Pica syndrome is a qualitative eating disorder. Those affected consume disgusting and inedible substances such as clay, garbage, excrement or objects. The treatment usually corresponds to a behavioral therapy intervention.
What is Pica Syndrome?
Many women experience cravings for unusual foods or combinations of foods during pregnancy. This pregnancy symptom has physical causes and is also known as picacism. The term pica syndrome, based on picacism, has become the name for a rare eating disorder. Those affected are driven by the consumption of inedible or nauseous substances as part of the disease. See dictionaryforall for CHD in Dictionary.
They often ingest inedible objects, such as scraps of paper or even objects. For a long time, the expression of allotriophagy was indicative of the disorder. Unlike bulimia or anorexia, pica syndrome is not a quantitative eating disorder, but is classified as a qualitative eating disorder. It is usually a mental disorder. However, physical connections are also known. Psychotherapy deals with treatment. Children are most commonly affected.
Pica syndrome is particularly common in people with mental retardation. People with dementia, autism or mental illnesses are often affected by pica syndrome. Those affected are also often extremely neglected children from families with multiple stress factors. Abuse, alcoholism and crime are observed in the family environment.
In this context, the psychoanalytic model discusses a stress disorder during the oral phase. In individual cases, however, a lack of nutritional awareness is also discussed as a cause, especially in the case of mentally handicapped people. Nutritional models point to somatic causes of pica syndrome. Those affected are often patients with a mineral deficiency. The consumed substances often contain exactly the mineral that those affected lack.
Symptoms, Ailments & Signs
Patients with pica syndrome consume substances that are not primarily part of the human diet. For example, geophagy, i.e. the consumption of soil, can often be observed. Sand, stones or paper are eaten just as often. The consumption of ash, lime, plant remains and clay can be observed just as often. These four substances are most commonly associated with the somatic causes of the nutritional model.
Some patients also eat things that are considered nauseous. This includes dust and waste, but also excrement. Eating feces is known as coprophagia and can cause serious infections. The most common consequences of pica syndrome include constipation and digestive problems such as intestinal blockage (ileus). Poisoning can also occur after the consumption of poisonous plant parts. Soil, clay, and ash are common sources of infection. Persistent picacism is malnutrition that can cause malnutrition with iron deficiency and vitamin deficiencies.
Diagnosis & course of disease
The diagnosis of pica syndrome is made according to DSM-IV. Several criteria must be met for a diagnosis to be made. The consumed substances must be of no appreciable nutritional value. Consumption must last at least one month and must not correspond to the age-appropriate level of development. Eating behavior must clearly differ from the culture-related norm.
In the case of co-existing mental disorders such as schizophrenia or cognitive impairment, the eating disorder must be so severe that it requires special attention to make the diagnosis. A serious disorder exists, for example, if the consumed substances cause health impairments or malnutrition. Other disorders should be considered in the differential diagnosis. Eating hair, for example, occurs primarily in the context of trichotillomania, in which impulse control is disturbed.
Pica syndrome can lead to digestive disorders that can range from mild to life-threatening. Serious complications include injuries to the esophagus, stomach and intestines, which can be caused by sharp or pointed objects. Sand, earth, clay, loam, uncooked rice, plant parts, and other inedible substances can cause severe constipation in some cases, which can result in intestinal obstruction and, less often, rupture of the intestine. Another complication of pica syndrome is infection and inflammation. They also often develop in the gastrointestinal tract.
Poisoning, which can be associated with the consumption of toxic plants, is more common in children and adults with cognitive disabilities. Some people with pica syndrome eat or lick dried paint. Poisoning is also possible in this way, for example with lead. Some physical complications of pica can be fatal if not treated in time.
When should you go to the doctor?
Unusual food preferences can indicate pica syndrome. A visit to the doctor is recommended if this tendency affects well-being, for example because unhealthy food or drinks are consumed. Parents who notice such behavior in their child should consult the pediatrician.
Otherwise normal eating habits are a clear indication of pica syndrome. Then a doctor should be turned on, who will first rule out other diseases. If the child has reduced intelligence or suffers from psychosocial stress, a doctor’s visit is particularly urgent. In addition to the pica syndrome, there may be other symptoms that need to be clarified.
In addition to the family doctor or pediatrician, child and adolescent psychologists can be consulted. Therapeutic treatment is always necessary for pica syndrome. Adults should also consult a doctor or psychologist if signs of the disorder are present and may be associated with underlying psychiatric conditions such as dementia or schizophrenia. At the latest, if deficiency symptoms, poisoning and other health problems occur as a result of the disturbed food intake, a medical examination is necessary. Those affected should speak to their family doctor as soon as possible and begin behavioral therapy.
