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Pica is a medical disorder characterized by an appetite for substances largely non-nutritive (e.g. metal [coins, etc.], clay, coal, soil, feces, chalk, paper, soap, mucus, ash, gum, etc.) or an abnormal appetite for some things that may be considered foods, such as food ingredients (e.g. flour, raw potato, raw rice, starch, ice cubes, salt).[1] In order for these actions to be considered pica, they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate. The condition's name comes from the Latin word for magpie, a bird that is reputed to eat almost anything.[2][3] Pica is seen in all ages, particularly in pregnant women, small children, and those with developmental disabilities.
Pica in children, while common (usually only in young children or children with autism or another mental or developmental disorder), may be dangerous. Children eating painted plaster containing lead may suffer brain damage from lead poisoning. There is a similar risk from eating dirt near roads that existed prior to the phaseout of tetra-ethyl lead in gasoline (in some countries) or prior to the cessation of the use of contaminated oil (either used, or containing toxic PCBs or dioxin) to settle dust. In addition to poisoning, there is also a much greater risk of gastro-intestinal obstruction or tearing in the stomach.[citation needed] This is also true in animals. Another risk of dirt-eating is the possible ingestion of animal feces and accompanying parasites. Pica can also be found in animals, and is most commonly found in dogs.

The scant research that has been done on the causes of pica suggests that the disorder is a specific appetite caused by mineral deficiency in many cases, typically iron deficiency, which sometimes is a result of celiac disease.[4] Often the substance eaten by someone with pica contains the mineral in which that individual is deficient.[citation needed] More recently, cases of pica have been tied to the obsessive–compulsive spectrum, and there is a move to consider OCD in the etiology of pica;[5] however, pica is not currently recognized as a mental disorder by the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Sensory, physiological, cultural, and psychosocial perspectives have also been used by some to explain the causation of pica.
Mental health conditions, such as obsessive-compulsive disorder (OCD) and schizophrenia can sometimes cause pica.[citation needed] It was suggested[by whom?] that stress associated with traumatic events is linked to pica disorder. Some of the traumatic events common in individuals with pica include maternal deprivation, parental separation or neglect, child abuse, disorganized family structure and poor parent-child interaction.[citation needed] Pica may also be a symptom of iron deficiency anemia secondary to hookworm infection.[citation needed] Symptoms may also include a bluish hue to the skin, particularly around the mouth.[citation needed]
However, pica can also be a cultural practice not associated with a deficiency or disorder. Investigation of kaolin (white dirt) ingestion among African-American women in the U.S. state of Georgia shows the practice there to be a DSM-IV "culture-bound syndrome" and "not selectively associated with other psychopathology".[6] Similar kaolin ingestion is also widespread in parts of Africa.[7] Such practices might stem from health benefits such as clay's ability to absorb plant toxins and protect against toxic alkaloids and tannic acids.[8]
Unlike in humans, pica in dogs or cats may be a sign of immune-mediated hemolytic anemia, especially when it involves eating substances such as tile grout, concrete dust, and sand. Dogs exhibiting this form of pica should be tested for anemia with a CBC or at least hematocrit levels.[9][10]
[edit]Treatment

Treatment for pica varies based on the patient's category (e.g. child, developmentally disabled, pregnant, or psychopathic) and may emphasize psychosocial, environmental, and family guidance approaches. An initial approach often involves screening for and, if necessary, treating any mineral deficiencies or other comorbid conditions.[4] For pica that appears to be of psychotic etiology, therapy and medication such as SSRIs have been used successfully.[11] However, previous reports have cautioned against the use of medication until all non-psychotic etiologies have been ruled out.[12]
Some medications may be helpful in reducing the abnormal eating behavior if pica occurs in the course of a developmental disorder, such as mental retardation or pervasive developmental disorder.[citation needed] These medications enhance dopaminergic functioning, which is believed to be associated with the occurrence of pica.[citation needed]
Behavior-based treatment options can be useful for developmentally disabled or mentally retarded individuals with pica. These may involve associating negative consequences with eating non-food items or good consequences with normal behavior, and may be contingent on pica being attempted or initiated regardless of a pica attempt. A recent study classified nine such classes of behavioral intervention:[13]
Presentation of attention, food, or toys, not contingent on pica being attempted
Differential reinforcement, with positive reinforcement if pica is not attempted and negative reinforcement if pica is attempted
Discrimination training between edible and inedible items, with negative consequences if pica is attempted
Visual screening, with eyes briefly for a short time after pica is attempted
Aversive presentation, contingent on pica being attempted:
oral taste (e.g., lemon)
smell sensation (e.g., ammonia)
physical sensation (e.g., water mist in face)
Physical restraint:
self-protection devices that prohibit placement of objects in the mouth
brief restraint contingent on pica being attempted
Time-out contingent on pica being attempted
Overcorrection, with attempted pica resulting in required washing of self, disposal of nonedible objects, and chore-based punishment
Negative practice (nonedible object held against patient's mouth without allowing ingestion)
[edit]Epidemiology

Few studies have been conducted to measure the prevalence of pica in various populations. Two prevalence studies conducted on pregnant women in the 1990s found rates of 8.1% for pregnant African-American women in the U.S.[14] and 8.8% for pregnant women in Saudi Arabia.[15] Rates of pica among pregnant women in developing countries can be much higher, however, with estimates of 63.7%[16] and 74.0%[17] reported for two different African populations. This is due to different cultural norms as well as greater levels of malnutrition. Two studies of mentally retarded adults living in institutions found that 21.8%[18] and 25.8%[19] of these groups suffered from pica. Prevalence rates for children with and without developmental disabilities are unknown.
[edit]Examples



Chalky stone composed of kaolinite with traces of quartz ingested by a patient with pica.
Amylophagia (consumption of starch)
Coprophagy (consumption of feces)
Geophagy (consumption of soil, clay, or chalk)
Hyalophagia (consumption of glass)
Consumption of dust or sand has been reported among iron-deficient patients.
Mucophagia (consumption of mucus)
Odowa (soft stones eaten by pregnant women in Kenya)[20]
Pagophagia (pathological consumption of ice)
Self-cannibalism (rare condition where body parts may be consumed; see also Lesch-Nyhan syndrome)
Trichophagia (consumption of hair or wool)
Urophagia (consumption of urine)
Xylophagia (consumption of wood)