by Natalie Papini

Natalie Papini (@nataliep310) is a 2022 CEED Summer Fellow. One of her summer projects was working with mentors Sam Chawner (@ChawnerSamuel) and Nadia Micali (@MicaliNadia) on a study of pica in the ALSPAC cohort (Avon Longitudinal Study of Parents and their Children).

When people think of eating disorders, they often list the three most common: anorexia nervosa, bulimia nervosa, and binge-eating disorder. A lesser-known eating disorder is pica. This occurs when a person consumes non-nutritive, non-food substances for at least one month outside of cultural norms or another mental or physical condition (APA, 2013).

Despite being less common in the general population, pica can pose serious health risks if a person eats something that could lead to gastrointestinal obstruction (blockage), serious dental issues (broken or eroded teeth), or even poisoning. Here are some facts about pica.

1. Pica can occur at any point in life and impacts more than just people who are pregnant.

A good friend of mine and registered dietitian recently asked me what I’ve been studying. When I explained that I’m studying pica behaviors in children, she responded with: “My mind is blown! I’ve never heard of pica occurring in children—I’ve only ever learned about that happening during pregnancy.”

Although pica has been reported in up to 22-33% of pregnancies and postpartum, it can also occur in children, adolescents, and adults of any gender (Fawcett et al., 2016). A diagnosis of pica can only be given in a child who is at least two years old, and most commonly occurs in children ages 2-3 years old (Al Nasser, Muco, & Alsaad, 2022; Tygai & Sharma, 2022).

As with all eating disorders, it is important to challenge stereotypes and biases around what a “typical” person with pica looks like. By challenging stigmas and stereotypes, we ensure eating disorders are better recognized and treated.  

2. People can desire or eat a variety of non-nutritive, non-food substances.

People report craving a wide variety of non-food substances and what they crave can differ based on a person’s age and the availability of the specific substance. Common cravings are dirt, paper, soap, string, cloth, paint, charcoal, starch, and clay (Al Nasser, Muco, & Alsaad, 2022; Tygai & Sharma, 2022). It is important to note that the substance a person eats must also be outside of cultural norms. For example, a person who eats clay in Africa, where eating clay is more common, would not be diagnosed with pica (APA, 2013; Huebl et al., 2016). Clayey soil, a nutrient-dense soil, can be purchased at marketplaces in certain parts of Africa (Huebl et al., 2016). Some research indicates people, especially pregnant women, consume this soil due to cravings or for its ability to soothe heartburn or morning sickness (Huebl et al., 2016).

3. Treatments exist to help someone with pica.

Treatment for pica focuses on decreasing accessibility to the craved or desired item a person wants to consume. If a nutrient deficiency exists (and may be even is what is driving the pica), a person may need a supplement (such as iron or zinc). Contingent reinforcement paired with discriminant training (example: presenting a positive stimulus when a person eats a nutritive food item, such as offering verbal praise or giving them a sticker) is the first-line treatment option for children who have pica (Moline et al., 2021). Behavioral and aversive treatment (treatment designed to change pica behavior by conditioning a person to associate eating a non-food item with a negative consequence or something undesirable) can help people with developmental delays understand which foods are good to eat and which are not safe to consume (Al Nasser, Muco, & Alsaad, 2022; Tygai & Sharma, 2022).

4. There’s still a lot we don’t know.

Pica is largely understudied. It is unclear what causes pica and how pica behaviors may change throughout a person’s life. Some research supports that pica could be the result of nutrient deficiencies (iron deficiency and malnutrition are the two most common), whereas others suggest pica stems from hunger or from protective effects that pica might have to relieve short-term illnesses (NEDA, 2018; Young, 2011). The way we measure pica also has limitations—most pica measurements only include a single item that fails to capture the specific frequency of pica behaviors and types of substances consumed (Dinkler & Bryant-Waugh, 2021). More research is needed to better understand what causes pica and how treatments can be tailored for subgroups of people (i.e., people who are pregnant, children, people with autism, people with neurodevelopmental disorders).  

Raising awareness of pica (what it is and who it affects) is critical to be able to detect and treat the illness. With greater understanding and awareness around pica, people may be able to better recognize pica as something they (and others!) have and to seek the most appropriate treatment based on their needs.

References

Al Nasser Y, Muco E, Alsaad AJ. Pica. 2022 May 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 30335275.

Dinkler, L., & Bryant-Waugh, R. (2021). Assessment of avoidant restrictive food intake disorder, pica and rumination disorder: interview and questionnaire measures. Current Opinion in Psychiatry, 34(6), 532-542.

Fawcett, E. J., Fawcett, J. M., & Mazmanian, D. (2016). A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. International Journal of Gynecology & Obstetrics, 133(3), 277-283.

Huebl, L., Leick, S., Guettl, L., Akello, G., & Kutalek, R. (2016). Geophagy in Northern Uganda: Perspectives from consumers and clinicians. The American Journal of Tropical Medicine and Hygiene, 95(6), 1440.

Moline, R., Hou, S., Chevrier, J., & Thomassin, K. (2021). A systematic review of the effectiveness of behavioural treatments for pica in youths. Clinical Psychology & Psychotherapy, 28(1), 39-55.

NEDA. (2018, February 22). Pica. National Eating Disorders Association. Retrieved June 22, 2022, from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/pica.

Tyagi, N., & Sharma, R. B. Risk Factors and Adapting Family-Based Treatment for Eating Disorders.

von Garnier, G., Stünitz, H., Decker, M., Battegay, E., Zeller, A. Pica and refractory iron deficiency anaemia: a case report. Journal of Medical Case Reports 2008, 2:324. doi:10.1186/1752-1947-2-324, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=5899430

Young, S. (2011). Craving earth. In Craving Earth. Columbia University Press.