Table of ContentsView AllTable of ContentsSymptomsWho It AffectsPica DiagnosisTypesCausesTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Who It Affects
Pica Diagnosis
Types
Causes
Treatment
Pica is the repeated eating of items that are not considered edible. It tends to be more common in children, pregnant people, and those with certain conditions.
Pica is a type offeeding and eating disorder. It can be serious and potentially life-threatening. When people have this condition, they will compulsively eat non-food items that do not have nutritional value. Items consumed vary substantially and can include paper, plastic, cloth, dirt, clay, paint, rocks, soap, cigarette butts, hair, and metal pieces such as coins.
Pica must be distinguished from the persistent consumption of other unusual substances, such as cornstarch and uncooked rice or pasta, which are nutritive substances, and ice, which is commonly consumed in beverages.
At a GlancePica can affect anyone, but it is more common in children, pregnant people, and those with developmental and intellectual disabilities. Non-food items that people may consume include hair, eggshells, paint chips, paper, soap, fabric, chalk, dirt, coffee grounds, feces, and other types of non-food substances. While sometimes harmless, the condition can pose serious health risks including poisoning, choking, and gastrointestinal blockages. Fortunately, treatment can help, which may include therapy, medication, and surgical interventions to remove blockages.
At a Glance
Pica can affect anyone, but it is more common in children, pregnant people, and those with developmental and intellectual disabilities. Non-food items that people may consume include hair, eggshells, paint chips, paper, soap, fabric, chalk, dirt, coffee grounds, feces, and other types of non-food substances. While sometimes harmless, the condition can pose serious health risks including poisoning, choking, and gastrointestinal blockages. Fortunately, treatment can help, which may include therapy, medication, and surgical interventions to remove blockages.
Symptoms of Pica
The core symptom of pica is eating non-food substances that don’t have any nutritional value. Some of these aren’t particularly harmful (like ice), but others can be dangerous and lead to serious health issues.
If you or someone else has this condition, you might experience symptoms such as:
Who Does Pica Affect?
Although the onset of pica can occur at any age, it most commonly emerges during childhood. Pica appears to be more common among pregnant women and children with developmental and intellectual disabilities. It often occurs along with other disorders, such asautism spectrum disorder,obsessive-compulsive disorder, andattention-deficit/hyperactivity disorder.
PrevalenceThere is limited research on pica. It is believed to be rare among healthy children in the US. Less than 10% of US children older than 12 meet diagnostic criteria for pica.One study reported a high prevalence of pica among children in treatment for sickle cell anemia,and another study showed high rates among school-aged children in Africa.
Prevalence
There is limited research on pica. It is believed to be rare among healthy children in the US. Less than 10% of US children older than 12 meet diagnostic criteria for pica.One study reported a high prevalence of pica among children in treatment for sickle cell anemia,and another study showed high rates among school-aged children in Africa.
The practice of eating dirt is culturally sanctioned in some African countries and may continue among African Americans as a culturally normative practice based on their heritage.
When pica behavior is a culturally-supported practice, it would not be diagnosed as a mental disorder.
According to theDiagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), four criteria are required for a diagnosis of pica:
In previous editions of the DSM, Pica was in the “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence.” In the current edition, it was moved into the new combined section, “Feeding and Eating Disorders.” This change reflects the fact that pica can occur in adults as well as children.
If a non-nutritive substance is eaten to suppress appetite in an individual withanorexia nervosa, a diagnosis of pica would not be made. Some people withavoidant/restrictive food intake disorder (ARFID), especially those whose selective eating is based on the sensory aspects of food, may also have pica.
These individuals are very sensitive to texture and may seek out nonnutritive substances with a preferred texture. Pica can also occur withnonsuicidal self-harmin cases in which foreign objects are swallowed.
Types of Pica
Different terms have evolved to specify the different substances that are consumed during pica:
Two related eating behaviors that do not qualify as pica also have terms:pagophagiarefers to the ingestion of ice, andamylophagiarefers to the ingestion of starches such as cornstarch and dried pasta.
