Title: Pica (disorder)

{{Short description|Compulsive eating of non-food items}}
{{CS1 config|name-list-style=vanc}}
{{Use mdy dates|date=December 2025}}
{{Infobox medical condition
| name = Pica
| image = Glore Stomach Display.jpg
| caption = Stomach contents of a psychiatric patient with pica: 1,446 items, including &quot;457 nails, 42 screws, safety pins, spoon tops, and salt and pepper shaker tops&quot;.
| field = [[Psychiatry]]
| pronounce = {{IPAc-en|ˈ|p|aɪ|k|ə}} {{respell|PY|kə}}&lt;ref&gt;{{cite web|work=[[Merriam-Webster]]|title=Pica|url=https://www.merriam-webster.com/dictionary/pica|access-date=April 19, 2020}}&lt;/ref&gt;
| symptoms = 
| complications = 
| onset = 
| types = 
| causes = {{unbulleted list|[[Iron deficiency]]|[[Autism spectrum|Autism]]|[[Culture-bound syndrome]]|[[Malnutrition]]|[[Schizophrenia]]}}
}}

'''Pica''' ({{IPAc-en|ˈ|p|aɪ|k|ə}} {{respell|PY|kə}}) is the psychologically compulsive craving or consumption of objects that are not normally intended to be consumed.&lt;ref&gt;OED ed. 3 via Apple Dictionary.&lt;/ref&gt; It is classified as an eating disorder but can also be the result of an existing mental disorder.&lt;ref name=&quot;:3&quot;&gt;{{Cite book|title=Diagnostic and Statistical Manual of Mental Disorders|date=2013-05-22|publisher=American Psychiatric Association|isbn=978-0-89042-555-8|series=DSM Library|chapter=Feeding and Eating Disorders|doi=10.1176/appi.books.9780890425596.dsm10|url-access=registration|url=https://archive.org/details/diagnosticstatis0005unse|via=archive.org}}&lt;/ref&gt; The ingested or craved substance may be biological, natural, or manmade. The term was drawn directly from the medieval Latin word for [[magpie]], a bird subject to much folklore regarding its opportunistic feeding behaviors.&lt;ref name='origin'&gt;{{Cite journal|last=T. E. C. Jr.|date=October 1, 1969|title=The origin of the word ''pica'' |url=https://pediatrics.aappublications.org/content/44/4/548 |journal=Pediatrics |volume=44|page=4|via=AAP|url-access=subscription}}&lt;/ref&gt;

According to the [[DSM-5|''Diagnostic and Statistical Manual of Mental Disorders'', 5th edition]] (DSM-5), pica as a standalone [[eating disorder]] must persist for more than one month at an age when eating such objects is considered [[Cognitive development|developmentally]] inappropriate, not part of culturally sanctioned practice, and sufficiently severe to warrant clinical attention. Pica may lead to intoxication in children, which can result in an impairment of both physical and mental development.&lt;ref name=Blinder2008&gt;{{cite journal|last=Blinder |first=Barton J.|last2=Salama |first2=C.|title=An update on pica: prevalence, contributing causes, and treatment|url=https://www.psychiatrictimes.com/view/update-pica-prevalence-contributing-causes-and-treatment|journal=Psychiatric Times|date=May 2008|volume=25|issue=6}}&lt;/ref&gt; In addition, it can cause surgical emergencies to address intestinal obstructions, as well as more subtle symptoms such as nutritional deficiencies, particularly [[iron deficiency]], as well as [[Parasitic disease|parasitosis]].&lt;ref name=Blinder2008 /&gt; Pica has been linked to other mental disorders. Stressors such as psychological trauma, maternal deprivation, family issues, parental neglect, pregnancy, and a disorganized family structure are risk factors for pica.&lt;ref name=Blinder2008/&gt;&lt;ref name=Singhi1981&gt;{{cite journal|last=Singhi|first=Sunit|last2=Singhi |first2=P.|last3=Adwani |first3=G.|title=Role of Psychosocial Stress in the Cause of Pica|journal=Clinical Pediatrics|date=December 1981|volume=20|issue=12|pages=783–785|doi=10.1177/000992288102001205|pmid=7307412|s2cid=1129239}}&lt;/ref&gt;

