Definition and Diagnosis
Pica is characterized by the persistent eating of non-nutritive, non-food substances (such as dirt, chalk, paper, or hair) over a period of at least one month, that is developmentally inappropriate and not part of a culturally supported practice.
Epidemiology
Pica is most commonly identified in children, in individuals with intellectual disability, and during pregnancy, though precise prevalence is difficult to estimate due to underreporting.
Risk Factors
Risk factors include intellectual or developmental disability, nutritional deficiencies (such as iron or zinc deficiency), pregnancy, neglect or under-stimulation in childhood, and co-occurring autism spectrum disorder.
Symptoms and Subtypes
The core feature is persistent ingestion of non-food items, which can lead to complications such as gastrointestinal obstruction, perforation, infection (e.g., from soil or feces ingestion), or toxicity depending on the substance consumed.
Diagnosis
DSM-5-TR criteria require persistent eating of non-nutritive substances for at least a month, that this behavior is developmentally inappropriate, not part of a culturally sanctioned practice, and severe enough to warrant independent clinical attention when occurring alongside another mental disorder.
Treatment
Management includes behavioral interventions, treatment of any underlying nutritional deficiency, environmental modification to reduce access to non-food items, and close monitoring for medical complications, particularly in children and pregnant individuals.
Prognosis
Pica in early childhood often resolves with age and appropriate intervention, though it can persist in individuals with intellectual disability and may require ongoing management and monitoring for medical complications.
Reference
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).