There are also many other non-edible substances that people may consume when they have pica. Some of these include:
What Causes Pica?
The motivation to consume these nonfood substances varies across individuals with pica.
Some individuals report a compulsion to eat particular substances and may report acravingdue to taste or consistency.Others report a need fororal stimulation.Some describe pica as a form ofself-soothing behaviorwhen arousal reaches a particular level.
Risk Factors
Due to extremely limited research on pica, risk factors are not well understood. A few theories have emerged to explain this condition:
Medical Risks
Pica can be associated with significant medical risks depending on the substances ingested and how severe the behavior is.
Heavy metals such as lead, mercury (from paper), zinc, and copper can be toxic. Pica can lead to masses of consumed matter in the stomach and gastrointestinal tract, blockages in the intestines, and tears requiring surgery.
Pica can also lead to issues including internal parasites, poisoning, choking, respiratory problems, and death.
Treatment for Pica
There is no widely-accepted treatment for pica.
Current interventions to address pica include surgery as well as nutritional, pharmacological, and behavioral treatments. Surgical interventions may be required when items ingested have caused damage to the body, but they do not address the underlying symptoms.
Nutritional supplements such as iron have been used for treatment when underlying nutritional deficiencies or excesses have been identified. Various medications have been tried although there are no conclusive studies on their use. There are limited studies of behavioral interventions for pica.
Interventions that seem most likely to be successful in treating pica in children are combination treatments that include reinforcement procedures such as contingent reinforcement and discrimination training.
Punishment procedures should only be considered when all other interventions have been insufficient and there is a significant risk from continued pica behaviors.
For adults with pica,cognitive behavioral therapy (CBT)may be a useful technique. Such treatment may focus on helping the person to change their thoughts about eating the nonfood item and changing the behavior and replacing it with another coping strategy.
Takeaways
If you or someone you know shows signs and symptoms of pica, it is important to reach out for help from a medical professional. The condition can pose health risks, and may indicate an underlying medical, mental health, or nutritional problem. Talk to your doctor to learn more about your condition and the treatments that can help.
Understanding Chewing and Spitting in Eating Disorders
18 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Leung AKC, Hon KL.Pica: A common condition that is commonly missed - an update review.Current Pediatric Reviews. 2019;15(3). doi:10.2174/1573396315666190313163530National Eating Disorder Association.Pica.Ganesan PR, Vasauskas AA.The association between pica and iron-deficiency anemia: A scoping review.Cureus. Published online April 20, 2023. doi:10.7759/cureus.37904Hong E, Dixon DR.Pica in individuals with developmental disabilities.Handbook of Childhood Psychopathology and Developmental Disabilities Treatment. 2017. doi:10.1007/978-3-319-71210-9_17Moline, R, Hou, S, Chevrier, J, Thomassin, K.A systematic review of the effectiveness of behavioural treatments for pica in youths.Clin Psychol Psychother. 2021; 28: 39– 55. doi: 10.1002/cpp.2491Rodrigues N, Shih S, Cohen LL.Pica in pediatric sickle cell disease.Journal of Clinical Psychology in Medical Settings. 2019;28(1). doi:10.1007/s10880-019-09671-xvan Hoeken D, Burns JK, Hoek HW.Epidemiology of eating disorders in Africa.Current Opinion in Psychiatry. 2016;29(6). doi:10.1097/yco.0000000000000274Jackson MS, Adedoyin AC, Winnick SN.Pica disorder among African American women: A call for action and further research.Social Work in Public Health. 