Pica is most commonly seen in [[pregnancy|pregnant women]],&lt;ref name=Span04&gt;{{cite journal|last1=López|first1=L. B.|last2=Ortega Soler |first2=C. R. |last3=de Portela |first3=M. L. |title=Pica during pregnancy: a frequently underestimated problem|journal=Archivos Latinoamericanos de Nutricion|date=March 2004|volume=54|issue=1|pages=17–24|pmid=15332352}}&lt;/ref&gt; small children, and people who may have [[Developmental disorder|developmental disorders]] such as [[Autism spectrum|autism]].&lt;ref name=Rose00&gt;{{cite journal | vauthors = Rose EA, Porcerelli JH, Neale AV | title = Pica: Common but commonly missed | journal = The Journal of the American Board of Family Practice | year = 2000 | volume = 13 | issue = 5 | pages = 353–358 | pmid = 11001006 }}&lt;/ref&gt; Children eating painted [[plaster]] containing [[lead]] may develop brain damage from [[lead poisoning]]. A similar risk exists from eating soil near roads that existed before the phase-out of [[tetraethyllead]] or that were sprayed with oil (to settle dust) contaminated by toxic [[Polychlorinated biphenyl|PCBs]] or [[Polychlorinated dibenzodioxins|dioxin]]. In addition to poisoning, a much greater risk exists of [[bowel obstruction|gastrointestinal obstruction]] or tearing in the [[stomach]]. Another risk of eating soil is the ingestion of animal feces and accompanying [[parasitism|parasites]]. Cases of severe bacterial infections occurrence (leptospirosis) in patients diagnosed with pica have also been reported.&lt;ref&gt;{{Cite journal |last1=Fabiani |first1=Adam |last2=Dal Bo |first2=Eugenia |last3=Di Bella |first3=Stefano |last4=Gabrielli |first4=Marco |last5=Bologna |first5=Alessandro |last6=Albert |first6=Umberto |last7=Sanson |first7=Gianfranco |date=2021-07-05 |title=Pica (Allotriophagy): An Underestimated Risk Factor for Severe Leptospirosis (Weil's Diseases)? Report of a Leptospira Septic Shock Successfully Managed with ECMO |journal=Infectious Disease Reports |language=en |volume=13 |issue=3 |pages=619–626 |doi=10.3390/idr13030058 |issn=2036-7449 |pmc=8293114 |pmid=34287302 |doi-access=free }}&lt;/ref&gt; Pica can also be found in animals such as dogs&lt;ref name=HSUS&gt;{{cite web |title=Pica: Why Pets Sometimes Eat Strange Objects |url=http://www.humanesociety.org/animals/resources/tips/pica_eating_strange_objects.html |website=The Humane Society of the United States |access-date=20 July 2019 |archive-url=https://web.archive.org/web/20160314025809/http://www.humanesociety.org/animals/resources/tips/pica_eating_strange_objects.html |archive-date=March 14, 2016 |language=en}}&lt;/ref&gt; and cats.&lt;ref&gt;{{Cite journal|last1=Bradshaw|first1=John W. S.|last2=Neville|first2=Peter F.|last3=Sawyer|first3=Diana|date=1997-04-01|title=Factors affecting pica in the domestic cat|url=http://www.sciencedirect.com/science/article/pii/S0168159196011367|journal=Applied Animal Behaviour Science|series=Behavioural Problems of Small Animals|language=en|volume=52|issue=3|pages=373–379|doi=10.1016/S0168-1591(96)01136-7|issn=0168-1591|url-access=subscription}}&lt;/ref&gt;

==Signs and symptoms==
[[Image:Pica stone.jpg|thumb|Chalky stone composed of [[kaolinite]] with traces of [[quartz]], small pieces of which were sucked on by a person with pica]]

Pica is the consumption of substances with no significant nutritional value such as soap, plaster, plastic or paint. Subtypes are characterized by the substance eaten:&lt;ref name=&quot;SturmeyHersen2012&quot;&gt;{{cite book|author1=Peter Sturmey|author2=Michel Hersen|title=Handbook of Evidence-Based Practice in Clinical Psychology, Child and Adolescent Disorders|url=https://books.google.com/books?id=Gg8EjCzk1IQC&amp;pg=PA304|date=2012|publisher=John Wiley &amp; Sons|isbn=978-0-470-33544-4|page=304}}&lt;/ref&gt;
{{Columns-list|colwidth=30em|* Acuphagia (sharp objects)&lt;ref&gt;{{Cite web|url=https://www.psychologytoday.com/blog/in-excess/201706/acuphagia-and-eating-metal|title=Acuphagia and Eating Metal|website=Psychology Today|language=en-US|access-date=2019-03-16}}&lt;/ref&gt;
* Amylophagia (purified starch, as from [[corn starch|corn]])&lt;ref name=&quot;Coleman AM 2015 576&quot;&gt;{{cite book |title= A Dictionary of Psychology |author= Coleman AM |publisher= Oxford University Press |year= 2015 |page= 576 }} See [https://books.google.com/books?id=zvlrBgAAQBAJ&amp;q=pica+hyalophagia&amp;pg=PA576 Google books link.]&lt;/ref&gt;&lt;ref&gt;{{cite book |title= Handbook of Evidence-Based Practice in Clinical Psychology, Child and Adolescent Disorders |vauthors=Sturmey P, Hersen M |publisher= John Wiley &amp; Sons |year= 2012 |page=304}} See [https://books.google.com/books?id=Gg8EjCzk1IQC&amp;q=pica+hyalophagia&amp;pg=PA304 Google books link.]&lt;/ref&gt;
* Cautopyreiophagia (burnt matches)
* Cintaphagia (tape)
* Coniophagia (dust)
* [[Coprophagia]] (feces)
* [[Dermatophagia]] (skin)
* Emetophagia (vomit)
* Geomelophagia (raw potatoes)&lt;ref name=&quot;Coleman AM 2015 576&quot;/&gt;&lt;ref&gt;{{cite journal|pmid=7148884|year=1982|last1=Johnson|first1=BE|last2=Stephens|first2=RL|title=Geomelophagia. An unusual pica in iron-deficiency anemia|volume=73|issue=6|pages=931–2|journal=The American Journal of Medicine|doi=10.1016/0002-9343(82)90802-6}}&lt;/ref&gt;
* [[Geophagia]] (earth, soil, sand, clay, chalk)
* [[Hematophagia]] ([[Clinical vampirism|vampirism]]) (blood)
* Hyalophagia (glass)&lt;ref name=&quot;Colman2015&quot;&gt;{{cite book|author=Andrew M. Colman|title=A Dictionary of Psychology|url=https://books.google.com/books?id=zvlrBgAAQBAJ&amp;pg=PA576|date=2015|publisher=OUP Oxford|isbn=978-0-19-105784-7|page=576}}&lt;/ref&gt;
* Kleptophagia (Small objects)
*[[Lignophagia]] (wood)
* Lithophagia (stones)&lt;ref&gt;{{cite journal|last=Somalwar|first=Ashutosh|author2=Keyur Kishor Dave|title=Lithophagia: Pebbles in and Pebbles out|journal=Journal of the Association of Physicians of India|date=March 2011|volume=59|page=170|pmid=21751627|url=http://japi.org/march_2011/article_07.pdf|access-date=2012-07-22|archive-date=2012-05-31|archive-url=https://web.archive.org/web/20120531160444/http://www.japi.org/march_2011/article_07.pdf}}&lt;/ref&gt;
* Metallophagia (metal)
* [[Mucophagy|Mucophagia]] (mucus)
* [[Pagophagia]] (ice)
* Plumbophagia (lead)
* Sapophagia (soap)
* [[Trichophagia]] (hair, wool, and other fibers)
* [[Urophagia]] (urine)
* Xylophagia (wood, or wood products such as paper)&lt;ref name=&quot;ncbi1&quot;&gt;{{cite journal|title=An unusual case of xylophagia (paper-eating)|first1=Mahesh |last1=Gowda |first2=Bhavin M. |last2=Patel |first3=S. |last3=Preeti |first4=M. |last4=Chandrasekar|date=2014|journal=Industrial Psychiatry Journal|pmc=4261218|pmid=25535449|doi=10.4103/0972-6748.144972|volume=23|issue=1|pages=65–7 |doi-access=free }}&lt;/ref&gt;
}}
This eating pattern should last at least one month to meet the time diagnostic criteria of pica.&lt;ref name=&quot;Pica&quot;&gt;[http://health.nytimes.com/health/guides/disease/pica/overview.html Pica] New York Times Health Guide&lt;/ref&gt;

