PICA: Bizarre Eating Disorder

Pica is an eating disorder defined as the persistent eating of non-nutritive substances for a period of at least 1 month at an age in which this behaviour is developmentally inappropriate (eg, 18-24 months). Individuals presenting with pica have been reported to mouth and/or ingest a wide variety of non-food substances, including, but not limited to, clay, dirt, sand, stones, pebbles, hair, faeces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches.

Although pica is observed most frequently in children, it is the most common eating disorder seen in individuals with developmental disabilities. In some societies, pica is a culturally sanctioned practice and is not considered to be pathologic. Pica may be benign, or it may have life-threatening consequences.

If pica is associated with mental retardation or pervasive developmental disorder, it must be sufficiently severe to warrant independent clinical attention. In such patients, pica typically is considered to be a secondary diagnosis. Furthermore, the pica must last for a period of at least 1 month.

The negative impact on a person’s health could amount to any of the following occurring:

• Ingestion of poisons: Lead toxicity is the most common type of poisoning associated with pica. Lead has neurologic, hematologic, endocrine, cardiovascular, and renal effects. Lead encephalopathy is a potentially fatal complication of severe lead poisoning, presenting with headache, vomiting, seizures, coma, and respiratory arrest. Ingestion of high doses of lead can cause significant intellectual impairment and behavioural and learning problems. Studies also have demonstrated that neuropsychologic dysfunction and deficits in neurologic development can result from very low lead levels, even levels once believed to be safe. A hypochromic microcytic anaemia, resembling iron deficiency anaemia, can also be seen with lead toxicity because lead interferes with heme synthesis beginning at blood lead concentrations of approximately 25 µg/dL.

• Gastrointestinal tract symptoms may include constipation, chronic or acute and/or diffuse or focused abdominal pain, nausea, vomiting, abdominal distension, and loss of appetite.

• Infections and parasitic infestations: Ascariasis is the most common soil-borne parasitic infection associated with pica. Some infections and parasitic infestations, ranging from mild to severe, are associated with the ingestion of infectious agents via contaminated substances, such as faeces or dirt. In particular, geophagia (meaning the consumption of earth, especially a high percentage of clay) has been associated with soil-borne parasitic infections, such as toxocariasis, (visceral larva migrans, ocular larva migrans) toxoplasmosis, and trichuriasis.

• Symptoms of toxocariasis are diverse and appear to be related to the number of larvae ingested and the organs to which the larvae migrate.

• Physical findings associated with visceral larva migrans may include fever, hepatomegaly, malaise, coughing, myocarditis, and encephalitis.

• Ocular larva migrans can result in retinal lesions and loss of vision.

• Gastrointestinal tract symptoms may be evident secondary to mechanical bowel problems, constipation, ulcerations, perforations, and intestinal obstructions caused by bezoar formation and the ingestion of indigestible materials into the intestinal tract.

Causes
Evidence suggests that there may be several causes of pica. One widely held theory points to iron deficiency as a major cause of pica. Several reports have described pica in individuals with documented iron deficiency, although there has been uncertainty as to whether the iron deficiency was a cause of pica or a result of it. Some substances, such as clay, are believed to block the absorption of iron into the bloodstream; it was thought that low blood levels of iron could be the direct result of pica. However, some studies have shown that pica cravings in individuals with iron deficiency cease once iron supplements are given to correct the deficiency. Another study looked specifically at the rate of iron absorption during pica conditions and normal dietary behaviour, and showed that the iron absorption was not decreased by pica. In addition, low blood levels of iron commonly occur in pregnant women and those with poor nutrition, two populations at higher risk for pica. Such findings offer strong support of iron deficiency as a cause, rather than result, of pica.

Nutritional deficiencies
Along with iron deficiencies, calcium, zinc, boran, and other nutrients (eg, thiamine, niacin, vitamins C & D) have been associated with pica.

• Assessment of nutritional beliefs may be relevant in the treatment of some patients with pica.

• Address any identified nutritional deficiencies; however, nutritional and dietary approaches have demonstrated success related to the prevention of pica in only a very limited number of patients.

