What is Pica (Eating Disorder)?

“Education is not the filling of a pot but the lighting of a fire.”
— W.B. Yeats

How many of us have seen other people chew and swallow items and found it odd? How many of us have seen the TV Series 'My Strange Addiction' and thought that eating nonedible items was indeed an addiction?

How about Pica - have you heard of this? Did you know that there's actually more to people's eating behavior than just being a 'strange addiction'?

This presentation is created for professionals, educators, parents, and students who wish to learn more about Pica Eating Disorder - its history, causes, treatment, and facts that debunk the myths and misconceptions surrounding the disorder.

Providing educational materials gears learners towards taking action for mental health awareness. By the end of the lesson, it will provide valuable knowledge to the learner and will equip them to know the importance of learning about Pica and what they can do to raise more awareness about the disorder.

1. "Hungry, but I
don't want food!"
PICA
EATING
DISORDER
By: Fullon, Garcia, Hombrebueno, Van Cauwenberghe

2. Introduction and History of the
Disorder
1.
2. Clinical Presentation
About Pica Eating Disorder
- Diagnostic Features
- Diagnostic Criteria
3. Etiology
- Nutritional Factors
- Psychological Factors
- Ethnic/Cultural Factors
4. Epidemiology
5. Suggested Treatment
- Treating Complications
- Vitamin or Mineral Supplements
- Psychological Evaluation and
Behavioral Interventions
6. Misconceptions About Pica

3. - an unusual condition where patients develop
cravings for non-nutritive substances that can
cause significant health risks
- examples of these substances are paper, soap,
cloth, hair, string, wool, soil, chalk, talcum
powder, paint, gum, metal, pebbles, charcoal or
coal, ash, clay, starch, or ice
- sometimes linked with obsessive-compulsive
disorder because individuals with Pica are
conscious of their behavior even though it is
unhealthy and illogical
Pica Eating Disorder

4. American Academy of Pediatrics identified Pica
as the medieval Latin name for a bird called the
magpie, which supposedly, has a appetite for
eating almost anything.
The first recorded case of Pica Eating disorder
was observed in a pregnant woman as she was
ingesting an abnormal amount of ice.
In DSM-5, Pica was formerly classified under the
section of disorders with onset of childhood and
adolescence, before it fell under the category of
eating disorders.
Brief History

5. Misconceptions
about Pica
addressing the elephant in the room

6. Pica is a childhood disorder.
Myth
Fact
Although pica is more prevalent among
children than among adults, it is an eating
disorder that can develop at any stage of
an individual’s life. Given that pica can
develop for different reasons, it can
affect all age groups: children, teenagers,
adults, and elderly.

7. Consuming odd foods is an example of pica.
Myth
Fact
Pica is the persistent consumption of nonfood items for at least one month
which have no nutritional value and are consumed intentionally. It is also not
part of a cultural or socially accepted practice such as geophagy in Africa.
Geophagy, or eating dirt or clay, is common especially for pregnant or lactating
African women because they believe that certain soils are considered to have
medicinal benefits and are often mixed with herbs as remedies for various
ailments (Holden, 2017). Economic factors may also play a role in this.

8. People with pica consume similar items.
Myth
Fact
People diagnosed with pica disorder can consume
many different kinds of items, as long as they are
intentionally consuming nonfood items without
nutritional value. The type of item a person consumes
depends on the underlying cause of their disorder, like
how a person with iron deficiency may develop a habit
of chewing rubber bands (Mpondo, Mwasada &
Nyundo, 2013).

9. Pica and pregnancy cravings are the same.
Myth
Fact
It is normal for pregnant women to experience cravings
during their pregnancy, and craving for nonfood items is
not a category for diagnosing pica disorder. However, a
diagnosis can be made when pregnant women eat
nonfood items intentionally, usually related with
nutritional deficiencies. Dirt, clay, and powdered laundry
detergent are common items pregnant women with pica
eating disorder ingest.

