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The scant research that has been done on the causes of pica suggests that the disorder is caused by ] in many cases, typically ] which is sometimes a result of ].<ref name=Rose00>{{cite journal | author = Rose, E.A., Porcerelli, J.H., & Neale, A.V. | title = Pica: Common but commonly missed | journal = The Journal of the American Board of Family Practice | year = 2000 | volume = 13 | issue = 5 | pages = 353–358 }} PMID 11001006</ref> Often the substance eaten by someone with pica contains the mineral in which that individual is deficient. More recently, cases of pica have been tied to the ], and there is a move to consider OCD in the ] of pica;<ref>{{cite journal | author = Hergüner, S., Ozyildirim, I., & Tanidir, C. | year = 2008 | title = Is Pica an eating disorder or an obsessive-compulsive spectrum disorder? | journal = Progress in Neuro-Psychopharmacology & Biological Psychiatry | volume = 32 | issue = 8 | pages = 2010–2011 }} PMID 18848964</ref> however, pica is not currently recognized by the widely used ] (DSM-IV) as being a mental disorder. Sensory, physiological, cultural, and psychosocial perspectives have also been used by some to explain the causation of pica. |
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The scant research that has been done on the causes of pica suggests that the disorder is caused by ] in many cases, typically ] which is sometimes a result of ].<ref name=Rose00>{{cite journal | author = Rose, E.A., Porcerelli, J.H., & Neale, A.V. | title = Pica: Common but commonly missed | journal = The Journal of the American Board of Family Practice | year = 2000 | volume = 13 | issue = 5 | pages = 353–358 }} PMID 11001006</ref> Often the substance eaten by someone with pica contains the mineral in which that individual is deficient. More recently, cases of pica have been tied to the ], and there is a move to consider OCD in the ] of pica;<ref>{{cite journal | author = Hergüner, S., Ozyildirim, I., & Tanidir, C. | year = 2008 | title = Is Pica an eating disorder or an obsessive-compulsive spectrum disorder? | journal = Progress in Neuro-Psychopharmacology & Biological Psychiatry | volume = 32 | issue = 8 | pages = 2010–2011 }} PMID 18848964</ref> however, pica is not currently recognized by the widely used ] (DSM-IV) as being a mental disorder. Sensory, physiological, cultural, and psychosocial perspectives have also been used by some to explain the causation of pica. |
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Mental health conditions, such as obsessive-compulsive disorder (OCD) and schizophrenia can sometimes cause pica.{{Citation needed}} Pica may also be a symptom of ] secondary to ] infection.{{Citation needed|date=July 2009}} Symptoms may also include a bluish hue to the skin, particularly around the mouth.{{Citation needed|date=July 2009}} |
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Mental health conditions, such as obsessive-compulsive disorder (OCD) and schizophrenia can sometimes cause pica.{{Citation needed}} It was suggested{{by whom}} that stress associated with traumatic events is linked to pica disorder. Some of the traumatic events common in individuals with pica include maternal deprivation, parental separation or neglect, child abuse, disorganized family structure and poor parent-child interaction.{{Citation needed}} Pica may also be a symptom of ] secondary to ] infection.{{Citation needed|date=July 2009}} Symptoms may also include a bluish hue to the skin, particularly around the mouth.{{Citation needed|date=July 2009}} |
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However, pica can also be a cultural practice not associated with a deficiency or disorder. Investigation of ] (white dirt) ingestion among ] women in the U.S. state ] shows the practice there to be a DSM-IV "culture-bound syndrome" and "not selectively associated with other psychopathology".<ref>R. Kevin Grigsby, et al. ''Southern Medical Journal''. 92.2 (February 1999). pp.190-192.</ref> Similar kaolin ingestion is also widespread in parts of Africa.<ref>Franklin Kamtche. (Balengou : around the mines) '']''. 12 January 2010. Retrieved 1 March 2010. {{fr icon}}</ref> |
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However, pica can also be a cultural practice not associated with a deficiency or disorder. Investigation of ] (white dirt) ingestion among ] women in the U.S. state ] shows the practice there to be a DSM-IV "culture-bound syndrome" and "not selectively associated with other psychopathology".<ref>R. Kevin Grigsby, et al. ''Southern Medical Journal''. 92.2 (February 1999). pp.190-192.</ref> Similar kaolin ingestion is also widespread in parts of Africa.<ref>Franklin Kamtche. (Balengou : around the mines) '']''. 12 January 2010. Retrieved 1 March 2010. {{fr icon}}</ref> Such practices might stem from health benefits such as clay's ability to absorb plant toxins and protect against toxic alkaloids and tannic acids.<ref>Marc Lallanilla. '']''. 3 October 2005. Retrieved 1 March 2010.</ref> |
