Pica, An Eating Disorder: Causes, Prevalence, Complications, Treatment

Key takeaways:

• Pica is an eating disorder where individuals crave non-food items like dirt, chalk, or ice.
• It is especially common in certain vulnerable groups, such as young children, pregnant women, and individuals with mental health conditions.
• Pica can lead to serious health complications and requires prompt medical intervention.
• A registered dietitian can help by addressing potential nutritional deficiencies and providing support.

Imagine feeling compelled to eat ice, chalk, dirt, or even hair—these cravings are real and surprisingly common among people with a condition known as pica. Although pica is often misunderstood, it affects millions worldwide, particularly among children and pregnant people.

Pica is an eating behavioral disorder that includes the purposeful consumption of largely inedible and non-food material.

Simply put, pica is eating mostly non-food substances. These cravings can last for weeks or a month and beyond, usually during developmental stages of curiosity in young children or during stages of life like pregnancy. 

To some, an occasional ingestion of such items may seem harmless, but pica is considered a serious condition when it persists and becomes habitual.

This is because some of the items people with this disorder consume can cause toxic and harmful effects on the body. And this condition is a growing concern in many parts of the world, including Africa.

Prevalence of pica in Africa

A school-based cross-sectional study was conducted at a school in north Sudan among 384 enrolled adolescents; 180 (46.9%) were male, and 204 (53.1%) were female adolescents.

The study showed the prevalence of pica symptoms to be 30.7%, accounting for 118 adolescents. The most common type of pica was geophagia (eating clay and sand), followed by pagophagia (eating ice) and flour. Symptoms of pica were most common amongst adolescent females. 

In Nigeria, pica prevalence has been recorded to be at about 78%, 53%, 13%, and 50%, respectively, in the Eastern, Northern, and Western parts of the country.

Another study conducted among pregnant people receiving antenatal care in Obio Cottage Hospital, Rumuobiakani, Port Harcourt, Nigeria, to determine the prevalence of pica practice revealed a relatively high prevalence of 62.86% pica practice among pregnant people.  

On the pattern of pica practice, clay was the most common (50%), followed by nail-biting (7.58%), sour food (6.06%), and plant roots/seeds/leaves (4.11%), among others. About 80.31% of those who practiced pica consumed non-food items twice a day.

Pica is not a rare phenomenon, which leaves the question, “What drives people to eat things that are not food?”

This and more will be discussed in this article. Understanding PICA's causes, health implications, and treatment options is essential for those who experience it, as well as for their loved ones and healthcare providers.

Common non-food items consumed by people with pica

Individuals with pica may develop cravings for a variety of non-food substances, including:

• Dirt or soil/clay
• Chalk
• Ice (often linked to iron deficiency anemia)
• Stones 
• Paper
• Soap
• Hair
• Paint chips
• Charcoal
• Cornstarch

Causes of pica

Although the exact cause of this disorder is not known, some risk factors serve as a determinant of why it occurs. It could be physical, physiological, psychological, or behavioral symptoms/factors.

Psychological factors

Pica is often characterized by or co-occurs with mental health issues that include a pattern of repetitive behaviors, intrusive thoughts, or intellectual disabilities.

• Conditions such as obsessive-compulsive disorder (OCD), autism spectrum disorder (ASD), trauma (child neglect/molestation), and schizophrenia may lead to the development of pica due to delusions or hallucinations.
• Anxiety disorders (generalized anxiety disorder or post-traumatic stress disorder), can cause intense feelings of stress or fear, leading to pica behaviors as a way to cope with these emotions.

Nutritional deficiencies

Some sources have indicated that pica may develop as a result of the body trying to correct a significant nutritional deficiency. Specific nutritional deficiencies, like iron, zinc, and calcium deficiencies, can lead to pica.

• Iron deficiency anemia: Iron deficiency is a common cause of pica found among pregnant people and young children, causing cravings for nonfood substances such as ice, dirt, or clay. The body requires iron to make a protein called hemoglobin found in red blood cells. Hemoglobin carries oxygen through the blood to body tissues. When the body is low in iron, it usually leads to anemia, which can cause fatigue and other symptoms.
• Zinc deficiency: Zinc is an important nutrient needed in small amounts for the normal functioning of the immune system, growth, development, and wound healing. Zinc deficiency can cause symptoms such as hair loss, diarrhea, skin rashes, and brittle fingernails. People with zinc deficiency may also develop pica and crave nonfood substances.
• Calcium deficiency: Calcium is another mineral the body needs for proper muscle function, bone health, and nerve function. When calcium is insufficient in the body, symptoms like osteoporosis, muscle cramps, and dental problems may occur. Calcium deficiency has also been associated with pica, causing cravings for nonfood substances, including paper, chalk, clay, and paint chips.

Pregnancy-related hormonal changes

It's uncertain why many pregnant people crave non-food items. Some studies have linked it to hormonal changes and stress, while others attribute it to the body’s attempt to obtain vitamins and minerals that are not sufficient through normal food consumption.

Cultural beliefs or practices

People with pica may have grown up in areas where it is believed that non-food items are nutritious and healthy and also hold symbolic significance.

Learned behavior

Children and peers can learn to consume non-food items from each other or people around them, and over time, it becomes a habit.

Who is more likely to develop pica?

Pica appears to be more prevalent in certain groups of people:

• Pregnant women: due to hormonal changes and stress
• Children: those with developmental delays and malnutrition
• Individuals with mental health disorders
• People in culturally influenced environments

Health complications associated with pica

Pica may not cause harm to some people, but it may lead to health complications in some people, including:

1. Gastrointestinal issues and blockages

Ingesting indigestible materials can lead to intestinal obstructions or perforations, causing stomach ulcers, indigestion, constipation, and malabsorption of nutrients into the body.

2. Toxicity

Substances like paint chips or soil may contain harmful chemicals (lead or pesticides) or bacterial or parasitic infestations, which can affect health tremendously, even leading to death.

3. Nutritional deficiencies

Focusing on consuming non-nutritive items can lead to a lack of essential nutrients in the body, further leading to malnutrition and depletion of already stored nutrients.

4. Dental damage

Chewing hard or abrasive materials can harm the teeth, leading to a broken tooth, inflamed gums, or mouth sores.

Pica in pregnancy

Pica is highly prevalent among pregnant women due to hormonal changes or deficiencies in iron and zinc. Although studies show an association between pica and hormones or deficiencies, there could be more reasons and factors affecting pregnant people with this condition. 

While cravings for non-food items might seem benign, they can pose risks like nutrient deficiencies, gastrointestinal issues, and lead poisoning to both mother and baby and cause more harm to the unborn child.

Pregnant individuals experiencing such cravings should consider consulting healthcare professionals for expert management.

How healthcare professionals diagnose and treat pica

Diagnosing pica often involves psychological evaluations, blood tests for deficiencies, and discussions of eating behaviors. Treatment may include:

• Addressing nutritional deficiencies
• Behavioral therapy
• Medications for underlying psychological conditions

When to seek medical attention

Seek help if cravings persist for non-food items or if physical symptoms such as stomach pain or poisoning occur.

How a registered dietitian can help people with pica

Dietitians can address underlying nutritional deficiencies (micronutrient deficiencies) and develop personalized meal plans to reduce cravings, manage pica, and improve overall health and well-being.