10. Pica isn't that serious.
Myth
Fact
Eating nonfood items causes serious health issues and
consequences. The most common types are intestinal
obstructions, tearing and infection (Pica Myths, 2019).
For example, eating feces may cause toxocariasis and
toxoplasmosis, and eating peeling paint may cause heavy
metal poisoning. Individuals may also habitually eat
nonfood items that it interferes with them getting
nutritional needs from edible food, which is concerning
for the individual’s overall physical and mental wellness.

11. Eating disorders are a choice.
Myth
Fact
Various factors are in play when diagnosing pica and
other eating disorders – genetic predispositions,
biological, sociocultural, and psychological factors.
Although pica is characterized by the intentional eating of
nonfood items, it is beyond just eating these items ‘by
choice’. The disorder cannot be easily remedied by telling
a person to ‘just eat healthier food’. There are underlying
issues that explain the eating behaviors, and the root of it
should be addressed when treating pica disorder.

12. It is impossible to recover from an eating
disorder.
Myth
Fact
This is a common misconception when it comes to eating
disorders. In most cases, pica is successfully treated
across different ages as long as proper treatment and
rehabilitation is implemented and applied. Recovery may
be from treating medical complications, prescribing
vitamin or mineral supplements, and psychological
evaluation or behavioral interventions.

13. Clinical
Presentation

14. Only licensed professionals can
diagnose pica.
These professionals include
pediatricians, gastroenterologists,
psychiatrists and/or clinical
psychologists.
Diagnostic Criteria

15. If you are concerned that your child or
someone you know may be
experiencing symptoms of pica, you
must consult with a medical
professional right away.
Online resources and screenings are
available, but they are not always
reliable and cannot definitively
diagnose any medical or mental health
conditions.
Diagnostic Criteria

16. Persistent eating of non-nutritive, nonfood
substances for a period of at least one
month.
The eating of nonnutritive, nonfood
substances is inappropriate to the
developmental level of the individual.
Diagnostic Criteria

17. The eating behavior is not part of a
culturally supported or socially normative
practice.
If occurring with another mental disorder,
or during a medical condition, it is severe
enough to warrant independent clinical
attention.
Specify if: In remission: After full criteria for
pica were previously met, the criteria have not
been met for a sustained period of time.
Diagnostic Criteria

18. PICA
Persistent eating of
nonfood substances for
at least one month
Intentional consumption of
nonnutritive substances that are
inappropriate to individual's
developmental level
Culture and social norms are
not bases of explanations for
the behavior
Another mental
disorder is present

19. Typical substances ingested tend to vary with
age and availability.
A. Eating of one or more non-nutritive, non-food
substances on a persistent basis over a period of at
least 1 month that is severe enough to warrant
clinical attention.
Diagnostic Features

20. The term non-food is included because the
diagnosis of Pica does not apply to ingestion of
diet products that have minimal nutritional
content
B. The eating of non-nutritive, non-food
substances must be developmentally
inappropriate.
Diagnostic Features

21. A minimum age of 2 years is suggested for a Pica
diagnosis to exclude developmentally normal
mouthing of objects by infants that results in
ingestion.
C. The behavior must not be part of a culturally
supported or socially normative practice.
Diagnostic Features

22. The eating of nonnutritive, nonfood
substances can be an associated feature of
other mental disorders (e.g., intellectual
disability [intellectual developmental
disorder], autism spectrum disorder,
schizophrenia).
D. If the eating behavior occurs exclusively in the
context of another mental disorder, a separate
diagnosis of Pica should be made only if the
eating behavior is sufficiently severe to warrant
additional clinical attention.
Diagnostic Features

23. Etiology

24. Pica is considered a multifactorial phenomenon due to the
fact that there is no known cause for it and that there are
numerous possible etiologies.
There have been several hypotheses put forward in an
attempt to explain this behavior, including nutritional and
dietary factors as well as psychological and biochemical
disorders
The cultural, ethnic, and family practices of people are
among the other areas being investigated for possible
causes.
Etiology

25. Pica is associated with an insufficient
diet and nutritional deficiencies in iron,
calcium, zinc, and other vitamins,
among other nutrients.