===Complications===
Complications may occur due to the substance consumed. For example, lead poisoning may result from the ingestion of paint or paint-soaked [[plaster]],&lt;ref&gt;{{Cite web|url=https://www.webmd.com/mental-health/mental-health-pica|title=Mental Health and Pica|website=WebMD|language=en|access-date=2019-03-16}}&lt;/ref&gt; [[hairball]]s may cause intestinal obstruction, and ''[[Toxoplasma gondii|Toxoplasma]]'' or ''[[Toxocaridae|Toxocara]]'' infections may follow ingestion of feces or soil.&lt;ref name=&quot;Spitzer, Robert L 1986&quot;&gt;Spitzer, Robert L. ''Diagnostic and Statistical Manual of Mental Disorders: (DSM III)''. Cambridge: Univ. of Cambridge, 1986. Print.&lt;/ref&gt;

==Causes==
Pica is currently recognized as a mental disorder by the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' (DSM-5). According to the DSM-5, mineral deficiencies are occasionally associated with pica, but biological abnormalities are rarely found.&lt;ref name=&quot;:3&quot;/&gt; People practicing forms of pica, such as [[Geophagia|geophagy]], [[Pagophagia|pagophagy]], and amylophagy, are more likely to be anemic or to have low [[hemoglobin]] concentration in their blood, lower levels of red blood cells ([[hematocrit]]), or lower plasma zinc levels.&lt;ref name=&quot;:1&quot;&gt;{{Cite journal|last1=Miao|first1=Diana|last2=Young|first2=Sera L.|last3=Golden|first3=Christopher D.|date=January 2015|title=A meta-analysis of pica and micronutrient status|journal=American Journal of Human Biology|volume=27|issue=1|pages=84–93|doi=10.1002/ajhb.22598|issn=1520-6300|pmc=4270917|pmid=25156147}}&lt;/ref&gt; Specifically, practicing geophagy is more likely to be associated with anemia or low hemoglobin.&lt;ref name=&quot;:1&quot; /&gt; Practicing pagophagy and amylophagy is more highly associated with anemia.&lt;ref name=&quot;:1&quot; /&gt; 

Mental health conditions such as [[obsessive–compulsive disorder]] (OCD) and [[schizophrenia]] have been proposed as causes of pica.&lt;ref&gt;{{cite journal|last=Gull|first=William W.|author-link=William Gull|year=1874|title=Anorexia nervosa (apepsia hysterica, anorexia hysterica)|journal=Trans. Clin. Soc. Lond.|volume=7|issue=5|pages=498–502|doi=10.1002/j.1550-8528.1997.tb00677.x|pmid=9385628|doi-access=free}}&lt;/ref&gt; More recently, cases of pica have been tied to the [[obsessive–compulsive spectrum]], and a move has arisen to consider OCD in the cause of pica.&lt;ref&gt;{{cite journal | vauthors = Hergüner S, Ozyildirim I, Tanidir C | year = 2008 | title = Is Pica an eating disorder or an obsessive–compulsive spectrum disorder? | journal = Progress in Neuro-Psychopharmacology &amp; Biological Psychiatry | volume = 32 | issue = 8 | pages = 2010–1 | doi = 10.1016/j.pnpbp.2008.09.011 | pmid = 18848964 | s2cid = 207408405 }}&lt;/ref&gt; Sensory, physiological, cultural, and psychosocial perspectives have also been used to explain the causation of pica.&lt;ref&gt;{{Cite journal |last1=Frazzoli |first1=Chiara |last2=Pouokam |first2=Guy Bertrand |last3=Mantovani |first3=Alberto |last4=Orisakwe |first4=Orish Ebere |date=2016-10-01 |title=Health risks from lost awareness of cultural behaviours rooted in traditional medicine: An insight in geophagy and mineral intake |url=https://www.sciencedirect.com/science/article/pii/S0048969716311998 |journal=Science of the Total Environment |volume=566-567 |pages=1465–1471 |doi=10.1016/j.scitotenv.2016.06.028 |pmid=27342642 |bibcode=2016ScTEn.566.1465F |issn=0048-9697|url-access=subscription }}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Gundacker |first1=Claudia |last2=Kutalek |first2=Ruth |last3=Glaunach |first3=Rosina |last4=Deweis |first4=Coloman |last5=Hengstschläger |first5=Markus |last6=Prinz |first6=Armin |date=2017-07-01 |title=Geophagy during pregnancy: Is there a health risk for infants? |url=https://www.sciencedirect.com/science/article/pii/S0013935116309902 |journal=Environmental Research |volume=156 |pages=145–147 |doi=10.1016/j.envres.2017.03.028 |pmid=28342960 |bibcode=2017ER....156..145G |s2cid=2661446 |issn=0013-9351|url-access=subscription }}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Nyanza |first1=Elias C. |last2=Joseph |first2=Mary |last3=Premji |first3=Shahirose S. |last4=Thomas |first4=Deborah SK |last5=Mannion |first5=Cynthia |date=2014-04-15 |title=Geophagy practices and the content of chemical elements in the soil eaten by pregnant women in artisanal and small scale gold mining communities in Tanzania |journal=BMC Pregnancy and Childbirth |volume=14 |issue=1 |page=144 |doi=10.1186/1471-2393-14-144 |issn=1471-2393 |pmc=3997190 |pmid=24731450 |doi-access=free }}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Njiru |first1=Haron |last2=Elchalal |first2=Uriel |last3=Paltiel |first3=Ora |date=2011-07-01 |title=Geophagy During Pregnancy in Africa: A Literature Review |url=https://journals.lww.com/obgynsurvey/abstract/2011/07000/geophagy_during_pregnancy_in_africa__a_literature.23.aspx |journal=Obstetrical &amp; Gynecological Survey |language=en-US |volume=66 |issue=7 |pages=452–459 |doi=10.1097/OGX.0b013e318232a034 |pmid=21944157 |s2cid=29431551 |issn=0029-7828|url-access=subscription }}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Madziva |first1=C. |last2=Chinouya |first2=M. J. |date=2023-10-01 |title=African migrant women acquisition of clay for ingestion during pregnancy in London: a call for action |journal=Public Health |volume=223 |pages=110–116 |doi=10.1016/j.puhe.2023.07.021 |pmid=37634450 |s2cid=261189504 |issn=0033-3506|doi-access=free }}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Madziva |first1=Cathrine |last2=Chinouya |first2=Martha Judith |date=2020 |title=Clay Ingestion During Pregnancy Among Black African Women in a North London Borough: Understanding Cultural Meanings, Integrating Indigenous and Biomedical Knowledge Systems |journal=Frontiers in Sociology |volume=5 |article-number=20 |doi=10.3389/fsoc.2020.00020 |issn=2297-7775 |pmc=8022624 |pmid=33869429 |doi-access=free }}&lt;/ref&gt;

