97 Pica (307.52)
DSM-IV-TR criteria
- A. Persistent eating of nonnutritive substances for a period of at least one month.
- B. The eating of nonnutritive substances is inappropriate to the developmental level.
- C. The eating behavior is not part of a culturally sanctioned practice.
- D. If the eating behavior occurs exclusively during the course of another mental disorder (e.g., Mental Retardation, Pervasive Developmental Disorder, Schizophrenia), it is sufficiently severe to warrant independent clinical attention.
Associated features
Pica is commonly Associated with Pervasive Developmental Disorders as well as Mental Retardation. Mineral and vitamin deficiencies have been reported in some cases though no specific biological abnormalities have been found. In some cases it is only after general medical complications that Pica comes into attention. Poverty, lack of parental supervision, developmental delay, and neglect can increase the risk for the condition. Pica is considered to be a serious eating disorder that could result in health problems such as lead poisoning, bowel problems, dental injury, and parasitic infections. In order for the action of ingesting these abnormal non-nutritive substances to be considered pica, the actions have to occur for more than one month at a cognitive level that recognizes the abnormality.
Child vs. adult presentation
Pica is more of a young child disorder and can occasionally be seen in pregnant females. This disorder is more commonly observed in children than adults. Pica in children occurs about the same in boys as in girls between the ages of 2 and 3. It can be found in ages younger, but eating items such as dirt, clay, paper, soap, mucus, cigarette butts, etc. are considered normal at a younger age. Pica is observed more in adults with mental retardation around the ages of 10-20 years. More common forms of Pica involve the ingestion of ice.
Gender and cultural differences in presentations
Although no specific data exist regarding racial predilection, the practice is reported to be more common among certain cultural and geographic populations. For example, geophagia (eating of soil) is accepted culturally among some families of African lineage and is reported to be problematic in 70% of the provinces in Turkey. People who live in the tropics, tribe-oriented societies, and in poverty are the places that geophagia is the most common form of pica. Pica is a widespread practice around different many places such as: western Kenya, southern Africa, India, Australia, Canada, Israel, Iran, Uganda, Wales, Turkey, and Jamaica. For instance, in Uganda, they purchase soil only for the purpose of ingestion. In the Unites States Pica is less common than international places; it is a disorder that is often unrecognized and not reported.
Epidemiology
It is estimated that Pica is seen in about 4-26% of institutionalized populations. The prevalence of Pica also increases with mental retardation, with it being high as15% for a