268).Ĭomplications: Hormonal abnormalities, sensitivity to temperature, dental problems. Altering patients’ perceptions of food, weight loss, and body shape/size are instrumental in ensuring the long-term effect of clinical management (Black & Andreasen, 2020, p.
Eating behaviors should be changed in a way that helps accept a more sustainable diet. Treatment aims to reduce the binge-eating frequency and disordered eating-related cognitions, improve metabolic health and weight, and regulate mood (Brownley et al., 2016, Abstract). While there are anecdotal reports about antipsychotic use to reduce pica behaviors, these drugs also cause constipation and other adverse effects.īesides the removal of the substance from the environment, it is important to assess the cultural traditions and beliefs that promote pica behavior.Management: Restoring a normal nutritional state by providing a plan and encouraging patients is a vital part of treatment. There are no medications specifically for the treatment of pica. Differential reinforcement is a commonly used strategy to induce different patient responses to pica by redirecting the undesired behavior to other activities. Behavioral and aversive treatment might be effective in patients with mental disabilities. Iron, zinc, and other nutrient supplementation should be provided when a deficiency is identified. Strategies should be utilized to decrease exposure to the craved substance, such as reducing access or providing an appropriate substitute with a similar texture. This could be achieved by screening for the condition among such populations. Primary prevention should be utilized to identify at-risk patients such as children who live in old homes with lead paint and woman who are pregnant. While the causes of Pica remain unknown, some of the risk factors for developing the disorder include the following: Another explanation would be sympathetic activation which would also increase blood flow to the brain. They contributed that to the activation of the dive reflex which would lead to peripheral vasoconstriction and an increase in central perfusion. In pagophagia, a Japanese study hypothesized that when a patient with anemia chews ice, it increases perfusion thus improving brain function.
The proposed mechanism of protection is binding to toxins and decreasing their intestinal absorption. Another proposed hypothesis that is gaining more attention is that pica for non-nutritive substances offers protection from harmful toxins during the most vulnerable stages of human cell replication and embryogenesis (childhood and pregnancy). This suggests that the idea that these cravings stem from a need for serum iron is an inadequate pathophysiological explanation for this phenomenon. Despite this, studies conducted on substances consumed by pica patients failed to show increased iron bioavailability among these substances. Many population-based studies have found a low level of serum iron/ferritin (and other micronutrients) among patients with pica. Iron deficiency anemia has also been implicated. Studies of psychological factors have reported an association between pica and stress, child neglect and abuse, and maternal deprivation. Many factors have been implicated in the etiology of pica however, no direct causality has been established. It is not unusual to notice that younger children are frequently eating nonnutritive substances. It is important to understand that in order to diagnose pica, the individual must be at least 2 years of age.
Pica usually occurs as an isolated disorder but there are instances when it may co-exist with schizophrenia, OCD, and trichotillomania. In some parts of the world, the consumption of non-nutritive substances is culturally accepted. In women, it is most often seen during pregnancy. Īlthough pica is seen in children, it is also a common eating disorder in patients who are intellectually impaired. The nature of ingested items is variable, including but not limited to earth (geophagy), raw starches (amylophagy), ice (pagophagia), charcoal, ash, paper, chalk, cloth, baby powder, coffee grounds, and eggshells. For diagnosis, the behavior must persist for at least one month, not be in keeping with the child's developmental stage (and age cut off of 24 months or more is suggested by DSM V), and not be socially normative or culturally acceptable behavior. The term is derived from "pica-pica," the Latin word for the magpie bird, because of the bird's indiscriminate gathering and eating a variety of objects for the sake of curiosity.
#Coding for pica eating disorder manual#
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines pica as eating nonnutritive, nonfood substances over a period of at least one month.
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