Pica

Last revised by Dr Ali Alsmair on 16 Mar 2022

Pica refers to a psychiatric disorder in which patients report a craving for and compulsive consumption of substances that are not food. Substances consumed include earth, clay, plaster, paint chips, string, hair, animal feces and stones 1

Although the condition can present in any age group, most commonly pica has a childhood-onset. Often onset is in patients with neurodevelopmental disorders 2. Conditions such as obsessive-compulsive disorder and attention-deficit/hyperactivity disorder are frequently co-morbid 2

Diagnostic criteria for diagnosis of pica according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states that the following four criteria must be met 3

  • persistent eating of nonnutritive, nonfood substances over a period of at least 1 month

  • the eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual

  • the eating behavior is not part of a culturally supported or socially normative practice

  • if the eating behavior occurs in the context of another mental disorder (e.g. intellectual disability (intellectual developmental disorder), autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is sufficiently severe to warrant additional clinical attention

In some cases, pica only comes to the attention of clinicians due to complications such as intestinal obstruction/perforation, infections or poisoning 3. Dental complications such as caries, erosion or abrasion, loss of vertical dimension occlusion and cracked teeth may also be present 2

The word "pica" is derived from the Latin word, pīca, which means magpie 4. This is due to the bird's tendency to collect a variety of objects and the belief that it could eat anything. The condition was first documented by the Greek physician Hippocrates (460 BC-370 BC) in the fourth century BC 4.

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Cases and figures

  • Case 1: chalk
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