Pica Disorder: Understanding the Compulsion to Eat Non-Food Items

Pica disorder is a psychiatric illness in which the patient ingests substances that are not nutritious, such as dirt, stones, paper, or biological substances. The name of the disorder comes from the scientific name of the magpie, Pica pica, due to this animal's habit of ingesting and stealing non-food inert objects.

Cause

Intake of non-food substances is normal under the age of two and tends to limit itself around that age. It is estimated that between 10% and 30% of children under 6 years of age present this type of behavior without subsequent consequences. The ingestion of non-nutritive substances has also been observed frequently in women, generally subsiding after delivery.

This phenomenon has often been described in patients with significant mental retardation. Likewise, pica disorder has also been seen in obsessive compulsive patients, in anxious patients or as a way to attract attention.

From an anthropological point of view, the ingestion of land is common in many cultures, without this being pathological in itself. In many cases it responds to a deficiency of iron or zinc that is tried to supply with the intake of these minerals in the earth, without the person being aware of its deficiency. At other times the intake of these substances is to relieve certain digestive symptoms such as heartburn (heartburn), nausea or vomiting. At a psychological level, various theories focus on this disorder as a maturational delay. As already mentioned, it is normal to put any object in the mouth until approximately two years of age.

Symptoms

Patients with pica disorder usually eat substances secretly and in general it gives them a feeling of relief and calm, it helps them reduce anxiety levels. On other occasions, when the motivation for eating is to attract attention, they do so publicly and paying attention to them reinforces the behavior. These patients do not eat the first thing they find, but in general their fixation is with a specific substance.

The main substances they ingest are:

• dirt and mud
• chalk and plaster
• painting
• stones
• starch
• ash and cigarette butts
• hair
• wool and other fabrics
• ice
• paper
• faeces
• bugger
• blood

Patients with this disorder often present with digestive symptoms such as nausea, vomiting, and diarrhea. Abdominal pain (gastric or generalized), increased salivation, and alterations in taste and smell are common. These patients often complain of hunger, although having pica disorder does not mean they reject food.

The main complication that these patients present is gastric or intestinal perforation, requiring intervention in 75% of patients with pica disorder for this reason. Perforation of the digestive tract is also the leading cause of death from this psychiatric disorder.

Other complications are intestinal obstruction, infection by parasites ingested from the soil or human or animal excrement, poisoning by toxic substances such as lead, mercury or phosphorus, or the accumulation of indigestible substances in the stomach, which is known like bezoar.

Diagnosis

The diagnosis is based on the anamnesis of the patient and his environment and on the existence of four criteria:

• Persistent intake of non-nutritive substances for more than a month
• Inappropriate attitude for the developmental level of the patient
• It should not be a socially sanctioned practice (for example, eating pork in Muslim or Jewish culture)
• Sufficient self-entity if associated with another mental disorder, such as mental retardation, schizophrenia or a developmental disorder.

It is necessary to carry out one to assess the possible toxic substances that may have been ingested, as well as assess the levels of iron, zinc and other trace elements. Sometimes it is necessary to perform an imaging test such as one or one. Fibroscopy may be required in some cases.

Treatment

The treatment of pica disorder will be based on informing the patient's family and friends of the situation so that they can support the patient. A favorable environment is a good reinforcement for the psychological therapy to which the patient will have to undergo. There are no specific drugs for this disease, but selective serotonin reuptake inhibitors (SSRIs), such as sertraline, fluoxetine, or paroxetine, are occasionally given. In case of detecting deficiencies of iron, zinc or other elements, the picture can be solved in part with the contribution of these substances.

Precautionary measures

There are no specific preventive measures against pica disorder. If you suspect it in a close person, it is important to contact a psychiatrist.