Pica may be a cultural practice not associated with a deficiency or disorder. Ingestion of [[Kaolinite|kaolin]] (white clay) among [[African Americans|African American]] women in the US state of [[Georgia (U.S. state)|Georgia]] shows the [[Geophagia|practice]] to be a DSM-4 &quot;[[culture-bound syndrome]]&quot; and &quot;not selectively associated with other psychopathology&quot;.&lt;ref&gt;{{cite journal|author=R. Kevin Grigsby |display-authors=etal |doi=10.1097/00007611-199902000-00005 |title=Chalk Eating in Middle Georgia: a Culture-Bound Syndrome of Pica? |journal=Southern Medical Journal |volume=92 |issue=2 |date=February 1999 |pages=190–192 |pmid=10071665}}&lt;/ref&gt; Similar kaolin ingestion is also widespread in parts of Africa.&lt;ref&gt;{{cite web|author=Franklin Kamtche|url=http://www.quotidienlejour.com/double-page-/reportage/504-balengou-autour-des-mines|title=Balengou: autour des mines|archive-url=https://web.archive.org/web/20110715141559/http://www.quotidienlejour.com/double-page-/reportage/504-balengou-autour-des-mines|archive-date=2011-07-15|trans-title=Balengou: around the mines|website=[[Le Jour (Cameroon)|Le Jour]]|date=12 January 2010|access-date=1 March 2010|language=fr}}&lt;/ref&gt; Such practices may stem from purported health benefits, such as the ability of clay to absorb plant toxins and protect against toxic alkaloids and [[tannic acid]]s.&lt;ref&gt;{{cite news|author=Marc Lallanilla|url=https://abcnews.go.com/Health/Story?id=1167623&amp;page=1|title=Eating Dirt: It Might Be Good for You|work=[[ABC News (United States)|ABC News]]|date=4 January 2006|access-date=30 November 2020}}&lt;/ref&gt;

==Diagnosis==
No single test confirms pica, but because pica can occur in people who have lower than normal nutrient levels and poor nutrition (malnutrition), the health care provider should test blood levels of iron and zinc.
Hemoglobin can also be checked to test for [[anemia]]. Lead levels should always be checked in children who may have eaten paint or objects covered in lead-paint dust. The healthcare provider should test and monitor for infection if the person has been eating contaminated soil or animal waste.&lt;ref name=&quot;Pica&quot;/&gt;

===DSM-5===
The DSM-5 posits four criteria that must be met for a person to be diagnosed with pica:&lt;ref name=&quot;:3&quot; /&gt;

#Person must have been eating non-nutritive nonfoods for at least one month.&lt;ref name=&quot;:3&quot; /&gt;
#This eating must be considered abnormal for the person's stage of development.&lt;ref name=&quot;:3&quot; /&gt;
#Eating these substances cannot be associated with a cultural practice that is considered normal in the social context of the individual.&lt;ref name=&quot;:3&quot; /&gt;
#For people who currently have a medical condition (e.g.: pregnancy) or a mental disorder (e.g.: [[autism spectrum]]), the action of eating non-nutritive nonfoods should only be considered pica if it is dangerous and requires extra medical investigation or treatment on top of what they are already receiving for their pre-existing condition.&lt;ref name=&quot;:3&quot; /&gt;

===Differential diagnosis===
In individuals with [[autism]], [[schizophrenia]], and certain physical disorders (such as [[Kleine–Levin syndrome]]), non-nutritive substances may be eaten.&lt;ref name=&quot;:3&quot; /&gt; In such instances, pica should only be noted as an additional diagnosis if the eating behaviour is sufficiently persistent and severe to warrant additional clinical attention.&lt;ref name=&quot;:3&quot; /&gt;

