Pica syndrome is a qualitative eating disorder. Sufferers consume disgusting and inedible substances, such as clay, garbage, feces, or objects. Treatment is usually equivalent 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, borrowed from picacism, has come to refer to a rare eating disorder. As part of the disorder, sufferers are driven by the consumption of inedible or disgusting substances. They often ingest inedible objects, such as scraps of paper or even objects. For a long time, the term allotriophagia was used to describe the disorder. Unlike bulimia or anorexia, pica syndrome is not a quantitative eating disorder, but is classified as a qualitative eating disorder. In most cases, it is a disorder with a mental cause. However, physical connections are also known. Psychotherapy deals with the treatment. Children are most often affected by it.
Causes
Pica syndrome mainly affects people with mentally delayed development. Dementia patients, autistic people, or patients with mental illnesses are also often affected by pica syndrome. In addition, those affected are often extremely neglected children from families with multiple stress factors. Abuse, alcoholism, and delinquency are observed in the family environment. The psychoanalytic model discusses a stress disorder during the oral phase in this context. In individual cases, however, a lack of nutritional awareness is also discussed as a cause, especially in mentally impaired individuals. Theoretical models of nutrition point to somatic causes for the pica syndrome. Thus, the affected persons are often patients with a mineral deficiency. The substances consumed would often contain the very mineral that the affected individuals lack.
Symptoms, complaints and signs
Patients of pica syndrome consume substances that are not primarily on the human diet. For example, geophagy, or the consumption of soil, can often be observed. Just as often, sand, stones or paper are eaten. Just as often, consumption of ash, lime, plant debris, and clay can be observed. These four substances are most often associated with the somatic causes of the nutritional model. Some patients also consume things that are considered disgusting. These include dust and litter, as well as excrement. The consumption of feces is known as coprophagy and can cause serious infections. The most common consequences of pica syndrome include constipation and digestive problems such as intestinal obstruction (ileus). Poisoning can also occur after eating toxic plant parts. Soil, clay, and ash often cause infections. Persistent picacism is malnutrition, which can cause malnutrition with iron deficiency and vitamin deficiency.
Diagnosis and course of the disease
The diagnosis of pica syndrome is made according to DSM-IV. Several criteria must thus be met to make the diagnosis. The substances consumed must be those without significant nutritional value. The consumption must last for at least one month and must not correspond to the age-appropriate stage of development. Eating behavior must be clearly different from the culturally determined norm. If there are co-existing mental disorders such as schizophrenia or cognitive disability, the eating disorder must be severe enough to require special attention for diagnosis. For example, a serious disorder exists when the substances consumed cause health impairment or malnutrition. Other disorders should be considered in the differential diagnosis. For example, hair consumption occurs primarily in the context of trichotillomania, in which impulse control is impaired.
Complications
Pica syndrome can lead to digestive disorders that can be mild to life-threatening. Severe complications include injuries to the esophagus, stomach, and intestines that can result from sharp or pointed objects.Sand, soil, clay, loam, uncooked rice, plant parts and other inedible substances trigger severe constipation in some cases, which can result in intestinal obstruction and, more rarely, intestinal rupture. Infections and inflammations are another complication of pica syndrome. They also commonly develop in the gastrointestinal tract. Poisoning, which can be associated with eating toxic plants, is more common in children and adults with cognitive impairment. Some people suffering from 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 may indicate pica syndrome. A visit to the doctor is recommended if this tendency affects well-being, for example, because unhealthy foods or drinks are consumed. Parents who notice such behavior in their child should consult the pediatrician. Otherwise normal eating behavior is a clear indication of pica syndrome. A medical professional should then be consulted, who will first rule out other conditions. If the child shows reduced intelligence or suffers from psychosocial stress, a visit to the doctor is particularly urgent. It is possible that there are other complaints besides the pica syndrome that need to be clarified. In addition to the family doctor or pediatrician, child and adolescent psychologists can be consulted. Therapeutic treatment is necessary in any case of pica syndrome. Adults should also consult a physician or psychologist if signs of the disorder are present and possibly associated with underlying psychiatric disorders 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, medical clarification is necessary. Affected individuals should speak with their primary care physician expeditiously and begin behavioral therapy.
