A Little Known Eating Disorder Is on the Rise

While hospitalizations for eating disorders are down overall, one category is rising at an alarming rate, says the Agency for Healthcare Research and Quality. From 1999 to 2009, hospitalizations for patients with an eating disorder called pica jumped a whopping 93 percent.

Pica is eating something that is not food, notably in large quantities and on a regular basis. What do people who have pica eat? The list is a long one: ashes, balloons, chalk, metal, grass, crayons, insects, sand, soap, paste, string, plastic, baby powder, paint chips, wallboard, and more. Some of these strange nonfood-food obsessions have names of their own. Geophagia is clay eating. Pagophagia is ice eating,

Pica gets its name from the Latin word for magpie. Magpies eat just about anything, but humans who eat nonfoods are choosier. The compulsion usually focuses on a single item. Doctors have operated on people whose intestines were blocked with nuts, bolts, or screws. People who regularly consume twigs, newsprint, or bathroom deodorizers are not as rare as you might guess.

Pica is defined, in part, by cultural norms. In the United States today, eating clay is considered pica, but in past centuries, it was not. Clay eating and soil eating were common in the 1800s, especially among slaves in the South. In the 1950s and 1960s, the practice was so popular that clay-filled lunch bags were sold at Alabama bus stops as snacks for travelers. Southerners mailed bags of hometown clay to their friends and relatives who moved north. Some reports estimate that clay eating is a daily practice in over 200 cultures worldwide.

Some pica behaviors involve substances that are foods but are not usually eaten alone or in large quantities. For example, small amounts of cornstarch thicken gravies and fruit pies. People with amylophagia may eat two or three boxes of cornstarch a week. Ingesting one-half box or more of cornstarch daily releases enough sugar into the bloodstream to send blood glucose levels rocketing. That can trigger diabetes, especially in pregnant women.

Why do people eat nonfood substances? In some cultures, pica is practiced for medicinal purposes and may actually have some value. For example, people in some parts of Nigeria eat kaolinite (a form of clay) to combat diarrhea. The clay actually forms a protective coating in the lining of the intestine and binds bacteria there, thus relieving diarrhea.

Other people say they eat clay, starch, or some other substance simply because they enjoy the taste, texture, or smell. Others claim pica behavior—such as crunching the frost that collects in the freezer—eases tension and anxiety. Some pregnant women eat clay because they believe it will relieve morning sickness. Some mental health professionals categorize pica as an obsessive-compulsive disorder. That term describes people who feel powerless to stop a behavior they know is bizarre, even risky.

Doctors can't always tell whether their patients are consuming nonfoods. People don't tell, either because they are embarrassed or because they see nothing odd about it. To find out how common pica truly is, Ellen Simpson and her colleagues in California asked pregnant Hispanic women about their eating habits. Somewhere between a third and a half reported eating nonfood items. Their favorites included dirt, ashes, clay, and magnesium carbonate, a mineral sold in blocks in Mexican pharmacies as a laxative. Some of the women said they simply liked the taste, texture, or aroma of the nonfood substances. Others said they "couldn't help themselves."

Most thought the pica was good for them or for the babies they carried. They believed that failure to satisfy their pica cravings would lead to miscarriage, illness, or an unhappy baby. The researchers could find no particular pattern in pica preferences. "Women who ate tar lived next door to women who ate laundry bluing who lived next door to women who ate dirt."

Doctors worry less about the pica itself than about its outcomes. Serious consequences include:

• Poisoning, such as lead poisoning from eating chips of old paint or soil that has old paint in it.
• Obstruction of the bowel or airways from consuming or choking on indigestible materials such as hair.
• Obesity from consuming too many calories, such as eating laundry starch.
• Inadequate protein or energy—intake from consuming things like coffee grounds or oyster shells in place of real foods.
• Nutritional deficiencies, such as the interference of soil with the absorption of iron, zinc, and potassium in the digestive system.
• Damage to teeth and gums from chewing abrasive materials such as twigs or metals.
• Infestations of parasites such as tapeworms resulting from consuming dirt or feces.
• High blood pressure, high levels of sodium salts in the blood, and abnormal liver functions such as those resulting from consuming large quantities of baking powder.
• Low birth weight, premature birth, mental and physical abnormalities, and even death among infants whose mothers practice pica during pregnancy.

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Despite the risks, these latest statistics show that pica is a growing public health problem. These new data reveal that, between 1999 and 2009, the number of hospital stays for patients with pica nearly doubled, from 964 to 1,862. Patients with pica and other eating disorders may also be hospitalized for other conditions such as depression, fluid and electrolyte disorders, schizophrenia, or alcohol-related disorders. Although 9 in 10 cases of eating disorders occur among women, those in men increased by 53 percent in the last decade.

What should you do if you have pica? The answer is a common-sense one: See your doctor and tell the truth. Since pica is generally considered an obsessive-compulsive or addictive disorder, the services of a qualified psychologist or psychologist may be just what you need to help you combat your eating disorder and return to good mental and physical health.