Pica.

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).

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 which is reputed to eat almost anything. Pica is seen in all ages, particularly in pregnant women, small children, and those with developmental disabilities.

Causes

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 is sometimes a result of celiac disease. Often the substance eaten by someone with pica contains the mineral in which that individual is deficient. 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; however, pica is not currently recognized by the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as being a mental disorder. Sensory, physiological, cultural, and psychosocial perspectives have also been used by some to explain the causation of pica.

Treatment

Treatment for pica will vary based on the patient's category (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. For pica that appears to be of psychotic etiology, therapy and medication such as SSRIs have been used successfully. However, previous reports have cautioned against the use of medication until all non-psychotic etiologies have been ruled out.

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:

• 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)