Treatment & Therapy
Pica syndrome is treated causally. The therapy is considered to be extremely difficult and lengthy. Most often, the psychotherapists in charge opt for a behavioral therapy treatment path. Behavioral therapies assume that the disorder is based on a systematic misattitude. This misalignment is specifically unlearned as part of the therapy. Behavioral therapy is not intended to uncover the roots of the disorder.
Rather, the current behavior and view of people should be examined and corrected if necessary. Behavioral therapy guides those affected to help themselves and gives them strategies to help them deal with their problems. The behavior analysis is at the beginning of the therapy. The behavior-supporting conditions and the consequences of the behavior are considered. In this regard, Kanfer developed the SORKC model, which contains five principles for learning processes.
A stimulus evokes the behavior. The organism reacts to the stimulus with cognitions and biological-somatic conditions, taking into account the individual biological and learning history of the person concerned. The behavior corresponds to an observable response that follows the stimulus and its processing. The behavior has contingency, which means that it is regularly and temporally related to the situation and the consequence.
The consequence of the behavior is a reward or punishment. When analyzing behavior using this model, the psychotherapist includes feelings and thoughts as well as physical processes or the patient’s environment. The therapy goals are developed in cooperation with the patient as much as possible. In the case of children, parents are regularly advised on proper supervision and rapid action in the event of poisoning.
If life is at risk, inpatient treatment is recommended. Nutrient deficiencies and other somatic causes are resolved. Medical intervention may be indicated in the event of intestinal blockages or other sequelae.
Outlook & Forecast
The further course and prognosis of pica syndrome cannot usually be predicted in general. Since this is a relatively unknown and unexplored syndrome, treatment measures are relatively limited, with behavioral therapy or psychotherapy being the mainstay required to alleviate the symptoms. The further course also depends heavily on the time of diagnosis, with early diagnosis always having a very positive effect on the further course of pica syndrome.
If pica syndrome is not treated by a doctor, in most cases it does not heal itself. In the worst case, those affected can poison themselves and die as a result of the poisoning. If left untreated, children can develop serious psychological problems later in life.
In the treatment of pica syndrome, the parents of the affected person are also primarily asked. They must pay attention to the symptoms and act quickly if the child wants to eat an inedible object. The therapy itself can take a few months or even years, and the parents also need support. As a rule, this syndrome does not reduce the life expectancy of the person affected.
Pica syndrome can be prevented to a certain extent by a low-stress family environment and a balanced diet.
In most cases, those affected by pica syndrome only have very few and only very limited follow-up measures available. Those affected should first pay attention to a quick and, above all, early diagnosis and recognition of the disease, so that there are no further complications and symptoms. The earlier the syndrome is recognized by a doctor, the better the further progression of the disease. Self-healing cannot occur.
Most patients are dependent on the help and treatment in a closed clinic. First and foremost, the help and support from one’s own family and friends has a very positive effect on the further course of the disease. In general, the trigger for pica syndrome should be prevented.
In many cases, permanent monitoring by other people is necessary to prevent the disturbed behavior from recurring. A general course cannot usually be given for pica syndrome. This disease may also reduce the life expectancy of the person affected.
You can do that yourself
In milder forms of pica syndrome, it can already help if those affected consistently suppress or gradually reduce the unusual eating behavior. This “stop” can be practiced by the person spitting out the pica substance and not continuing to eat it.
If there is a risk to health, medical and therapeutic support is strongly recommended. People with pica who are in therapy should focus on applying what they have learned in everyday life. Any kind of self-help presupposes that the person concerned is reflected and perceives the pica behavior as a problem. In the case of children, the mentally handicapped or acute schizophrenics, the ability to reflect is often limited, so that self-help is not always possible. In such a case, outside help can be useful.
Parents of children with pica should keep an extra close eye on their children. In some cases, dangerous situations can be avoided if the child only plays with small parts that could be swallowed – if at all – and otherwise has no access to such toys under careful observation. Batteries, magnets, erasers and similar objects are also affected. Food such as raw rice, pet items, washing and dishwashing utensils should also be kept out of reach. Typical risk situations outdoors arise from poisonous plants or eating sand. Parents should also give children with pica syndrome age-appropriate praise and rewards for not eating inedible substances.