2020;35(5):1-10. doi:10.1080/19371918.2020.1791778American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.Call C, Walsh BT, Attia E.From DSM-IV to DSM-5.Current Opinion in Psychiatry. 2013;26(6). doi:10.1097/yco.0b013e328365a321Bryant‐Waugh R, Micali N, Cooke L, Lawson EA, Eddy KT, Thomas JJ.Development of the Pica, ARFID, and rumination disorder interview, a multi‐informant, semi‐structured interview of feeding disorders across the lifespan: A pilot study for ages 10–22.International Journal of Eating Disorders. 2018;52(4). doi:10.1002/eat.22958Hartmann AS, Becker AE, Hampton C, Bryant-Waugh R.Pica and Rumination Disorder in DSM-5.Psychiatric Annals. 2012;42(11). doi:10.3928/00485713-20121105-09Mishori R, McHale C.Pica: an age-old eating disorder that’s often missed.J Fam Pract. 2014;63(7):E1-E4.Ali Z.Pica in people with intellectual disability: a literature review of aetiology, epidemiology and complications.Journal of Intellectual & Developmental Disability.2001;26(3):205-215, doi: 10.1080/13668250020054486Williams F, Gibbs S, Addo AS.The assessment and management of pica in people with intellectual disability.BJPsych Advances. 2022;28(6):383-392. doi:10.1192/bja.2022.24Roy A, Fuentes-Afflick E, Fernald LCH, Young SL.Pica is prevalent and strongly associated with iron deficiency among Hispanic pregnant women living in the United States.Appetite. 2018;120:163-170. doi:10.1016/j.appet.2017.08.033Matson JL, Hattier MA, Belva B, Matson ML.Pica in persons with developmental disabilities: Approaches to treatment.Research in Developmental Disabilities. 2013;34(9). doi:10.1016/j.ridd.2013.05.018Thomas JJ, Becker KR, Breithaupt L, et al.Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder.Journal of Behavioral and Cognitive Therapy. 2021;31(1). doi:10.1016/j.jbct.2020.10.004
18 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Leung AKC, Hon KL.Pica: A common condition that is commonly missed - an update review.Current Pediatric Reviews. 2019;15(3). doi:10.2174/1573396315666190313163530National Eating Disorder Association.Pica.Ganesan PR, Vasauskas AA.The association between pica and iron-deficiency anemia: A scoping review.Cureus. Published online April 20, 2023. doi:10.7759/cureus.37904Hong E, Dixon DR.Pica in individuals with developmental disabilities.Handbook of Childhood Psychopathology and Developmental Disabilities Treatment. 2017. doi:10.1007/978-3-319-71210-9_17Moline, R, Hou, S, Chevrier, J, Thomassin, K.A systematic review of the effectiveness of behavioural treatments for pica in youths.Clin Psychol Psychother. 2021; 28: 39– 55. doi: 10.1002/cpp.2491Rodrigues N, Shih S, Cohen LL.Pica in pediatric sickle cell disease.Journal of Clinical Psychology in Medical Settings. 2019;28(1). doi:10.1007/s10880-019-09671-xvan Hoeken D, Burns JK, Hoek HW.Epidemiology of eating disorders in Africa.Current Opinion in Psychiatry. 2016;29(6). doi:10.1097/yco.0000000000000274Jackson MS, Adedoyin AC, Winnick SN.Pica disorder among African American women: A call for action and further research.Social Work in Public Health. 2020;35(5):1-10. doi:10.1080/19371918.2020.1791778American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.Call C, Walsh BT, Attia E.From DSM-IV to DSM-5.Current Opinion in Psychiatry. 2013;26(6). doi:10.1097/yco.0b013e328365a321Bryant‐Waugh R, Micali N, Cooke L, Lawson EA, Eddy KT, Thomas JJ.Development of the Pica, ARFID, and rumination disorder interview, a multi‐informant, semi‐structured interview of feeding disorders across the lifespan: A pilot study for ages 10–22.International Journal of Eating Disorders. 2018;52(4). doi:10.1002/eat.22958Hartmann AS, Becker AE, Hampton C, Bryant-Waugh R.Pica and Rumination Disorder in DSM-5.Psychiatric Annals. 2012;42(11). doi:10.3928/00485713-20121105-09Mishori R, McHale C.Pica: an age-old eating disorder that’s often missed.J Fam Pract. 2014;63(7):E1-E4.Ali Z.Pica in people with intellectual disability: a literature review of aetiology, epidemiology and complications.Journal of Intellectual & Developmental Disability.2001;26(3):205-215, doi: 10.1080/13668250020054486Williams F, Gibbs S, Addo AS.The assessment and management of pica in people with intellectual disability.BJPsych Advances. 