“Asking for help is not a sign of weakness. It’s a sign of strength. Oftentimes our society tells us that if we ask for help, we’re weak. But the strongest thing someone can do is take that first step in getting help, whatever shape or form that is.”— Demi Lovato
What exactly is pica?
Pica is an eating disorder which causes a person to eat non-food substances that have no nutritional value. Typically, an individual diagnosed with pica will report eating substances such as chalk, paper, soap, ice, sand, charcoal, string, hair, ash, cigarette butts, and paint. Pica can affect individuals from all walks of life, at any stage in life, although pica usually starts in childhood. Most people diagnosed with pica still eat nutritious meals and in some cases, may even eat very healthily with the exception of the non-food substances they ingest. These confusing behaviours can lead to the denial around the disorder becoming entrenched, thus delaying seeking help or treatment.
Another aspect of this disorder which can be misleading is the fact that short-term symptoms of pica can often present in pregnant women and young infants. A woman in her second trimester of pregnancy may experience a strong compulsion to consume inedible items such as coal, metals or toothpaste which can be a sign of vitamin or mineral deficiency. Such cravings or compulsions tend to ease off/disappear completely once into the third trimester or post-partum.
Similarly, babies will experiment with and often ingest all manner of non-food substances/items including mud, grass, paper, and small objects as a normal part of sensory learning. Hence any diagnosis of pica in a child must be made post twenty-four months once the infant has passed this stage of development. Cambridge NHS states: “It is common in certain groups of the population and occurs more frequently in children with learning difficulties. It is associated with autism spectrum disorder. Nutritional factors such as low levels of iron or zinc may be linked. Some children may get a pleasurable feeling or sensory stimulation from eating non-food items.”
Pica can cause serious health problems, compromise the digestive system, and even result in lead poisoning, especially if a person is compulsively eating paint or chewing and swallowing paperclips. Choking can occur whilst eating hard objects, as can intestinal blockages, and parasitic infections. At Addcounsel, we recognise how serious pica is, especially when a person is compulsively eating and chewing dangerous substances.
What causes pica?
Health professionals have established that there isn’t an exact single cause for pica. There could be many factors at play which cause the feeding disorder including genetics and environment. Severe stress, underlying mental health disorders, low socioeconomic status, child neglect and abuse, could all contribute to the risk factors of developing pica. We also know that pica will often coexist with autism and developmental problems, learning/intellectual disabilities, depression, pregnancy, iron deficiency anaemia, trichotillomania (hair pulling disorder), excoriation disorder (skin picking disorder), schizophrenia, and obsessive-compulsive disorder (OCD).
Beat Eating Disorders UK writes on the causes of pica: “The reasons that people develop pica are not yet clear, although several scientists have linked it to the nervous system, and have understood it as a learned behaviour or coping mechanism. In some cases, people with pica have been found to be deficient in certain minerals or vitamins, but this is often not the case. The percentage of people who have it is not yet known, as different researchers may use different definitions of pica, leading to some confusion.”
The National Library of Medicine (National Center for Biotechnology Information, USA) has written a detailed paper on pica and covers the ongoing debate among health professionals regarding iron deficiency being the primary cause of pica: “Studies of psychological factors have reported an association between pica and stress, child neglect and abuse, and maternal deprivation. Iron deficiency anaemia has also been implicated. Many population-based studies have found a low level of serum iron/ferritin (and other micronutrients) among patients with pica.” The authors continue: “Despite this, studies conducted on substances consumed by pica patients failed to show increased iron bioavailability among these substances. This suggests that the idea that these cravings stem from a need for serum iron is an inadequate pathophysiological explanation for this phenomenon.”
