato, starch, ice cubes). 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 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.

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. Often the substance eaten by those with the disorder contains the mineral of deficiency. If a mineral deficiency is not identified as the cause of pica, it often leads to a diagnosis of a mental disorder.

Pica may also be a symptom of iron deficiency anemia secondary to hookworm infection. Symptoms may also include a pinkish hue to the skin, particularly around the mouth.

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.

Treatment

Treatment emphasizes psychosocial, environmental, and family guidance approaches. Treatment options include: discrimination training between edible and inedible 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 (punishment when child eats non-food items).

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.

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