==Treatment==
Both psychotherapeutic and pharmacological interventions for pica have been criticized for low evidence quality.&lt;ref name=&quot;:02&quot;&gt;{{Cite journal |last1=Williams |first1=Fionnuala |last2=Gibbs |first2=Susie |last3=Addo |first3=Ama S. |date=November 2022 |title=The assessment and management of pica in people with intellectual disability |url=https://www.cambridge.org/core/journals/bjpsych-advances/article/assessment-and-management-of-pica-in-people-with-intellectual-disability/CCE4F8AFE3216EB4534D4E211F829862 |journal=BJPsych Advances |language=en |volume=28 |issue=6 |pages=383–392 |doi=10.1192/bja.2022.24 |issn=2056-4678|url-access=subscription }}&lt;/ref&gt; It is recommended that treatment options for pica vary by patient and suspected causes.&lt;ref name=&quot;:02&quot; /&gt; Pica may often fade on its own when in pregnant women or children,&lt;ref name=&quot;:12&quot;&gt;{{Cite web |date=2022-05-06 |title=Pica: What It Is, Causes, Symptoms &amp; Treatment |url=https://my.clevelandclinic.org/health/diseases/22944-pica |publisher=Cleveland Clinic}}&lt;/ref&gt; though treatment and routine evaluation are advised due to potentially serious consequences.&lt;ref name=&quot;:02&quot; /&gt;

Due to its impact on physical health, pica may require a vast assortment of experts to be managed, and it is recommended that physical health conditions be addressed prior to treatment.&lt;ref name=&quot;:02&quot; /&gt; An initial approach often involves screening for, and if necessary, treating any mineral deficiencies or other [[Comorbidity|comorbid conditions]].&lt;ref name=&quot;Rose00&quot; /&gt; From there, treatment may primarily involve decreasing access to the craved substance or providing a supplement, especially for at-risk patients (e.g. pregnant women).&lt;ref name=&quot;:22&quot;&gt;{{Citation |last1=Al Nasser |first1=Yasser |title=Pica |date=2025 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK532242/ |access-date=2025-09-03 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30335275 |last2=Muco |first2=Erind |last3=Alsaad |first3=Ali J.}}&lt;/ref&gt; [[Iron deficiency|Iron deficiencies]] or other nutrient deficiencies should be treated using dietary supplements and through dietary changes.&lt;ref name=&quot;:22&quot; /&gt;&lt;ref&gt;{{Cite journal |last1=Ganesan |first1=Pallavi R. |last2=Vasauskas |first2=Audrey A. |date=2023 |title=The Association Between Pica and Iron-Deficiency Anemia: A Scoping Review |journal=Cureus |volume=15 |issue=4 |article-number=e37904 |doi=10.7759/cureus.37904 |issn=2168-8184 |pmc=10199804 |pmid=37220446 |doi-access=free}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Abu |first1=Brenda A. Z. |last2=Morrissey |first2=Abigail |last3=Wu |first3=Yan |last4=Castillo |first4=Daniel A. |last5=Becker |first5=Rachel |last6=Wu |first6=TongTong |last7=Fiscella |first7=Kevin |last8=Gill |first8=Steven |last9=Xiao |first9=Jin |date=2025-01-03 |title=Pica practices, anemia, and oral health outcomes: a systemic review |journal=BMC Oral Health |volume=25 |issue=1 |page=13 |doi=10.1186/s12903-024-05371-7 |issn=1472-6831 |pmc=11697756 |pmid=39754099 |doi-access=free}}&lt;/ref&gt;

Certain psychotherapeutic approaches have been found helpful for pica. Behavior-based treatment options can be useful for people who have a developmental disability or mental illness.&lt;ref name=&quot;:22&quot; /&gt;&lt;ref name=&quot;:12&quot; /&gt; These treatments may involve teaching strategies to help patients alter their responses to certain stimuli. Behavioral treatments have been shown to reduce pica severity by 80% in people with intellectual disabilities.&lt;ref&gt;{{Cite journal |last1=Hagopian |first1=Louis P. |last2=Rooker |first2=Griffin W. |last3=Rolider |first3=Natalie U. |year=2011 |title=Identifying empirically supported treatments for pica in individuals with intellectual disabilities |journal=Research in Developmental Disabilities |volume=32 |issue=6 |pages=2114–2120 |doi=10.1016/j.ridd.2011.07.042 |pmid=21862281}}&lt;/ref&gt; [[Aversion therapy]] is another option, wherein the person learns through [[positive reinforcement]] and mild aversions which foods are good and which ones they should not eat.&lt;ref name=&quot;:22&quot; /&gt;&lt;ref name=&quot;:12&quot; /&gt; Differential reinforcement is also commonly used to block pica responses by redirecting focus to other activities.&lt;ref name=&quot;:22&quot; /&gt;&lt;ref name=&quot;:12&quot; /&gt;

