Rare But Real: Pica Eating Disorder and Everything to Know

Eating ice, nibbling on the end of a pen, maybe even paper — we’re all culprits. But what happens when someone isn’t doing these things unknowingly? What does it mean if someone is compulsively eating things that aren’t considered food but are potentially dangerous if ingested?

This is what happens when someone has a pica eating disorder. Keep reading to discover more about this condition, including the health consequences that can arise from it and how it can be treated with different types of therapy.

What Is Pica Eating Disorder?

Pica eating disorder is a mental health condition used to describe when people are compulsive to swallow non-food items or items with no significant nutritional value, such as hair, dirt, or paint chips.

Who Suffers from Pica the Most?

Pica seems to affect pregnant women, young children, and intellectually impaired people. While it’s common for young children to put non-food or small items in their mouths out of sheer exploration — this is called mouthing — children with pica go beyond that and actually ingest things they shouldn’t deliberately.

A high prevalence (10%) of pica seems to be reported in patients with intellectual disabilities and correlates with the severity of impairment.

The National Library of Medicine published research on a German prevalence study that included 804 children. It was found that 99 of those children (12.3%) had engaged with pica behavior at some point in their lives.

The medical publication also reported a meta-analysis of studies on the prevalence of pica during pregnancy, where an estimated 27.8% of pregnant women reported experiencing pica.

According to the American Pregnancy Association, the reason pregnant women develop pica symptoms might be due to an iron deficiency. Cravings that pregnant women with pica include burnt matches, stones, charcoal, mothballs, toothpaste, soap, sand, plaster, baking soda, and cigarette ashes.

The Journal of Eating Disorders published a cross-sectional study in 2023 examining 384 adolescents in northern Sudan. Of the 384, 118 (30.7%) adolescents showed pica symptoms. Interestingly, 102 of the 118 adolescents displaying pica behavior most commonly ingested clay and sand (geophagy). The results showed no significance in age, but markedly more females showed pica symptoms than males.

Types of Pica

The things that people with pica crave and eat vary but can include:

• Earth: Geophagy, the word used for consuming earth or soil-like substances, also includes ingesting clay and chalk

• Starch: Amylophagia encompasses craving and eating starches, such as uncooked rice or pasta, laundry starch, and cornstarch.

• Ice: Pagophagia is the term given for the intense desire to ingest ice, freezer frost, or iced drinks

Other substances include charcoal, ash, paper, cloth, baby powder, coffee grounds, crayons, cleaning supplies, erasers, rubber bands, screws, and eggshells.

Symptoms of Pica Eating Disorder

For a pica diagnosis, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states that the persistent ingestion of non-nutritive, non-food substances must occur over at least one month.

The National Eating Disorders Association (NEDA) states that eating the non-food substance “should not be a part of culturally supported or socially normative practice (e.g., some cultures promote eating clay as part of a medicinal practice).”

NEDA also discloses that “the eating of these substances must be developmentally inappropriate. In children under two years of age, mouthing objects is a normal part of development and allows the child to explore their senses. Mouthing may sometimes result in ingestion. In order to exclude developmentally normal mouthing, children under two years of age should not be diagnosed with pica.”

Unlike other eating disorders, such as anorexia nervosa and avoidant restrictive food intake disorder (ARFID), people with pica aren’t generally averse to ingesting food.

Causes of Pica Eating Disorder

While doctors don’t know exactly what causes pica, there are various risk factors:

Medical Conditions

Iron deficiency anemia and malnutrition are two of the most common causes. In individuals with these deficiencies, pica is a sign that the body is trying to replenish what it’s significantly lacking. Still, the deficiencies can often be treated with medication or vitamin supplements.

Those suffering from malnutrition might experience feelings of fullness from eating non-food items, while those with an iron or zinc deficiency might experience specific cravings.

Other Mental Health Diagnoses

Pica can often occur alongside other mental health conditions associated with impaired functioning, such as intellectual disability, autism spectrum disorder, schizophrenia, and obsessive-compulsive disorder (OCD).

Trichotillomania (the persistent urge to pull out hair from the scalp, eyebrows, or other areas of the body) and excoriation (chronic skin picking) have also been associated with pica eating disorder.

