Anorexia and bulimia are two very widespread and known eating disorders that are very commonly talked about.  What many people don't know is that there are many other forms of eating disorders.  One that I find interesting is one such disorder called Pica.  Pronounced “pie-ka”.  It is an uncontrollable ingestion of non-food substances.  I will talk about what pica is, how to prevent it, treatments and consequences of having this disorder.  Pica in children is very common as well in children; about 25% and 30% have it.  When children are little they put whatever they can find in their mouth because they are small and are curious.  Children with pica go a little further and actually swallow what they put in their mouth. “People in general who have this condition often eat a variety of these non-food items, including but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, paint, laundry detergent, etc.”(Clifton-Pennell, 2008).  Pica can cause serious health problems, how much of something people with pica ingest can have a huge impact on their health.  Most people do not gain weight due to the fact that most of the things they are eating do not have any calories or fat.  Pica is not actually categorized as an eating disorder oddly enough, but is considered to be incorporated with feeding and movement, and speech disorders in a separate heterogeneous group of disorders. 

 

Description: E:\105_extras\pica.jpg

“Extensive research on the history and terminology of eating disorders from the 16th to the 20th century suggests that historically, Pica was regarded as a symptom of other disorders rather than a separate entity”(Jones. 1992).  Pica was first addressed in a medical book in 1563, where geophaglia was described in pregnant women and in children.  Geophaglia is the practice of eating earthly or soil like substances such as clay and chalk in order to obtain essential nutrients such as sulfur and phosphorus from the soil.  It’s mostly known to be in animals, but when in humans it is classified as Pica.  In the 1800’s in the southern states, mostly among slaves, and is still accepted behavior in many cultures, clay ingestion has been used for medicinal purposes.  It’s said to affect the microorganisms in the gut or to help relieve intestinal spasms.

 

According to emedicine.medscape.com, “Pica is most commonly in children and in individuals with mental retardation; children with mental retardation and autism are affected more frequently than children without those conditions.  Conditions of having Pica: Ingesting poisons can lead to lead poisoning associated with eating lead based products.  The side effects of lead poisoning can range from headache, vomiting, seizures coma and respitory failure.  With lead poisoning you can also experience brain damage.  If the person eats dirt, there is another chance of lead poisoning.  This is especially true if the dirt is from roads that were used prior to leaded gasoline being recalled or when contaminated oil was still used to settle read dust.  There is also the risk of potentially tearing the stomach or blockage in the intestines.  These often require surgery to correct.  Another condition caused by Pica is exposure to infectious agents, various infections and parasitic infections.  This could happen if you ingest feces or dirt.  Some other symptoms associated with Pica, is GI tract effects and dental effects” (Ellis, 2009).  

 

There is a group of citizens called the “Pica Task Force”.  Not only are they there to help people with Pica, get the word out about it, but they are also there to get cigarettes banned.  If not banned to at least the littering of cigarette butts banned.  You might be asking what Pica and cigarettes have to with each other.  They have more in common than you think?  The health hazards associated with cigarette smoking have been widely publicized and well known.  Some chemicals that are found in cigarettes are Acetone (nail polish remove), Ammonia (Cleaning agent), and rat poison, just to name a few.  Here where Pica and cigarettes get together.  When people toss aside there cigarette butt after smoking it, they discard it wherever.  People with Pica actually eat the remains of those.  When they ingest the butts they are ingesting not only those 3 chemicals mentioned before but a recorded 599 chemicals also found in cigarettes.  This concerns the Pica Task Force greatly.  It also hits close to home for one of the members.  Judith Solomon is the parent of an adult with Pica who will eat these cigarette butts.  It causes her to worry because of all the chemicals found in cigarettes.  She had to place her son in an institution where smoking was prohibited.  His conditioned has improved tremendously.  What happens when he gets out though and people are still discarding there cigarette butts for him to find?  The Pica Task Force is very passionate about getting a ban on littering cigarette butts.  They would like there to be a law on throwing them out in the trash so that someone like Judith Solomon’s son won’t eat them or anyone with Pica for that matter.

 

 Pica does not choose who gets it. Pica is the most common eating disorder found in many people with developmental disorders.  It does not choose one country, one race, one gender or one age group.  Although it does not choose a specific race, it is reported that Pica is in certain races more than others.  Though not many studies have been conducted to measure the popularity of Pica in various populations, two current studies done of pregnant women in the 1990’s found rates of 8.1% for African-American women in the U.S. and 8.8% for pregnant women in Saudi Arabia(Feldman 2000). 

 

Description: E:\105_extras\eating+dirt.jpg

 

 

Although Pica can be somewhat harmless it can be fatal as well, depending on the kind of things eaten and if it did any damage on its way down the throat and into the stomach.  One incident that did result in death was of a 61 year old man from Whales.  His name was Dewi Evans.  He did not die of poisoning but from on obstruction caused by the objects he ate.  He died during surgery.  This was not Mr. Evans’s only surgery in removing objects he had eating.  This was his third and last surgery seeing as though he did not make it out alive.  The objects he had eaten were a screw, a pen top, a magnet, and some coins.  “In 2002, a 62-year-old French man with a history of mental illness went to hospital complaining of stomach pains. An x-ray showed he had swallowed five kilograms of coins, necklaces and needles; his stomach was so heavy it had been forced down between his hips. He died after an operation to remove the objects. In 2000, Edward Cope, a 33-year-old man with autism from Manchester, died from complications after swallowing 10 buttons, a drawing pin, pieces of chain and bone and a large amount of black foam rubber” (Saner, 2006).An article I read on advice to people suffering from pica was about a 42 year old woman who suffered from pica and wanted to know why she and so many people suffer from it.  She believes hers is mainly related to stress and says it began to get a lot worse following her son's suicide.  She wrote in to a website called daily strength and was replied back by a psychiatrist, Dr. Kimberly Dennis. Dr. Dennis replied by saying, "The exact cause of pica is unknown, and it’s probably multi-factorial. I think you have a lot of insight around what it gives you— a sense of power or sense of control. It makes a lot of sense to me that your pica has spun out of control in the context of your recent loss. Feeling out of control or powerless over a substance or behavior is the hallmark of addiction, which at its root is a spiritual disease. "