Use of medication in pica treatment is generally scarce when not aimed at treating underlying conditions, as no existing pharmacological intervention is specifically tailored towards pica.&lt;ref name=&quot;:02&quot; /&gt;&lt;ref name=&quot;:22&quot; /&gt; [[Antipsychotic]] medication is recommended in certain instances, though is generally cautioned against due to side-effects and the anecdotal nature of evidence.&lt;ref name=&quot;:22&quot; /&gt;&lt;ref name=&quot;:12&quot; /&gt; [[Selective serotonin reuptake inhibitor|SSRIs]] have been successfully used  for pica associated with [[Obsessive–compulsive disorder|OCD]].&lt;ref&gt;{{cite journal |vauthors=Bhatia MS, Gupta R |date=2007-05-11 |title=Pica responding to SSRI: An OCD spectrum disorder? |journal=The World Journal of Biological Psychiatry |volume=10 |issue=4–3 |pages=936–8 |doi=10.1080/15622970701308389 |pmid=17853279 |s2cid=30089547}}&lt;/ref&gt; A case-report found that [[asenapine]] resulted in significant improvement on a woman with several mental health conditions after [[bariatric surgery]],&lt;ref&gt;{{Cite journal |last1=Tabaac |first1=Burton J. |last2=Tabaac |first2=Vanessa |date=February 2015 |title=Pica patient, status post gastric bypass, improves with change in medication regimen |journal=Therapeutic Advances in Psychopharmacology |volume=5 |issue=1 |pages=38–42 |doi=10.1177/2045125314561221 |issn=2045-1253 |pmc=4315675 |pmid=25653830}}&lt;/ref&gt; whereas another found use in [[venlafaxine]] for pica associated with depression.&lt;ref&gt;{{Cite journal |last1=Mehra |first1=Aseem |last2=Sharma |first2=Nidhi |last3=Grover |first3=Sandeep |date=2018 |title=Pagophagia in a Female with Recurrent Depressive Disorder: A Case Report with Review of Literature |journal=Turk Psikiyatri Dergisi = Turkish Journal of Psychiatry |volume=29 |issue=2 |pages=143–145 |pmid=30215844 |url=https://www.turkpsikiyatri.com/PDF/C29S2/en/11TPD_17029_GROVER_pagophagia_P.pdf}}&lt;/ref&gt; Reports prior to these publications have cautioned against the use of medication until all non-psychogenic causes have been ruled out.&lt;ref&gt;{{cite journal |vauthors=Fotoulaki M, Panagopoulou P, Efstratiou I, Nousia-Arvanitakis S |year=2007 |title=Pitfalls in the approach to pica |journal=European Journal of Pediatrics |volume=166 |issue=6 |pages=623–4 |doi=10.1007/s00431-006-0282-1 |pmid=17008997 |s2cid=1429977}}&lt;/ref&gt;

==Epidemiology==
The prevalence of pica is difficult to establish because of differences in definition and the reluctance of patients to admit to abnormal cravings and ingestion,&lt;ref name=Blinder2008 /&gt; thus leading to the [[prevalence]] recordings of pica among at-risk groups being in the range of 8% to 65% depending on the study.&lt;ref name=Span04/&gt; Based on compiled self-report and interview data of pregnant and postpartum women, pica is most prevalent geographically in Africa, with an estimated prevalence of 44.8%, followed by North and South America (23.0%) and Eurasia (17.5%).&lt;ref name=&quot;:2&quot;&gt;{{Cite journal|last1=Fawcett|first1=Emily J.|last2=Fawcett|first2=Jonathan M.|last3=Mazmanian|first3=Dwight|date=June 2016|title=A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period|journal=International Journal of Gynaecology and Obstetrics|volume=133|issue=3|pages=277–283|doi=10.1016/j.ijgo.2015.10.012|issn=1879-3479|pmid=26892693|s2cid=205265004}}&lt;/ref&gt; Factors associated with Pica in this population were determined to be anemia and low levels of education, both of which are associated with low socioeconomic backgrounds.&lt;ref name=&quot;:2&quot; /&gt; Two studies of adults with [[Intellectual disability|intellectual disabilities]] living in [[Psychiatric hospital|institutions]] found that 21.8%&lt;ref&gt;{{cite journal | vauthors = Ashworth M, Hirdes JP, Martin L | year = 2009 | title = The social and recreational characteristics of adults with intellectual disability and pica living in institutions | journal = Research in Developmental Disabilities | volume = 30 | issue = 3 | pages = 512–20 | doi = 10.1016/j.ridd.2008.07.010 | pmid = 18789647 }}&lt;/ref&gt; and 25.8%&lt;ref&gt;{{cite journal | vauthors = Danford DE, Huber AM | year = 1982 | title = Pica among mentally retarded adults | journal = American Journal of Mental Deficiency | volume = 87 | issue = 2 | pages = 141–6 | pmid = 7124824 }}&lt;/ref&gt; of these groups had pica.&lt;ref name=&quot;Hartmann&quot;&gt;{{cite journal|title=Pica and Rumination Disorder in DSM-5|vauthors=Hartmann AS, Becker AE, Hamptom C, Bryant-Waugh R | journal=Psychiatric Annals |date= November 2012 |volume= 42 |issue= 11 |pages= 426–30 |doi= 10.3928/00485713-20121105-09}}&lt;/ref&gt;

Prevalence rates for children are unknown.&lt;ref name=&quot;Hartmann&quot;/&gt;&lt;ref name=&quot;Kaplan&quot;&gt;{{Cite book | last1=Chatoor | first1=I | title=Kaplan and Sadock's Comprehensive Textbook of Psychiatry | publisher=Lippincott, Williams &amp; Wilkins | editor-last1=Sadock | editor-first1=BJ | editor-last2=Sadock | editor-first2=VA | editor-last3=Ruiz | editor-first3=P | year=2009 | chapter=Chapter 44: Feeding and eating disorders of infancy and early childhood | edition=9th | page=3607 | isbn= 978-0-7817-6899-3 }}&lt;/ref&gt; Young children commonly place non-nutritious material into their mouths. This activity occurs in 75% of 12-month-old infants, and 15% of two- to three-year-old children.&lt;ref name=&quot;Kaplan&quot;/&gt;

In institutionalized children with mental disabilities, pica occurs in 10&amp;ndash;33%.&lt;ref name=&quot;Kaplan&quot;/&gt;

==History==
The condition currently known as pica was first described by [[Hippocrates]].&lt;ref name=&quot;:0&quot;&gt;{{Cite journal|last1=Michalska|first1=Aneta|last2=Szejko|first2=Natalia|last3=Jakubczyk|first3=Andrzej|last4=Wojnar|first4=Marcin|date=2016|title=Nonspecific eating disorders - a subjective review|journal=Psychiatria Polska|volume=50|issue=3|pages=497–507|doi=10.12740/PP/59217|doi-access=free|issn=2391-5854|pmid=27556109}}&lt;/ref&gt;