Signs and symptoms of pica
Here are some of the most recognisable symptoms of pica:
- Persistently eating non-food substances for over a month. Non-food substances may vary and include items such as string, soil, wool, chalk, talcum powder, stones, pebbles, ice, clay, ash, paper, hair, sticks/pieces of wood or brick. In some cases, pica can last for years, especially when a person has a learning/intellectual disability and/or severe autism
- Ingesting non-food substances which are not part of a cultural and/or religious ritual or practice (in some cases in economically deprived environments individuals will eat soil or clay to compensate for the lack of iron in their diet; therefore, this would be deemed acceptable)
- Dental manifestations such as broken and/or chipped teeth, tooth loss due to chewing, sucking, and crunching hard non-food substances. Gum disease can also occur because of sucking on and chewing metal objects
- Constipation, mechanical bowl problems, vomiting, and ulcerations
One of the most common unwanted consequences of pica is lead toxicity which can induce further serious adverse effects:
- GI tract symptoms caused by lead toxicity such as abdominal pain, colic, and diarrhoea
- Lead toxicity can trigger irregular heart rhythms (arrhythmias) and respiratory arrest
- Complications around lead toxicity can seriously impact cardiovascular functions
- Adverse effects of lead poisoning can lead to neurological symptoms such as migraine, irritability, incoordination, cranial nerve paralysis, coma, lethargy, ataxia, seizures, and death
Getting a diagnosis for pica
Addcounsel’s team of world-class health professionals recognise that to get a diagnosis for pica, an individual must meet certain criteria. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for pica are as follows:
- Persistent ingestion of non-nutritive, non-food substances over a period of at least one month
- The eating of such non-nutritive, non-food substances is inappropriate to the developmental level of the individual (for example, a child under the age of eighteen months won’t be diagnosed for pica)
- Eating non-nutritive, non-food substances which is not part of a cultural, religious, or socially normative practice
- If the behaviour occurs within the context of another mental disorder or medical condition (e.g., schizophrenia, a severe learning disability, pregnancy), it’s sufficiently severe to warrant clinical attention. For example, compulsive eating of paperclips or dried thick paint could warrant clinical attention
How is pagophagia linked to pica?
Pagophagia is considered a subtype of pica, which compels an individual to eat and chew ice, snowflakes, and ice cubes. Although eating ice usually carries less risk than ingesting lumps of dry paint, an individual eating ice for a sustained period of more than a month may very well be diagnosed with pica. Pagophagia is usually linked to iron deficiency. Here are some of the additional symptoms and signs associated with pagophagia:
- Shortness of breath
- Chest and stomach pain
- Irregular heartbeat and heart palpitation
- Muscle weakness and slow reflex responses
- Dizziness, vertigo and heavy-headedness
- Tongue sores/blisters
- Lack of appetite
- Headaches and migraine
Getting help for pica
Getting help for pica takes courage. At Addcounsel, we understand how hard it is to reach out for help and discuss an eating disorder, especially pica. It’s possible to recover from this eating disorder and go on to live a happy and fulfilling life. While there are behavioural strategies which are universally recognised for the treatment of pica such as sensory reinforcement, overcorrection, and reinforcement of non-pica behaviours, our seasoned experts have developed a “whole person” approach to private pica treatment, addressing not just the symptoms but the underlying causes that lead to the eating disorder in the first place. We help you develop effective, lifelong coping skills and strategies for self-management, to ensure a sustained recovery.
Contact us today
When you enter our discreet facilities in Mayfair, Chelsea, Knightsbridge and Notting Hill, London, you’ll begin a course of pica treatment designed for, and tailored towards, your specific needs. We leverage the world’s most extensive menu of treatments to provide you with individualised therapy, working with 24/7 access to a team of world-class experts headed by one of the UK’s leading psychiatrists.
Treatment takes place on a one-to-one basis at our private luxury rehabilitation clinic in Mayfair, London. You’ll work with a live-in psychiatrist, backed by a team of hand-picked experts who will help you learn the skills and strategies needed to manage your eating disorder, and progress towards recovery.
We understand that eating disorders can be a highly sensitive issue, especially for those in the public eye or those under professional scrutiny. We take your privacy, anonymity, and security as seriously as you do. Our team of therapists, nutritionists, hepatologists and consultants across multiple fields are discreet, professional, and carefully vetted, working directly with you and you only — no groups, no scrutiny, no judgment. Contact us today to start your recovery journey.