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Unlike in humans, in dogs or cats, pica may be a sign of ], especially when it involves eating substances such as tile ], ] dust, and ]. Dogs exhibiting this form of pica should be tested for anemia with a ] or at least ] levels.<ref>{{cite book | last = Plunkett | first = Signe J. | date = 2000 | title = Emergency Procedures for the Small Animal Veterinarian | publisher = Elsevier Health Sciences | pages = 11 | isbn = 0702024872}}</ref><ref>{{cite book | last = Feldman | first = Bernard F. | coauthors = Joseph G. Zinkl, Nemi Chand Jain, Oscar William Schalm | date = 2000 | title = Schalm's Veterinary Hematology | publisher = Blackwell Publishing | pages = 506 | isbn = 0683306928}}</ref> |
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==Prevalence== |
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Few studies have been conducted to measure the ] of pica in various populations. Two prevalence studies conducted on pregnant women in the 1990s found rates of 8.1% for pregnant ] women in the ]<ref>{{cite journal | author = Edwards, C.H., Johnson, A.A., Knight, E.M., Oyemade, U.J., Cole, O.J., Westney, O.E., et al. | title = Pica in an urban environment | journal = The Journal of Nutrition | year = 1994 | volume = 124 | issue = 6 Suppl | pages = 954S-962S }} PMID 8201446</ref> and 8.8% for pregnant women in ].<ref>{{cite journal | author = al-Kanhal, M.A., & Bani, I.A. | date = 1995 | title = Food habits during pregnancy among Saudi women | journal = International Journal for Vitamin and Nutrition Research | volume = 65 | issue = 3 | pages = 206–210 }} PMID 8830001</ref> Rates of pica among pregnant women in ] can be much higher, however, with estimates of 63.7%<ref>{{cite journal | author = Nyaruhucha, C.N. | year = 2009 | title = Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania | journal = Tanzania Journal of Health Research | volume = 11 | issue = 1 | pages = 29–34 }} PMID 19445102</ref> and 74.0%<ref>{{cite journal | author = Ngozi, P.O. | year = 2008 | title = Pica practices of pregnant women in Nairobi, Kenya | journal = East African Medical Journal | volume = 85 | issue = 2 | pages = 72–79 }} PMID 18557250</ref> reported for two different ] populations. This is due to different cultural norms as well as greater levels of ]. Two studies of ] adults living in ] found that 21.8%<ref>{{cite journal | author = Ashworth, M., Hirdes, J.P., & Martin, L. | year = 2009 | title = The social and recreational characteristics of adults with intellectual disability and pica living in institutions | journal = Research in Developmental Disabilities | volume = 30 | issue = 3 | pages = 512–520 }} PMID 18789647</ref> and 25.8%<ref>{{cite journal | author = Danford, D.E., & Huber, A.M. | date = 1982 | title = Pica among mentally retarded adults | journal = American Journal of Mental Deficiency | volume = 87 | issue = 2 | pages = 141–146 }} PMID 7124824</ref> of these groups suffered from pica. Prevalence rates for children with and without developmental disabilities are unknown. |
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Few studies have been conducted to measure the ] of pica in various populations. Two prevalence studies conducted on pregnant women in the 1990s found rates of 8.1% for pregnant ] women in the ]<ref>{{cite journal | author = Edwards, C.H., Johnson, A.A., Knight, E.M., Oyemade, U.J., Cole, O.J., Westney, O.E., et al. | title = Pica in an urban environment | journal = The Journal of Nutrition | year = 1994 | volume = 124 | issue = 6 Suppl | pages = 954S-962S }} PMID 8201446</ref> and 8.8% for pregnant women in ].<ref>{{cite journal | author = al-Kanhal, M.A., & Bani, I.A. | date = 1995 | title = Food habits during pregnancy among Saudi women | journal = International Journal for Vitamin and Nutrition Research | volume = 65 | issue = 3 | pages = 206–210 }} PMID 8830001</ref> Rates of pica among pregnant women in ] can be much higher, however, with estimates of 63.7%<ref>{{cite journal | author = Nyaruhucha, C.N. | year = 2009 | title = Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania | journal = Tanzania Journal of Health Research | volume = 11 | issue = 1 | pages = 29–34 }} PMID 19445102</ref> and 74.0%<ref>{{cite journal | author = Ngozi, P.O. | year = 2008 | title = Pica practices of pregnant women in Nairobi, Kenya | journal = East African Medical Journal | volume = 85 | issue = 2 | pages = 72–79 }} PMID 18557250</ref> reported for two different ] populations. This is due to different cultural norms as well as greater levels of ]. Two studies of ] adults living in ] found that 21.8%<ref>{{cite journal | author = Ashworth, M., Hirdes, J.P., & Martin, L. | year = 2009 | title = The social and recreational characteristics of adults with intellectual disability and pica living in institutions | journal = Research in Developmental Disabilities | volume = 30 | issue = 3 | pages = 512–520 }} PMID 18789647</ref> and 25.8%<ref>{{cite journal | author = Danford, D.E., & Huber, A.M. | date = 1982 | title = Pica among mentally retarded adults | journal = American Journal of Mental Deficiency | volume = 87 | issue = 2 | pages = 141–146 }} PMID 7124824</ref> of these groups suffered from pica. Prevalence rates for children with and without developmental disabilities are unknown. |
