Pica: Not Your Usual Eating Disorder

What do sponge, clay, soil, paint, soap, chalk, cigarette ash, and paper have in common? Not much, at first sight, but look closer. None of these things are food items, yet there are people who consume them compulsively. 

Many patients with eating disorders place their lives at risk by starving themselves. At the other end of the spectrum, you have people so obese that their bodies could just stop at any time. Pica falls into a whole other category, though. Pica is not your usual eating disorder — it doesn't have anything to do with eating too little or too much, but rather with eating things that aren't food at all. 

Who would want to eat things that aren't food? You must be pretty crazy to have cravings for cigarette ash or sponge, right? While it's true that a relatively large percentage institutionalized populations have pica, this eating disorder can develop in anyone. The true prevalence of this eating disorder in society at large isn't known, perhaps because folks who have it are afraid to seek medical help for pica.

What we do know is that pica can develop during pregnancy, and some researchers speculate that nutritional deficiencies are behind the compulsion to eat non-food items. 

What Is Pica, And What Are The Dangers of This Eating Disorder?

The eating disorder pica gets its name from "pica pica", the Latin word for magpie. Magpies are birds that eat almost anything and are known for their compulsion to take shiny things to their nests. People who suffer from the eating disorder pica crave eat any non-food items compulsively, but the ones listed above are some of the more commonly chosen things. 

The latest version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, has the following diagnostic criteria for pica:

• A person must suffer from the compulsive eating of non-food items for at least one month

• This habit has to be inappropriate for the developmental level of the individual (your orally-fixated infant does not have pica)

• The eating disorder can't be part of a cultural or social practice (in some parts of southern Africa, people eat soft stones as a snack)

• The symptoms and eating habits must be severe enough to warrant clinical attention if it happens in people with mental disorders like autism spectrum disorder or physical conditions like pregnancy

Quite a few people apparently crave ice cubes and give into that craving. Though ice cubes are made from water, which is the most essential food item out there, its temperature can cause problems that can range from from damaged tooth enamel to metabolic changes. Because of the complications associated with consuming ice on a regular basis, the compulsive eating of ice cubes counts as pica as well. 

Eating paint can lead to lead poisoning, and eating items that can't possibly be digested can cause constipation and bowel obstruction. Eating sharp items can lead to bowel perforations, and eating items contaminated with bacteria, like soil, can result in serious infections.

Pica cravings can be invasive enough to interfere with the consumption of actual food as well — or to put it in plain English, if your stomach is full of sponge, you're not going to be hungry. Though some people speculate that nutritional deficiencies can be the reason someone develops pica (iron deficiency = craving for scrap metal?), pica can cause nutritional deficiencies if it keeps a patient away from normal food. 

What are the risk factors for pica? And how can the condition be treated? More about that on the next page.

Pica: Causes And Treatment

What Causes Pica?

The underlying reasons due to which a person develops the eating disorder pica is as individual as the non-food items patients crave. Pica is more common in children and pregnant women, those people with developmental disorders such as autism, and among certain ethnic groups.

The DSM-5 says that the compulsive eating of non-food items can't be part of a culturally accepted practice for a pica diagnosis to be made, but that doesn't make these habits any less harmful. Kenya is home to a type of soft stone called "odowa" that is apparently quite addictive, for example. Kenyans eating these stones cannot be diagnosed with pica, but might still benefit from treatment. 

Pica can also directly result from mental illnesses — people suffering from schizophrenia may hear voices telling them to ingest dangerous items, to name one example. In addition, the Handbook of Clinical Child Psychology suggests that between four and 26 percent of institutionalized child patients have pica. 

There is evidence to suggest that pica can result from nutritional deficiencies, particularly iron deficiency. This may also explain why this disorder is seen in pregnant women more often. Whatever the cause of pica, treating the disorder is likely to be your main concern if you or someone you love is suffering from strange food compulsions. 

Treating Pica

The treatment of pica is acknowledged as complex by anyone who has studied the disorder. In people who are already under medical supervision, ensuring the patient avoids the foods they crave is the best approach, and this is often achieved by watching them closely. The same holds true for children with pica, who are under the care of their parents — these moms and dads need to watch their kids closely to make sure they only eat appropriate things.

Behavioral therapies are sometimes helpful to people who have pica. Adults who do not suffer from developmental disorders but have strange cravings should probably be checked for nutritional deficiencies and then work with a therapist to develop strategies to stay away from the non-food items they crave. It may be useful to see pica as an addiction and to learn about steps people who quit smoking or gambling take to overcome their challenges, and you could even join a support group for addicts.