What are options for treating PICA (eating crap)?

Pica is an eating disorder typically characterized by the continual eating of nonnutritive substances for a period of at least 4 weeks at an age in which this behavior is developmentally inappropriate (e.g., >18-24 mo). Today, the definition of PICA has been expanded to include eating of nonnutritive substances.

Individuals who are diagnosed with pica have been reported to mouth and/or gulp down a wide variety of nonfood materials, including, but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches.

In the majority of cases of children who have been diagnosed with PICA, natural recovery occurs with time. Most children who have no mental problems simply grow out of the disorder. However, some children may need a multidisciplinary approach involving psychologists or social workers. The role of physician in early treatment stage is that of reassurance.

When spontaneous recovery does not take place, some type of treatment must be offered. Expansion of management plan must take into relation symptoms of pica and causative factors, as well as treatment of potential complications of the disorder.

The variety of behavioral strategies that have been proven to be effective in treating PICA include

- Antecedent treatment
- Distinction guidance between edible and
non-edible items
- Self-protection equipment that prevent
insertion of objects in the mouth
(mouth guards)
- Sensory strengthening of proper foods
- Differential strengthening of other or
unrelated behaviors, such as screening
(covering eyes briefly), or performing
exercise (or watching TV) is encouraged
- Conditional aversive oral taste (silver
acetate, lemon)
- Conditional aversive smell consciousness
(sulfur or ammonia),
- Conditional aversive physical awareness
(water spray, mild static shock therapy),
- Brief time out with physical restraint of
arms
- Correction of the environment
- Administer appropriate responses to
reinforce positive behavior

PICA- eating crap

Pica is an exotic name for a mental disorder which is characterized by persistent eating of non food substances such as hair, paint, paper, soil, pencils, metal pins, etc. However, some individuals may eat foods like raw rice, excess salt or sugar, flour, etc. The disorder is quite common and is estimated to occur in 4-25% of the population. A fascinating observation is that the majority will continue to eat only one these non nutritive items during the course of the disorder. Of course, there are others who will eat multiple items.

Pica is most commonly observed in the 1st-3rd decade of life. It may occur early in children but is often mistaken for just children being foolish. To make a diagnosis of Pica, one must persist with these eating habits for more than one month at an age where such a habit would be considered developmentally unsuitable.

Most individuals who develop Pica are healthy individuals. Pica has often been reported during pregnancy where females suddenly develop a taste for bizarre items. The disorder is also seen in wide variety of mental disturbed individuals, esp. those with dementia and some types of schizophrenia.

The majority of healthy individuals eat the non nutritive substances secretly and often are brought to hospital with symptoms of bowel obstruction. Some children eat plaster from the walls and in the past, lead poisoning was a common emergency admission. A number of individuals require surgery because the foreign material may have either blocked the bowel or caused a perforation in the stomach. At surgery, the diagnosis of pica is usually made by the findings of hair, soil or plastic straws, etc.