Nutritional
Factors

26. Pica is a learned behavior
More prevalent in environments with less social
interaction.
Children who experience neglect are at higher risk
of developing Pica disorder
People with certain mental health conditions like
Obsessive-Compulsive Disorder (OCD) and
Schizophrenia may develop pica as a coping
mechanism
Psychological Factors

27. In some impoverished countries, eating dirt or
clay is not done out of choice, but rather as a
result of a lack of food supplies in the area.
This is what the children and women of these
countries consume in order to appear full
enough to get them through the day without
experiencing hunger pangs.
Ethnic/ Cultural Factors

28. Can be categorized according to the type of substance ingested:
clay ingestion
ice ingestion
excessive starch consumption
may contain a wide variety of toxic contaminants such as
lead, mercury, arsenic, fluoride, etc.
Geophagia
Pagophagia
Amylophagia
Other Substances
Pica Complications
Nasser, Y. A. (2021, July 29). Pica. StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532242/

29. Epidemiology

30. The actual number of those affected by
pica is unclear due to under-reporting
among affected subjects. However, it is
most likely more prominent in developing
countries.
Prevalence of Pica
Fawcett, E., Fawcett, J., & Mazmanian, D. (2016). A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. International Journal of Gynaecology and Obstetrics. 133 (3): 277–283. doi:10.1016/j.ijgo.2015.10.012. ISSN 1879-3479. PMID 26892693

31. 27.8%
68%
Prevalence of Pica
Fawcett, E., Fawcett, J., & Mazmanian, D. (2016). A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. International Journal of Gynaecology and Obstetrics. 133 (3): 277–283. doi:10.1016/j.ijgo.2015.10.012. ISSN 1879-3479. PMID 26892693
27.8–68% of pregnant
women experience pica
Pica is present in up to 50% of
children aged 18–36 months
Pica can be seen in 10% of people
who are mentally challenged
Pica is present in 10% of
children older than age 12
There are some studies from the United States that shed light on pica prevalence:

32. Suggested
Treatment

33. The first line of treatment for individuals with pica eating
disorder is addressing the illness from ingesting nonfood
items, such as constipation, diarrhea, ulcer, intestinal tear,
infection, or any combination of these. They are treated as
advised by their physician or a medical professional.
Lead poisoning can also be acquired from eating items with
chemicals like paint chips, in which case chelation therapy is
prescribed. Chelation therapy is a method for removing heavy
metals, such as mercury or lead, from the blood (Cafasso,
2018). Together with medications, this allows the individual to
excrete the lead in their urine.
Treating complications
from nonfood items

34. In some cases, pica is caused by malnutrition or
nutritional deficits. The doctor would prescribe vitamin
or mineral supplements to address this.
For example, if the individual has iron or zinc deficiency,
they will be given iron supplements or vitamins to treat
the eating disorder (Holm, 2012). Usually, pica
symptoms would disappear after nutritional treatment
(Monroe, 2018). If pica symptoms persist despite
addressing the illnesses and nutritional deficits,
psychological intervention is done.
Vitamin or mineral
supplements

35. In collaboration with a mental health team, the eating behavior is addressed by
identifying the underlying psychological factors leading to the disorder.
The Handbook for Clinical Child Psychology currently supports general behavioral
strategies as the most effective treatment approach for pica, with training in which
foods are edible and which foods cannot be eaten through the use of positive
reinforcement (WebMD, 2005).
The doctor may also order psychological evaluation to determine if the individual
has another underlying mental health condition, such as OCD or autism spectrum
disorder (Holm, 2012). Treatment would vary depending on the diagnosis.
Prescriptions may require therapy, medication, or both.
Psychological evaluation and
behavioral interventions

36. It is advised that individuals who exhibit symptoms of pica, or
people who know of individuals who do, would consult
physicians and medical professionals for treatment and
recommendations on how to address the symptoms.
Should psychological and behavioral intervention be sought, it
would be as ordered by the medical professional. As such, the
individual can consult a recommended mental health
professional in such case.
Who to consult?