The term pica originates in the [[Latin]] word for [[magpie]], ''pi&amp;#x304;ca''&lt;!--u+304 is a combining macron--&gt;,&lt;ref name='origin'/&gt;&lt;ref&gt;{{cite encyclopedia |url=http://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.04.0059:entry=pica|title=pi&amp;#x304;ca|encyclopedia=[[A Latin Dictionary]]|first1=Charlton T.|last1=Lewis|author-link1=Charlton Thomas Lewis|first2=Charles|last2=Short|date=1879|publisher=[[Clarendon Press]]|via=[[Perseus Project]]|url-status=live|archive-url=https://archive.today/20210713162210/http://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.04.0059:entry=pica|archive-date=2021-07-13}}&lt;/ref&gt; a bird famed for its unusual eating behaviors and believed to eat almost anything.&lt;ref name=&quot;MentalHealth&quot;&gt;{{cite book | last1 = Thyer | first1 = Bruce A. | last2 = Wodarski | first2 = John S | pages = [https://archive.org/details/socialworkinment0000unse/page/133 133] | title = Social work in mental health: an evidence-based approach | publisher = John Wiley and Sons | year = 2007 | isbn = 978-0-471-69304-8 | url = https://archive.org/details/socialworkinment0000unse/page/133 }}&lt;/ref&gt; The Latin may have been a translation of a Greek word meaning both 'magpie, jay' and 'pregnancy craving, craving for strange food'.&lt;ref&gt;{{Cite web|url=https://www.etymonline.com/word/pica#etymonline_v_14930|title = Pica &amp;#124; Etymology, origin and meaning of pica by etymonline}}&lt;/ref&gt;&lt;ref&gt;{{Cite web|url=http://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.04.0057:entry=ki/ssa^|title=Henry George Liddell, Robert Scott, A Greek-English Lexicon, κίσσα^}}&lt;/ref&gt; In 13th-century Latin work,{{clarify|date=February 2015}} pica was referenced by the Greeks and Romans;{{when|date=February 2015}} however, it was not addressed in medical texts until 1563.&lt;ref name=&quot;Rose00&quot; /&gt;

In the southern United States in the 1800s, geophagia was a common practice among the slave population.&lt;ref name=Rose00 /&gt; Geophagia is a form of pica in which the person consumes earthly substances such as [[clay]], and is particularly prevalent to augment a mineral-deficient diet.&lt;ref&gt;{{cite web|title=geophagy|url=http://www.merriam-webster.com/medical/geophagy?show=0&amp;t=1320448115|work=Merriam-Webster Dictionary|access-date=27 October 2014}}&lt;/ref&gt; Kaolin was consumed by slaves from West African in the Southeastern United States, particularly the Georgia belt, due to the antidiarrheal qualities in the treatment of dysentery and other abdominal ailments.&lt;ref&gt;{{Cite book|title=Life Traces of the Georgia Coast: Revealing the Unseen Lives of Plants and Animals|last=Martin|first=Anthony|publisher=Indiana University Press|year=2013|isbn=978-0-253-00602-8|page=43}}&lt;/ref&gt; The practice of consuming kaolin rocks was thereafter studied scientifically, the results of which led to the subsequent pharmaceutical commercialization of kaolinite, the clay mineral contained in kaolin. Kaolinite became the active ingredient in antidiarrheal drugs such as [[Kaopectate]], although it was replaced by [[Palygorskite|attapulgite]] in the 1980s and by [[bismuth subsalicylate]] starting in 2004.&lt;ref&gt;{{Cite journal|title=Diarrhea: Sweeping Changes in the OTC Market|first1=W. Steven|last1=Pray|first2=Joshua J.|last2=Pray|journal=US Pharmacist|date=2005|volume=30|issue=1|url=http://www.medscape.com/viewarticle/498381_3|access-date=2017-03-24}}&lt;/ref&gt;

Research on [[eating disorder]]s from the 16th to the 20th centuries suggests that during that time in history, pica was regarded more as a symptom of other disorders rather than its own specific disorder. Even today, what could be classified as pica behavior is a normative practice in some cultures as part of their beliefs, healing methods, or religious ceremonies.&lt;ref name=Rose00 /&gt;

Prior to the elimination of the category of &quot;feeding disorders in infancy and early childhood&quot;, which is where pica was classified, from the DSM-5, pica was primarily diagnosed in children.&lt;ref name=&quot;:0&quot; /&gt; However, since the removal of the category, psychiatrists have started to diagnose pica in people of all ages.&lt;ref name=&quot;:0&quot; /&gt;

The [[Glore Psychiatric Museum]] in [[St. Joseph, Missouri|Saint Joseph]], [[Missouri]] has a 1910 exhibit with &quot;an imaginative starburst arrangement of 1,446 buttons, screws, bolts, and nails that were eaten by a patient who died unexpectedly. They were only discovered during her autopsy.&quot;&lt;ref&gt;{{cite web | url=https://www.roadsideamerica.com/story/2142 | archive-url=https://web.archive.org/web/20210422211426/https://www.roadsideamerica.com/story/2142 | archive-date=22 April 2021 | title=Glore Psychiatric Museum, St. Joseph, Missouri }}&lt;/ref&gt;

