Pica
307.52 Pica
Diagnostic Features
The essential feature of Pica is the eating of one or more nonnutritive substances on a persistent basis for a period of at least 1 month (Criterion A). The typical substances ingested tend to vary with age. Infants and younger children typically eat paint, plaster, string, hair, or cloth. Older children may eat animal droppings, sand, insects, leaves, or pebbles. Adolescents and adults may consume clay or soil. There is no aversion to food. This behavior must be developmentally inappropriate (Criterion B) and not part of a culturally sanctioned practice (Criterion C). The eating of nonnutritive substances is an associated feature of other mental disorders (e.g., Pervasive Developmental Disorder, Mental Retardation). If the eating behavior occurs exclusively during the course of another mental disorder, a separate diagnosis of Pica should be made only if the eating behavior is sufficiently severe to warrant independent clinical attention (Criterion D).
Associated Features and Disorders
Pica is frequently associated with Mental Retardation and Pervasive Developmental Disorders. Although vitamin or mineral deficiencies (e.g., zinc) have been reported in some instances, usually no specific biological abnormalities are found. In some cases, Pica comes to clinical attention only following general medical complications (e.g., lead poisoning as a result of ingesting paint or paint-soaked plaster, mechanical bowel problems, intestinal obstruction as a result of hair ball tumors, intestinal perforation, or infections such as toxoplasmosis and toxocariasis as a result of ingesting feces or dirt). Poverty, neglect, lack of parental supervision, and developmental delay increase the risk for the condition.
Specific Culture, Age, and Gender Features
In some cultures, the eating of dirt or other seemingly nonnutritive substances is believed to be of value. Pica is more commonly seen in young children and occasionally in pregnant females.
Prevalence
Epidemiological data on Pica are limited. Among individuals with Mental Retardation, the prevalence of the disorder appears to increase with the severity of the retardation (e.g., it has been reported to be as high as 15% in adults with Severe Mental Retardation).
Course
Pica may have its onset in infancy. In most instances, the disorder appears to last for several months and then remits. It may occasionally continue into adolescence or, less frequently, into adulthood. In individuals with Mental Retardation, the behavior may diminish during adulthood.
Differential Diagnosis
Before approximately ages 18-24 months, mouthing and sometimes eating of nonnutritive substances are relatively common and do not imply the presence of Pica. Pica is diagnosed only when the behavior is judged to be persistent (i.e., present for at least 1 month) and inappropriate given the individual's developmental level. Eating of nonnutritive substances may occur during the course of other mental disorders (e.g., in a Pervasive Developmental Disorder, in Schizophrenia as a result of delusional beliefs, and in Kleine-Levin syndrome). In such instances, an additional diagnosis of Pica should be given only if the eating behavior is sufficiently severe to warrant independent clinical attention. Pica can be distinguished from other eating disorders (e.g., Rumination Disorder, Feeding Disorder of Infancy or Early Childhood, Anorexia Nervosa, and Bulimia Nervosa) by the consumption of nonnutritive substances.
Diagnostic criteria for 307.52 Pica
- Persistent eating of nonnutritive substances for a period of at least 1 month.
- The eating of nonnutritive substances is inappropriate to the developmental level.
- The eating behavior is not part of a culturally sanctioned practice.
- If the eating behavior occurs exclusively during the course of another mental disorder (e.g., Mental Retardation, Pervasive Developmental Disorder, Schizophrenia), it is sufficiently severe to warrant independent clinical attention.