 

Description: E:\105_extras\chalk-eater.jpgYou might be wandering what makes people with Pica eat the things they eat.  Do they just look at an object and want to eat it?  For the most part no one really would enjoy eating dirt or soap unless there was something in our minds compelling us to. The appeal of eating these things like talcum powder, raw rice, chalk, and uncooked flour is they all have a dry texture. People with Pica eat these substances because they have become addicted to it, the way it feels attracts them, the sound of the chalk crunching when they eat it appeals to them(Thyer,Ballas-Christos).  A woman once recalled wanting to eat soap because she can remember taking baths as a child and the smell of certain soaps would make her mouth water and she couldn’t help but want to eat it.  She eventually gave into the urge and began to eat soap (Johnson, 2008).

One woman lived eating tube socks, saying it relaxed her.  One might wonder why someone wanting to relax wouldn’t just sit down, maybe watch some T.V., do some yoga or meditation. But chewing on tube socks?  That one still remains a mystery.

 

Description: E:\105_extras\tube sock.jpg


For the treatment of Pica there are a few options. There is no single test to confirm Pica.  In some cases if the deficiency behind the pica is found first, the patient will receive the right treatment, and the pica will go away on its own in time.  However, if the pica alone is discovered, the patient may be misdiagnosed with a mental disorder and not given the proper treatment.  Pica occurs in most people that have lower nutrient levels and poor nutrition (malnutrition), a health care provider should text blood levels of iron and zinc”(Williams, et all 2009).  According to Bernard Feldman, "Treatments should first address any missing nutrients and other medical problems, such as lead exposure.”  Treatment involves behavior and development, and family education approaches.  Other successful treatments include associating the Pica behavior with bad consequences or punishment (mild aversion therapy) followed by positive reinforcement for eating the right foods.  Medications may help reduce the abnormal eating behavior, if pica occurs as part of a developmental disorder such as mental retardation.”  The form of treatment when family steps in may be a good form a treatment compared to medicine.

 

 What happens with the family approach is the family teaches the pica patient the bad consequences of eating non-food substances.  The family may take away what the person is eating, may slap the hand when the person is eating the substance.  They will eventually learn what will happen if they eat the “bad” things.  When they eat “good” food they will be have positive feedback.

The Prognosis: “Treatment success varies.  In most cases, the disease can last several months, and then can disappear on its own.  In some cases, it may continue into the teen years into adulthood, especially when it occurs with developmental disorders” (Mudgett, 2002).  If you happen to find yourself eating cigarette butts, paint, or sand, you could possibly just have an iron deficiency or there could be something mentally wrong with you which in that case you should seek a physician’s help.

 

Pica although very rarely talked about is a very serious eating disorder that someone how gets either misdiagnosed or just gets swept under the rug.  It’s something that everyone should be informed about, just as they would be informed about anorexia and bulimia.  Just like those two eating disorders are very serious and can be fatal if not treated, pica can be too. 

 

References:

 

Williams, D.E., Kirkpatrick-Sanchez, S., Enzinna, C., Dunn, J., & Border-Karasack, D. (2009). The clinical management and prevention of pica: a retrospective follow-up of 41 individuals with intellectual disabilities and pica. Journal of Applied Research in Intellectual Disabilities, 22. Retrieved from http://www.blackwell-synergy.com/doi/abs/10.1111/j.1468-3148.2008.00490.x

 

 

Ellis, C.R. (2009, June 4). Eating disorder, pica. Retrieved from http://emedicine.medscape.com/article/914765-overview

 

 

 

Mudgett, H. (2002, June 10). What is pica? Retrieved from http://www.suite101.com/article.cfm/eating_disorders/92615

 

 Clifton-Pennell, P. (2008, March 15). The pica disorder. Retrieved from http://www.associatedcontent.com/article/659085/the_pica_disorder.html?cat=70

 

Parry-Jones, B., & Parry-Jones, W. (1992). Pica: symptom or eating disorder. a historical assessment. Retrieved from http://www.bjp.rcpsych.org/cgi/content/abstract/160/3/341

 

Saner, E. (2006). There's nothing he wouldn't eat. Retrieved from http://www.guardian.co.uk/lifeandstyle/2006/oct/24/healthandwellbeing.health2

 

Abrahams, P. (2003). Human geophagy: a review of its distribution, causes and implications. 13(0-19-516204-8), Retrieved from en.wikipedia.org/wiki/geophagy

 

Skinner, C., & Berger, A. (2005). Geology and health: closing the gap. Retrieved from Medscape.com/viewarticle/405804_4

 

Feldman, B., Zinkl, J., Jain, N., & Schalm, O. (2000). Schalm's veterinary hematology. 506. Retrieved from en.wikipedia.org/wiki/pica_disorder

 

Klein, S. (1997). Pick up for pica. Retrieved from www.tobacco/org/resources/health/pica.html