Although pica can occur in individuals of any background, a higher incidence of pica is associated with:

• pregnancy

• developmental delay and mental retardation

• psychiatric disease and autism

• early childhood

• poor nutrition or low blood levels of iron and other minerals

• certain cultural or religious traditions

Other reports suggest that pica may have a psychological basis and may even fall into the spectrum of obsessive-compulsive disorder. Pica has a higher incidence in populations with an underlying diagnosis involving mental functioning. These diagnoses include psychiatric conditions like schizophrenia, developmental disorders including autism, and conditions with mental retardation. These conditions are not characterized by iron deficiency, which supports a psychological component in the cause of pica.

Cultural and religious traditions may also play a role in pica behaviour. In some cultures, non-food substances are believed to have positive health or spiritual effects. Among some African Americans in the south, ingesting a particular kind of white clay is believed to promote health and reduce morning sickness during pregnancy. Other cultures practice pica out of belief that eating a particular substance may promote fertility or bring good luck.

The hallmark feature of pica, consistently consuming non-food substances, often does not present publicly. People may be embarrassed to admit to these unusual eating habits, and may hide it from their family and physician. In other cases, an individual may not report the pica to a physician simply because of a lack of knowledge of pica’s potential medical significance.

Because the eating behaviours of pica are not usually detected or reported, it is the complications of the behaviour that bring it to attention. Complications vary, depending on the type of pica. Geophagia has potential side effects that most commonly affect the intestine and bowel. Complications can include constipation, cramping, pain, obstruction caused by formation of an indigestible mass, perforation from sharp objects like rocks or gravel, and contamination and infection from soil-dwelling parasites.

Pica involving the ingestion of substances such as lead-based paint or paper containing mercury can cause symptoms of toxic poisoning as noted previously. Compulsive consumption of even a seemingly harmless substance like ice (known as pagophagia) can have negative side effects, including decreased absorption of nutrients by the gut.

Pica in pregnant women is sometimes diagnosed after childbirth because of a health problem in the newborn caused by the substance(s) ingested by the mother. In one instance reported, a newborn girl was treated for lead poisoning caused by her mother’s eating fragments of lead-glazed pottery during pregnancy!

Treatment
Treatment of pica will often depend on the cause and type of pica. Conventional medical treatment may be appropriate in certain situations. For example, supplementation with iron-containing vitamins has been shown to cause the unusual cravings to subside in some iron-deficient patients.

Medical complications and health threats, including high lead levels, bowel perforation or intestinal obstruction, will require additional medical management, beyond addressing the underlying issue of pica.

Alternative treatment
Because most cases of pica do not have an obvious medical cause, treatment with counselling, education, and nutritional management is often more successful and more appropriate than treatment with medication. Some therapists specializing in eating disorders may have expertise in treating pica. Natural iron supplements, colloidal minerals and vitamins can be administered and a diet consisting of fresh healthy fruit, vegetables, grains and fish would be encouraged. These combined therapies can help some people overcome the craving to eat non-edible, non-nutrient substances. In most cases there will be an imbalance of minerals in the system, so the need to take colloidal minerals for a lengthy period of time may be necessary.

Any toxicity or parasites that the person acquired through this disorder can be treated with herbal remedies. There are some very powerful affective herbs that rid the body of all parasites, organisms and worms that are not conducive to a person’s health and well-being.

Such herbs as Cloves, Blackwalnut, Wormwood and Myrrh are powerful anti parasitic.

Please do not self-administer, because these herbs are very potent, the correct quantities and doses are paramount for effectiveness and safety. Some herbs are administered combined for a synergistic effect for different parasites or worms. Some are given separately. The herbs would have to be taken over a period of time consistently and cleanse the system at a deep cellular level. Homoeopathic’s can also be brought on board to help with the overall detoxifying process. Remedies to strengthen the immunity and cleanse the blood, along with establishing a healthy digestive/bowel function are important for the long term optimum health of the person. If the person is suffering from emotional imbalance, anxiety or depression then other remedies will be required to assist here.

So this disorder can be helped with a number of supporting therapies. Each person would have to explore and find what is comfortable for them, but counselling is an excellent therapy to combine with the overall treatment to reach a positive conclusion and be freed of the need to indulge in non-nutrient substances.

Lyn has written articles on a variety of topics and runs a private practice located in Bondi, Sydney. Lyn can be contacted on 0403 231 804 or lynraven@zeta.org.au. Website www.zeta.org.au/~lynraven

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