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It was suggested{{by whom}} that stress associated with traumatic events is linked to pica disorder. Some of the traumatic events common in individuals with pica include maternal deprivation, parental separation or neglect, child abuse, disorganized family structure and poor parent-child interaction.{{Citation needed}} |
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Unlike in humans, in dogs or cats, pica may be a sign of ], especially when it involves eating substances such as tile ], ] dust, and ]. Dogs exhibiting this form of pica should be tested for anemia with a ] or at least ] levels.<ref>{{cite book | last = Plunkett | first = Signe J. | date = 2000 | title = Emergency Procedures for the Small Animal Veterinarian | publisher = Elsevier Health Sciences | pages = 11 | isbn = 0702024872}}</ref><ref>{{cite book | last = Feldman | first = Bernard F. | coauthors = Joseph G. Zinkl, Nemi Chand Jain, Oscar William Schalm | date = 2000 | title = Schalm's Veterinary Hematology | publisher = Blackwell Publishing | pages = 506 | isbn = 0683306928}}</ref> |
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==Treatment== |
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==Treatment== |
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 (in some countries) 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. Pica can also be found in animals, and is most commonly found in dogs.
The scant research that has been done on the causes of pica suggests that the disorder is caused by mineral deficiency in many cases, typically iron deficiency which is sometimes a result of celiac disease. Often the substance eaten by someone with pica contains the mineral in which that individual is deficient. More recently, cases of pica have been tied to the obsessive–compulsive spectrum, and there is a move to consider OCD in the etiology of pica; however, pica is not currently recognized by the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as being a mental disorder. Sensory, physiological, cultural, and psychosocial perspectives have also been used by some to explain the causation of pica.
Mental health conditions, such as obsessive-compulsive disorder (OCD) and schizophrenia can sometimes cause pica. It was suggested that stress associated with traumatic events is linked to pica disorder. Some of the traumatic events common in individuals with pica include maternal deprivation, parental separation or neglect, child abuse, disorganized family structure and poor parent-child interaction. Pica may also be a symptom of iron deficiency anemia secondary to hookworm infection. Symptoms may also include a bluish hue to the skin, particularly around the mouth.
However, pica can also be a cultural practice not associated with a deficiency or disorder. Investigation of kaolin (white dirt) ingestion among African-American women in the U.S. state Georgia shows the practice there to be a DSM-IV "culture-bound syndrome" and "not selectively associated with other psychopathology". Similar kaolin ingestion is also widespread in parts of Africa. Such practices might stem from health benefits such as clay's ability to absorb plant toxins and protect against toxic alkaloids and tannic acids.
Treatment for pica will vary based on the patient's category (child, developmentally disabled, pregnant, or psychopathic) and may emphasize psychosocial, environmental, and family guidance approaches. An initial approach often involves screening for and, if necessary, treating any mineral deficiencies or other comorbid conditions. For pica that appears to be of psychotic etiology, therapy and medication such as SSRIs have been used successfully. However, previous reports have cautioned against the use of medication until all non-psychotic etiologies have been ruled out.
Some 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 medications enhance dopaminergic functioning, which is believed to be associated with the occurrence of pica.
Behavior-based treatment options can be useful for developmentally disabled or mentally retarded individuals with pica. These may involve associating negative consequences with eating non-food items or good consequences with normal behavior, and may be contingent on pica being attempted or initiated regardless of a pica attempt. A recent study classified nine such classes of behavioral intervention:
