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Pica is a disorder that involves regularly eating non-food substances. For example, someone may routinely consume dirt or ice chips. The condition may resolve on its own, but it also poses the possibility of dangerous medical problems, so early identification and treatment is key. The name derives from the Latin word for "magpie," a bird known to ingest many possible items.

Symptoms

Pica is diagnosed when a person regularly eats non-food substances for a period of one month or longer, according to the DSM-5. A diagnosis is only given if the behavior is not developmentally appropriate or culturally supported.

Pica often occurs in the context of another mental health condition, such as autism, intellectual disability, obsessive-compulsive disorder, and schizophrenia. In more serious cases, a person will receive both diagnoses.

People with pica may consume the following items:

  • Dirt
  • Clay
  • Starch
  • Ice
  • Paper
  • Soap
  • Cloth
  • Hair
  • String
  • Wool
  • Soil
  • Chalk
  • Talcum powder
  • Paint
  • Gum
  • Metal
  • Pebbles
  • Charcoal or coal
  • Ash

How common is pica?

Pica most commonly occurs in childhood and pregnancy. Research suggests that 20 to 30 percent of children between ages one and six practice pica at some point. A metaanalysis of women during pregnancy and the post-partum period estimated that around 28 may percent experience pica. The relatively high incidence of pica in pregnant women is likely due to the bodies increased nutritional needs, especially for minerals such as iron and zinc. 

Has pica increased over time?

Yes, a report by the Agency for Healthcare Research and Quality suggests that hospitalizations for eating disorders rose 24 percent between 1999 and 2009, and that pica hospitalizations rose 93 percent, more than any other eating disorder.

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Causes

Scientists don’t fully understand what causes pica. It most often occurs temporarily in childhood and during pregnancy, although adults and non-pregnant people can occasionally develop the condition as well.

Pica is not diagnosed based on craving unusual items—which many people experience during pregnancy—but rather consuming those items regularly for a sustained time period.

Malnutrition and nutrition deficiencies may also contribute to the development of pica. Research suggests that those with iron and zinc deficiencies, for example, may be more likely to develop the condition and benefit from supplements and dietary changes. Pica has been linked to living in poverty and a lack of parental supervision, which may translate into inadequate food and nutrition.

Can anxiety cause pica?

Pica may develop in conjunction with anxiety and obsessive-compulsive disorder. Case studies show that the disorder has emerged in response to stressful circumstances, such as abandonment or divorce, and the eating of non-food substances may serve as a coping mechanism to relieve anxiety or intrusive thoughts.

Can memory deficits cause pica?

There is some evidence that memory deficits, particularly those acquired from brain injury, may cause pica; studies have identified people who developed symptoms following an injury. One possible explanation is that brain injury may disrupt sensory perception and therefore the ability to differentiate edible and non-edible foods.

Treatment

Pica often resolves on its own. However, it may also lead to medical complications such as intestinal obstruction, bowel problems, weight loss, broken teeth, infections, or poisoning. Therefore, it’s important to monitor and treat the condition as early as possible.

Treatment for pica varies based on what substance the person has consumed and how it has affected the body. Doctors may treat the medical problems first, assess potential causes of the disorder such as nutrient deficiencies, and then develop a treatment plan that may involve changes to diet and nutrition as well as therapy.

If pica is a result of inadequate supervision, treatment may involve educating the family and teaching children to distinguish between food and non-food items, and addressing housing and economic needs if possible.

If pica is a result of stress, treatment may involve talk therapy or family therapy and the development of coping skills, such as learning stress-reduction techniques or finding a safe substance to chew on instead.

What medical complications can result from pica?

Pica can have serious consequences. Examples 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 food.

• 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 among infants whose mothers practice pica during pregnancy.

References
Bhatia, M.S., Gupta, R. (2006) Pica responding to SSRI: An OCD spectrum disorder? The World Journal of Biological Psychiatry. 
Borgna-Pignatti, C., Zanella, S. (2016). Pica as a manifestation of iron deficiency. Expert Review of Hematology.
Fawcett, E., et al. (2016) A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. International Journal of Gynecology & Obstetrics.
Funayama, M., et al. (2017) Semantic memory deficits are associated with pica in individuals with acquired brain injury. Behavioural Brain Research.
Leung, A., Lun Hon K. (2019) Pica: A Common Condition that is Commonly Missed - An Update Review. Current Pediatric Reviews.
Tatay-Manteiga, A. (2020) Pica: obsessive-compulsive spectrum disorder, recurrent depression or eating disorder? Actas espanolas de psiquiatria.
T.E.C. (1969). The Origin of the World Pica. Pediatrics.
Walker, A.R.P., et al. (1997) Pica. Perspectives in Public Health.
Zhao, Y., Encinosa, W. (2011) An Update on Hospitalizations for Eating Disorders, 1999 to 2009. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs.
Last updated: 09/17/2021