Pica, an often Overlooked Eating Disorder

By: Maggie Klyce, Primary Therapist

Typically, when we think of eating disorders, we think of the most common ones such as Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder. However, Pica is an eating disorder that often gets overlooked, partly because until the publication of the DSM-5, Pica was categorized as a disorder of onset in childhood and adolescence. But with the 2013 DSM-5 publication, the American Psychiatric Association determined it fit better in the “Feeding and Eating Disorders” category.

The name Pica was derived from the Latin word for magpie, a bird that is notorious for eating almost anything. Pica is a disorder characterized by individuals consuming non-nutritive substances such as chalk, clay, dirt, paper, ice, cornstarch, and other non-nutritive substances. To be diagnosed, the behavior:

• Must be age inappropriate.
• Occurs for at least one month.
• Fall outside of any cultural norms.
• Must be of severity to warrant additional clinical attention if it is co-occurring with another disorder.

Often, Pica is a childhood diagnosis, but there are adults who struggle also, with pregnant women exhibiting a higher incident. It has been suggested that the higher incidence may be due to an iron deficiency and the eating of nonnutritive substances. Pica is also more likely to be present in adults with an intellectual disability, and is more likely to be seen in a co-morbid presentation with obsessive compulsive disorder and autism spectrum disorders.

In anorexia, symptoms of Pica may be attempts to avoid eating caloric foods while still maintaining a feeling of fullness. However, if the primary means is a method of weight control, anorexia needs to remain the diagnosis. Only recently has Pica been suggested to be linked in some manner to an obsessive-compulsive spectrum. Adults with this disorder tend to recognize the abnormality that is present but are plagued by a continuous compulsion to engage in the behavior.

Even though hospitalizations for other eating disorders have decreased over the last two decades, the hospitalization rate for pica has risen. There are serious medical complications that can result from Pica including bowel obstruction, toxicity, malnourishment, dental damage, parasitic infestation, and abnormal liver functions. Unfortunately, many individuals are ashamed of their behavior and do not discuss their symptoms with medical professionals unless a severe complication has occurred. It is important that healthcare providers ask questions and to screen for Pica if it is suspected.

Magnolia Creek treats Pica, as well as other eating disorders, and it is important that treatment is conducted with a multidisciplinary team. First, any nutritional imbalances or medical factors contributing to the disorder must be addressed and corrected. Secondly, clients will be provided education on appropriately balanced meals and be involved in the planning and preparation of their food to help them learn how to nourish their bodies adequately. If there is any sensory component that plays a part in the disorder, this issue will be addressed as well.

From a therapeutic standpoint, Pica responds well to behavioral interventions, which mirror what is the gold standard in the treatment of Obsessive Compulsive Disorder and a component in the treatment of other eating disorders. The interventions are typically in the form of exposure and response prevention. Sometimes medications such as SSRI’s (selective serotonin reuptake inhibitors) may be helpful as well in the treatment of Pica.

At Magnolia Creek, we operate as a multidisciplinary team and can offer the therapeutic, nutritional, medical, and psychiatric care needed to treat Pica, and other eating disorders effectively. We offer a continuum of care to help meet the needs of you or your loved one so that recovery can take place.

Magnolia Creek is one of the premier treatment centers for adult women with eating disorders. Our highly-credentialed staff works with clients to offer an individualized treatment plan through a full continuum of care. Nestled on 36 wooded acres, our beautiful lakefront property houses residential, outpatient and aftercare treatment programs. To learn more about Magnolia Creek Treatment Center for Eating Disorders, please call our admissions office at 205-235-6989 or complete our contact form. We are an in-network treatment provider with Blue Cross Blue Shield and Aetna insurances; clients and their families also can pay privately.