==Animals==
Unlike in humans, pica in dogs or cats may be a sign of [[Warm antibody autoimmune hemolytic anemia|immune-mediated hemolytic anemia]], especially when it involves eating substances such as tile [[grout]], [[concrete]] dust, and [[sand]]. Dogs exhibiting this form of pica should be tested for anemia with a [[complete blood count]] or at least [[hematocrit]] levels.&lt;ref&gt;{{cite book | last = Plunkett | first = Signe J. | year = 2000 | title = Emergency Procedures for the Small Animal Veterinarian | publisher = Elsevier Health Sciences | page = 11 | isbn = 978-0-7020-2487-0}}&lt;/ref&gt;&lt;ref&gt;{{cite book | last = Feldman | first = Bernard F. |author2=Joseph G. Zinkl |author3=Nemi Chand Jain |author4=Oscar William Schalm | year = 2000 | title = Schalm's Veterinary Hematology | publisher = Blackwell Publishing | page = 506 | isbn = 978-0-683-30692-7}}&lt;/ref&gt; Although several hypotheses have been proposed by experts to explain pica in animals, insufficient evidence exists to prove or disprove any of them.&lt;ref name=HSUS/&gt; In addition to domestic cases, animal studies have helped scientists better understand pica and other disordered eating patterns. Animal Models of Eating Disorders highlights that eating disorders are often caused by a mix of environmental, genetic, and social factors, and studying animals can help isolate these causes. For example, researchers can separate abnormal eating patterns from changes in body weight to see how eating behavior alone affects health and brain function.&lt;ref&gt;{{Cite journal |last=Kim |first=S. F. |date=2012-06-01 |title=Animal models of eating disorders |url=https://pmc.ncbi.nlm.nih.gov/articles/PMC3351502/ |journal=Neuroscience |volume=211 |pages=2–12 |doi=10.1016/j.neuroscience.2012.03.024 |issn=1873-7544 |pmc=3351502 |pmid=22465439}}&lt;/ref&gt; 

Experimental studies have also explored treatment responses. One study found that pica-like behavior in rats caused by chemotherapy drugs was reduced after specific [[Vagotomy|vagotomies]], showing a biological connection between the brain, stomach, and eating behavior.&lt;ref&gt;{{Cite journal |last=De Jonghe |first=Bart C. |last2=Horn |first2=Charles C. |date=March 2008 |title=Chemotherapy-induced pica and anorexia are reduced by common hepatic branch vagotomy in the rat |url=https://journals.physiology.org/doi/full/10.1152/ajpregu.00820.2007 |journal=American Journal of Physiology-Regulatory, Integrative and Comparative Physiology |volume=294 |issue=3 |pages=R756–R765 |doi=10.1152/ajpregu.00820.2007 |issn=0363-6119|url-access=subscription }}&lt;/ref&gt; These findings help explain how pica and related eating behaviors can be both physical and psychological. All bodies are interconnected, all functions and processes in a body of any animal are affected by one another, through these experiments and observation we can infer how any eating disorder or specifically pica has a noticeable affect in all aspects of life.

== Cultural and Real-Life Perspectives ==
Cultural research continues to show that pica is not only medical but also social. For example, a study in [[North Central (Nigeria)|North-Central Nigeria]] found that pica among women is often shaped by cultural beliefs and community practices, rather than just psychological or nutritional causes.&lt;ref&gt;{{Cite journal |last=Uche |first=Anthony Ogbonna |last2=Oloyede |first2=David Binta |last3=Aiyelabegan |first3=Chinwe Jameelah |date=2025-03-31 |title=PUBLIC PERCEPTION OF PICA PRACTICE AMONG WOMEN IN NORTH-CENTRAL NIGERIA |url=https://journals.aphriapub.com/index.php/AJSBS/article/view/3058 |journal=African Journal of Social and Behavioural Sciences |language=en |volume=15 |issue=2 |issn=2141-209X}}&lt;/ref&gt; Real-life cases, such as a 10-year-old boy who felt a strong, uncontrollable urge to eat fibers and described relief after doing so, demonstrate how pica can overlap with obsessive-compulsive behaviors.&lt;ref&gt;{{Cite journal |last=Hergüner |first=Sabri |last2=Ozyildirim |first2=Ilker |last3=Tanidir |first3=Cansaran |date=2008-12-12 |title=Is Pica an eating disorder or an obsessive-compulsive spectrum disorder? |url=https://pubmed.ncbi.nlm.nih.gov/18848964 |journal=Progress in Neuro-Psychopharmacology &amp; Biological Psychiatry |volume=32 |issue=8 |pages=2010–2011 |doi=10.1016/j.pnpbp.2008.09.011 |issn=0278-5846 |pmid=18848964}}&lt;/ref&gt;

== See also ==
* {{Slink|Animal psychopathology#Pica|}}
* [[Jacques de Falaise]]
* [[Michel Lotito]], Frenchman known for his ability to eat and digest metal, nicknamed Monsieur Mangetout ('Mr. Eat-All')
* [[Swallow (2019 film)|''Swallow'']], a 2019 film about a young woman who, emotionally stifled in her marriage and domestic life, develops an impulse to consume inedible objects.

==References==
{{Reflist|30em}}

==Further reading==
*{{Cite book|title = Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry|url = https://books.google.com/books?id=fFi7DR2hmaIC|publisher = Lippincott Williams &amp; Wilkins|date = 2011-12-26|isbn = 978-1-4511-7861-6|language = en|first1 = Benjamin J.|last1 = Sadock|first2 = Virginia A.|last2 = Sadock}}

{{Medical resources
| DiseasesDB = 29704
| ICD11 = {{ICD11|6B84}}
| ICD10 = {{ICD10|F|50|8|f|50}}, {{ICD10|F|98|3|f|90}}
| ICD9 = {{ICD9|307.52}}
| ICDO = 
| OMIM = 
| MedlinePlus = 001538
| eMedicineSubj = ped
| eMedicineTopic = 1798
| MeshID = D010842
}}
{{Mental and behavioral disorders|selected = physical}}
{{Feeding}}
{{Authority control}}

[[Category:Pica (disorder)| ]]
[[Category:Dog diseases]]
[[Category:Eating behaviors of humans]]
[[Category:Eating disorders]]
[[Category:Mental disorders diagnosed in childhood]]
[[Category:Animals by eating behaviors]]