2022;28(6):383-392. doi:10.1192/bja.2022.24Roy A, Fuentes-Afflick E, Fernald LCH, Young SL.Pica is prevalent and strongly associated with iron deficiency among Hispanic pregnant women living in the United States.Appetite. 2018;120:163-170. doi:10.1016/j.appet.2017.08.033Matson JL, Hattier MA, Belva B, Matson ML.Pica in persons with developmental disabilities: Approaches to treatment.Research in Developmental Disabilities. 2013;34(9). doi:10.1016/j.ridd.2013.05.018Thomas JJ, Becker KR, Breithaupt L, et al.Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder.Journal of Behavioral and Cognitive Therapy. 2021;31(1). doi:10.1016/j.jbct.2020.10.004
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Leung AKC, Hon KL.Pica: A common condition that is commonly missed - an update review.Current Pediatric Reviews. 2019;15(3). doi:10.2174/1573396315666190313163530National Eating Disorder Association.Pica.Ganesan PR, Vasauskas AA.The association between pica and iron-deficiency anemia: A scoping review.Cureus. Published online April 20, 2023. doi:10.7759/cureus.37904Hong E, Dixon DR.Pica in individuals with developmental disabilities.Handbook of Childhood Psychopathology and Developmental Disabilities Treatment. 2017. doi:10.1007/978-3-319-71210-9_17Moline, R, Hou, S, Chevrier, J, Thomassin, K.A systematic review of the effectiveness of behavioural treatments for pica in youths.Clin Psychol Psychother. 2021; 28: 39– 55. doi: 10.1002/cpp.2491Rodrigues N, Shih S, Cohen LL.Pica in pediatric sickle cell disease.Journal of Clinical Psychology in Medical Settings. 2019;28(1). doi:10.1007/s10880-019-09671-xvan Hoeken D, Burns JK, Hoek HW.Epidemiology of eating disorders in Africa.Current Opinion in Psychiatry. 2016;29(6). doi:10.1097/yco.0000000000000274Jackson MS, Adedoyin AC, Winnick SN.Pica disorder among African American women: A call for action and further research.Social Work in Public Health. 2020;35(5):1-10. doi:10.1080/19371918.2020.1791778American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.Call C, Walsh BT, Attia E.From DSM-IV to DSM-5.Current Opinion in Psychiatry. 2013;26(6). doi:10.1097/yco.0b013e328365a321Bryant‐Waugh R, Micali N, Cooke L, Lawson EA, Eddy KT, Thomas JJ.Development of the Pica, ARFID, and rumination disorder interview, a multi‐informant, semi‐structured interview of feeding disorders across the lifespan: A pilot study for ages 10–22.International Journal of Eating Disorders. 2018;52(4). doi:10.1002/eat.22958Hartmann AS, Becker AE, Hampton C, Bryant-Waugh R.Pica and Rumination Disorder in DSM-5.Psychiatric Annals. 2012;42(11). doi:10.3928/00485713-20121105-09Mishori R, McHale C.Pica: an age-old eating disorder that’s often missed.J Fam Pract. 2014;63(7):E1-E4.Ali Z.Pica in people with intellectual disability: a literature review of aetiology, epidemiology and complications.Journal of Intellectual & Developmental Disability.2001;26(3):205-215, doi: 10.1080/13668250020054486Williams F, Gibbs S, Addo AS.The assessment and management of pica in people with intellectual disability.BJPsych Advances. 2022;28(6):383-392. doi:10.1192/bja.2022.24Roy A, Fuentes-Afflick E, Fernald LCH, Young SL.Pica is prevalent and strongly associated with iron deficiency among Hispanic pregnant women living in the United States.Appetite. 2018;120:163-170. doi:10.1016/j.appet.2017.08.033Matson JL, Hattier MA, Belva B, Matson ML.Pica in persons with developmental disabilities: Approaches to treatment.Research in Developmental Disabilities. 2013;34(9). doi:10.1016/j.ridd.2013.05.018Thomas JJ, Becker KR, Breithaupt L, et al.Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder.Journal of Behavioral and Cognitive Therapy. 2021;31(1). doi:10.1016/j.jbct.2020.10.004
Leung AKC, Hon KL.Pica: A common condition that is commonly missed - an update review.Current Pediatric Reviews. 2019;15(3). doi:10.2174/1573396315666190313163530
National Eating Disorder Association.Pica.
