Pica: Common but Commonly Missed

, , and , Department of Family Medicine, Wayne State University, Detroit.

J Am Board Fam Med. 2000;13(5) 

In This Article

Pica

The Diagnostic and Statistical Manual of Mental Disorder: DSM - IV[1] defines pica as "the persistent eating of nonnutritive substances for a period of at least one month, without an association with an aversion to food." The behavior must be developmentally inappropriate and not part of a culturally sanctioned practice, and severe enough to warrant clinical attention. The DSM-IV manual states that the condition is frequently associated with mental retardation, but it has been seen in all ages and both sexes, and particularly in young children and pregnant women.[1]

Other authors describe variations on these themes. Parry-Jones and Parry-Jones[2] note that there are several references throughout history suggesting that pica can also include the compulsive eating of food substances, essentially normal food in abnormal quantities, blurring the distinction with such food cravings as those associated with premenstrual syndrome or pregnancy.[2] As this suggestion implies, it can be misleading to classify all pica as abnormal. In addition, pica might represent a symptom complex rather than a disease.[2]

Pica is most frequently observed in pregnant women, patients of lower socioeconomic status, and children.[3] It is also found in some cases of iron-deficiency anemia as well as in deficiencies of other nutrients such as zinc.[4] In some cultures pica is considered normal and even therapeutic,[2] falling outside of the DSM-IV definition of a disorder.[1] The types of substances ingested are listed in Table 1. The eating patterns are referred to as "-phagias," such as pagophagia for ice eaters, geophagia for clay eaters, and amylophagia for starch eaters. Interestingly, the range of reported items of consumption has not changed much during the past 4 centuries.[2]

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