PICA complications include intrinsic toxicity; bowel obstructions (as in hair eating or trichophagia); excess caloric intake (as seen in starch); dietary starvation; parasitic and/or opportunistic infections; and tooth damage. PICA is difficult to diagnose in many cases because consequences do not emerge or are not detected. Furthermore, many individuals are reluctant to self-report such practices due to embarrassment or a lack of awareness that the activity could be harmful to their health.