Ganesan PR, Vasauskas AA.The association between pica and iron-deficiency anemia: A scoping review.Cureus. Published online April 20, 2023. doi:10.7759/cureus.37904
Hong E, Dixon DR.Pica in individuals with developmental disabilities.Handbook of Childhood Psychopathology and Developmental Disabilities Treatment. 2017. doi:10.1007/978-3-319-71210-9_17
Moline, R, Hou, S, Chevrier, J, Thomassin, K.A systematic review of the effectiveness of behavioural treatments for pica in youths.Clin Psychol Psychother. 2021; 28: 39– 55. doi: 10.1002/cpp.2491
Rodrigues N, Shih S, Cohen LL.Pica in pediatric sickle cell disease.Journal of Clinical Psychology in Medical Settings. 2019;28(1). doi:10.1007/s10880-019-09671-x
van Hoeken D, Burns JK, Hoek HW.Epidemiology of eating disorders in Africa.Current Opinion in Psychiatry. 2016;29(6). doi:10.1097/yco.0000000000000274
Jackson MS, Adedoyin AC, Winnick SN.Pica disorder among African American women: A call for action and further research.Social Work in Public Health. 2020;35(5):1-10. doi:10.1080/19371918.2020.1791778
American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.
Call C, Walsh BT, Attia E.From DSM-IV to DSM-5.Current Opinion in Psychiatry. 2013;26(6). doi:10.1097/yco.0b013e328365a321
Bryant‐Waugh R, Micali N, Cooke L, Lawson EA, Eddy KT, Thomas JJ.Development of the Pica, ARFID, and rumination disorder interview, a multi‐informant, semi‐structured interview of feeding disorders across the lifespan: A pilot study for ages 10–22.International Journal of Eating Disorders. 2018;52(4). doi:10.1002/eat.22958
Hartmann AS, Becker AE, Hampton C, Bryant-Waugh R.Pica and Rumination Disorder in DSM-5.Psychiatric Annals. 2012;42(11). doi:10.3928/00485713-20121105-09
Mishori R, McHale C.Pica: an age-old eating disorder that’s often missed.J Fam Pract. 2014;63(7):E1-E4.
Ali Z.Pica in people with intellectual disability: a literature review of aetiology, epidemiology and complications.Journal of Intellectual & Developmental Disability.2001;26(3):205-215, doi: 10.1080/13668250020054486
Williams F, Gibbs S, Addo AS.The assessment and management of pica in people with intellectual disability.BJPsych Advances. 2022;28(6):383-392. doi:10.1192/bja.2022.24
Roy A, Fuentes-Afflick E, Fernald LCH, Young SL.Pica is prevalent and strongly associated with iron deficiency among Hispanic pregnant women living in the United States.Appetite. 2018;120:163-170. doi:10.1016/j.appet.2017.08.033
Matson JL, Hattier MA, Belva B, Matson ML.Pica in persons with developmental disabilities: Approaches to treatment.Research in Developmental Disabilities. 2013;34(9). doi:10.1016/j.ridd.2013.05.018
Thomas JJ, Becker KR, Breithaupt L, et al.Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder.Journal of Behavioral and Cognitive Therapy. 2021;31(1). doi:10.1016/j.jbct.2020.10.004
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