Stress

For children dealing with the stress of living in poverty, being abused or neglected, or maternal deprivation, pica is particularly prevalent. Other risk factors include learned behavior, epilepsy, and familial psychopathology.

Health Consequences of Pica Eating Disorder

Pica eating disorder itself doesn’t cause harmful health consequences. The danger is in what people with the condition ingest.

Here are several of the health risks of pica. Lead poisoning is a serious complication that can occur due to clay ingestion, a very common form of pica. It can lead to constipation, hypokalemia with myopathy, and nutritional deficiencies, and clay can also be a source of many infectious agents, such as parasites. Lead, mercury, arsenic, and fluoride, to name a few, also contain a wide variety of toxic contaminants and, if eaten, can lead to lead poisoning. Lead poisoning could have dire consequences, particularly among women who are pregnant, and high levels can result in seizures.

Constipation or diarrhea can also develop when those with pica eat things the body can’t digest (like hair). Gastrointestinal infections arise from eating soil or feces, which can have worms or parasites.

Further health complications include:

• Intestinal obstruction from eating things that cause blockages in the intestines

• Mouth or teeth injuries, tooth decay, and sensitivities are side effects of ice ingestion (pagophagia)

• Iron deficiency, high blood sugar, and obesity have been associated with excessive starch consumption (amylophagy) because of the high carbohydrate content

Additionally, during pregnancy, pica can have critical consequences on the growing fetus. There are also case reports that describe toxicity in the uterus during pregnancy because of lead poisoning from pica. This can lead to fetal neurological disability. Maternal geophagy has also been linked to childhood motor function delay.

Treatment for Pica

Pica in pregnant people doesn’t tend to stick around and will usually go away on its own. Children with pica can also grow out of it, so long as they have someone to teach them the difference between edible and non-edible items.

For people with pica who also have intellectual disabilities, it’s vital that they are supervised and that desired non-food items are removed.

There’s little knowledge about specific treatments for pica; however, if you suspect that you, your child, or a loved one are displaying pica-like eating habits, it’s highly recommended to visit a healthcare provider.

Visit a Healthcare Provider

If it’s thought that someone has pica, they should first be tested for mineral or nutrient deficiencies to correct those along with any other medical conditions that might be the root cause.

Blood, urine, and feces tests may be carried out to check for infections, poisoning, and electrolyte imbalances, while x-rays, computerized tomography (CT) scans, and magnetic resonance imaging (MRI) scans can be performed to check for signs of blockage or internal damage caused by pica-eating behavior.

In the event that pica has caused a serious health condition, an electrocardiogram (ECG or EKG) is done to look for problems with the heart’s electrical rhythm that can happen due to certain electrolyte imbalances or parasitic infections.

If worrying eating habits continue after someone’s nutrient deficiencies have been rectified, behavioral interventions might be necessary.

Several different interventions have been developed by scientists in the autism community that might help someone who is dealing with pica. For example, redirecting someone’s attention away from the desired item they want to eat and rewarding them for not eating it or putting the item down is an effective practice.

Medical professionals can also help parents manage and stop pica-related behaviors. They may advise that parents invest in childproof locks and high shelving to keep items out of reach.

Psychotherapy

A few different therapy methods can be utilized for treating pica, which include:

• Mild aversive therapy: By using positive and negative reinforcement, mild aversive therapy teaches someone with pica that there’ll be appropriate consequences if pica food items aren’t avoided, and rewards if they are

• Behavioral therapy: This therapy method requires a mental health professional to teach a person coping mechanisms and strategies to help them change their behavior

• Differential reinforcement: This method teaches people to avoid pica behaviors by instead pivoting their attention to other behaviors and activities

If you’re feeling nervous about therapeutic treatment, check out these tips to help you prepare for your first session.

Grow Therapy’s Mental Health Professionals Can Help

Due to the various items that people ingest when they have a pica eating disorder, it can be a dangerous condition. Thankfully, it can be managed and treated with the right information, support, and guidance.

If you think you or a loved one, including a child, has developed concerning eating behaviors, Grow Therapy has specialized mental health professionals who can help you or your child care for their mental health.

If you are concerned about your child for other reasons, here are some signs that your child might need therapy.