Treatment and therapy
Pica syndrome is treated causally. Therapy is considered extremely difficult and lengthy. Most often, supervising psychotherapists opt for a behavioral treatment approach. Behavioral therapies presuppose that the disorder is based on a systematic maladjustment. This maladjustment is specifically unlearned in the course of therapy. Behavior therapy is therefore not intended to uncover the roots of the disorder. Rather, the current behavior and view of the person is to be examined and corrected if necessary. Behavioral therapy thus guides the person to help himself and gives him strategies to help him encounter his problems. Behavior analysis is the beginning of therapy. The behavior-supporting conditions and the consequences of the behavior are considered. In this regard, Kanfer developed the SORKC model, which notes five bases for learning. A stimulus elicits the behavior. The organism responds to the stimulus with cognitions and biological-somatic conditions, taking into account the individual’s biological and learning background. The behavior thereby corresponds to an observable response that follows the stimulus and its processing. The behavior has contingency, that is, 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. Therapy goals are developed as much as possible in collaboration with the patient. In the case of children, parents are regularly advised on proper supervision and rapid action in the event of poisoning. If life is in danger, inpatient treatment is recommended. Nutrient deficiencies and other somatic causes are corrected. Medical intervention may be indicated for intestinal obstruction or other sequelae.
Outlook and prognosis
The subsequent course and prognosis of pica syndrome usually cannot be predicted in general.Since it is a relatively unknown and unexplored syndrome, the measures of treatment are relatively limited, whereby especially behavioral therapy or psychotherapy is necessary to alleviate the symptoms. The further course also depends strongly on the time of the diagnosis, whereby an early diagnosis always has a very positive effect on the further course of the pica syndrome. If the pica syndrome is not treated by a doctor, in most cases there is also no self-healing. In the worst case, the affected person can become poisoned and die as a result of the poisoning. In children, if left untreated, it can lead to severe psychological problems later in life. In the treatment of pica syndrome, it is primarily the parents of the affected person who are called upon. They must pay attention to the symptoms and act quickly if the child tries to eat an inedible object. The therapy itself can take several months or even years, and the parents also need support. Usually, this syndrome does not reduce the life expectancy of the affected person.
Prevention
Pica syndrome can be prevented to some extent by maintaining a low-stress family environment and a balanced diet.
Follow-up
In most cases, affected individuals with pica syndrome have very few and also very limited follow-up care measures available to them. Here, affected persons should first pay attention to a quick and, above all, early diagnosis and detection of the disease, so that it does not lead to further complications and complaints. The earlier the syndrome is recognized by a doctor, the better the further course of the disease usually is. Self-cure cannot occur. Most patients are dependent on help and treatment in a closed clinic. First and foremost, the help and also the 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 so that the disturbed behaviors do not occur again. A general course cannot usually be given for pica syndrome. Possibly, this disease also reduces the life expectancy of the affected person.
This is what you can do yourself
In milder forms of pica syndrome, it may already help if affected persons consistently suppress or gradually reduce the unusual eating behavior. This “stop” can be practiced by having the affected person spit out the pica substance again and not continue eating it. If there is a risk to health, medical and therapeutic support is strongly recommended. People with pica who are undergoing therapy should focus primarily on applying what they have learned in their daily lives. Any type of self-help requires that the individual be reflective and perceive the pica behavior as a problem. In the case of children, the mentally handicapped or the acutely schizophrenic, the ability to reflect is often limited, so that self-help is not always possible. In such a case, outside help may be useful. Parents of children with pica should keep a particularly close eye on their children. In some cases, dangerous situations can be avoided if the child only plays with small parts that can be swallowed under careful observation – if at all – and otherwise has no access to such toys. Batteries, magnets, erasers and similar objects are also affected. Food such as raw rice, items for pets, washing and dishwashing utensils should also be stored out of reach. Typical outdoor risk situations arise from poisonous plants or eating sand. Parents should also praise and reward children with pica syndrome in an age-appropriate manner when they do not eat inedible substances.