37. Where to seek help?
National Eating Disorders
Association (NEDA)
Philippine Mental Health
Association (PMHA)
National Center for Mental
Health (NCMH)
National Association of Anorexia
Nervosa and Associated Disorders
(ANAD)
If you are in a crisis and need help
immediately, text “NEDA” to 741741 to be
connected with a trained volunteer at Crisis
Text Line.
For counseling, you may get in touch with
them via Facebook Messenger, through
[email protected], or contact them at
[phone] 0917-565-2036.
For free psychosocial support,
[email protected]/[email protected],
landline [phone], or you may reach
your regional DOH helpline through
bit.ly/DOHhelplines
ANAD is a professionally supported and peer-
run support group for people with eating
disorders. You may join ANAD's support group
through https://bit.ly/ANADSupport or contact
them through their helpline at 1 (888)-375-
7767.

38. Recommended
Pica Strategies

39. A. Keep a look out for potentially dangerous pica items.
B. Tell others (guidance counselor, health professionals) about pica.
C. Request support, for example from
learning disability/autism or mental health
services.
D. Provide safe alternatives to chew/bite and
eat.
E. Distract away from pica and increase
engagement in other activities.
For parents/carers:
National Autistic Society. (2022). Understanding and managing pica. Autism.org.uk. https://www.autism.org.uk/advice-and-guidance/professional-practice/managing-pica

40. A. Work together to manage risk and share
information.
B. Provide access to regular physical health
checks.
C. Provide services to assess and diagnose
pica.
D. Include information about pica in medical
records, care plans and education and health
care plans (EHCPs).
E. Seek additional training/resources on pica.
For professionals:
National Autistic Society. (2022). Understanding and managing pica. Autism.org.uk. https://www.autism.org.uk/advice-and-guidance/professional-practice/managing-pica

41. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA:
American Psychiatric Publishing.
Cafasso, J. (2018). What Does Chelation Therapy Treat? Healthline; Healthline Media.
https://www.healthline.com/health/chelation-therapy
Fawcett, E., Fawcett, J., & Mazmanian, D. (2016). A meta-analysis of the worldwide prevalence of pica during
pregnancy and the postpartum period. International Journal of Gynaecology and Obstetrics. 133 (3): 277–283.
doi:10.1016/j.ijgo.2015.10.012. ISSN 1879-3479. PMID 26892693
Holden, J. (2017). Eat dirt? Why on earth would you do that? The Irish Times; The Irish Times.
https://www.irishtimes.com/life-and-style/health-family/eat-dirt-why-on-earth-would-you-do-that-1.2934821
Holm, G. (2012). Everything You Need to Know About Pica. Healthline; Healthline Media.
https://www.healthline.com/health/pica#treatment
Khan, Y. & Tisman, G (2010). Pica in iron deficiency: a case series. Journal of Medical Case Reports.
https://doi.org/10.1186/1752-1947-4-86
Mental Health and Pica. (2005). WebMD; WebMD. https://www.webmd.com/mental-health/mental-health-pica
Monroe, J. (2018). Pica Disorder and How to Treat It. Newport Academy; Newport Academy.
https://www.newportacademy.com/resources/mental-health/pica-eating-disorder/
Mpondo, B., Mwasada, G., & Nyundo, A. (2013). Pica as a persistent eating disorder associated with iron deficiency
anaemia: two case reports. South Sudan Medical Journal.
http://www.southsudanmedicaljournal.com/archive/august-2018/pica-as-a-persistent-eating-disorder-
associated-with-iron-deficiency-anaemia-two-case-reports.html
Pica Myths. (2019). The Recovery Village Drug and Alcohol Rehab; The Recovery Village Drug and Alcohol Rehab.
https://www.therecoveryvillage.com/mental-health/pica/pica-myths/
Rice, A. (2021). What Is Pica? - Pica Eating Disorder. Familydoctor.org. https://familydoctor.org/condition/pica/
References:

42. What's your favorite takeaway?
What can we do to raise more awareness about Pica?
Why is it important to learn about Pica?
How can we be more sensitive towards people with eating disorders?

43. end