While many people are at least somewhat familiar with the signs and symptoms of well-known eating disorders like bulimia and anorexia, lesser-known eating disorders continue to fly under the radar. One of those eating disorders is pica, a diagnosis that’s significantly different from other eating disorders in many ways, but still just as serious. Read on to learn more about pica, its different symptoms and causes, what pica eating disorder treatment looks like, and more.

What is pica?

Pica disorder is primarily characterized by the consumption of things that aren’t food and don’t contain any nutritional value. Those with pica might eat a large variety of things that aren’t meant to be eaten, such as dirt, paper, charcoal, cloth, and more. The medical term for the illness originates from the Latin word for magpie (Pica pica) which is a bird known for eating unusual objects.

“Pica is an eating disorder where a person habitually eats non-food items,” says Jessie Menzel, PhD, Clinical Psychologist and VP of Clinical Programs at Equip. “The Diagnostic and Statistical Manual of Mental Disorders classifies something as an eating disorder if the main target of treatment is going to be eating, which is certainly true for pica.”

Menzel goes on to explain that pica can affect anyone, but it occurs more frequently among children and those with cognitive or intellectual disabilities. While up to one third of children ages one to six exhibit eating behaviors like those observed in pica, experts aren’t entirely sure just how many intentionally consume non-food materials, like dirt (in other words, they’re not sure which of these children have pica and which are just putting non-food items in their mouths because they’re little kids).

Registered dietitian Katy Zanville, MS, RDN, adds on to Menzel’s definition, explaining that “pica is a condition in which a child or adult eats non-food substances such as ice, raw starch, dirt, baby powder, chalk, coffee grounds, charcoal, and egg shells for a period of at least one month. It’s often seen in children, intellectually impaired adults, and pregnant women.”

While, as Zanville points out, pica can occur in adults, experts aren’t sure how common adult pica is and the diagnosis initially appeared in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a “disorder usually first diagnosed in infancy, childhood, or adolescence.” Pica only appeared in its current form—as a disorder affecting people of all ages—with the 2013 publication of the DSM-5. Given this, research on pica in adults is fairly limited.

Here’s what we know based on the current research on the prevalence of pica:

• Approximately 1.1% of adults experience recurrent pica behaviors, according to one study.
• About 5% of kids ages 7 to 14 experience pica symptoms according to another study.
• Between 27.8–34% of pregnant and postpartum women experience pica symptoms, according to a global meta-analysis of pica during pregnancy and the postpartum period. Prevalence was higher in Africa compared with other locations, increasing as the prevalence of anemia increased, and decreasing as education on the deficiency spread, suggesting that pica in these instances may be driven by nutritional deficiencies.
• About 1 in 5 adults with intellectual disabilities may experience pica symptoms, according to research.

What are the symptoms of pica?

While pica can take many forms, the defining symptom is the regular consumption of non-food items. “The hallmark symptom of pica is eating something that isn’t food,” Menzel says. “Some examples of items that someone might ingest include hair, paper, clay, chalk, small rocks, erasers—anything! The eating can often be compulsive in nature, meaning that a person will have a strong, almost irresistible urge to eat.”

The DSM defines pica as “eating non-nutritive, non-food substances over a period of at least one month.” The specific symptoms of pica include:

• Eating non-food, non-nutritive substances over a prolonged period of one month or more
• Ingesting non-food items for reasons other than a medical condition or gastrointestinal problem
• Eating these items in a way that is considered developmentally inappropriate. For example, it’s common for children under two years old to put small, non-food objects in their mouths in order to explore their senses. Even when this accidentally results in consuming the object, children under two are not diagnosed with pica.
• Consuming non-food substances that are not part of cultural or social norms or practices (for example, in some cultures it may be considered appropriate or customary to consume non-food materials for medicinal or spiritual practices).

Menzel emphasizes this last point, noting that “eating non-food items is common practice in some cultural groups and it’s important to be aware of this potential.”

Zanville adds that pica does not involve the body image concerns or mental health implications of other eating disorders. “Pica differs from other eating disorders because it doesn’t include a desire for weight loss and can be treated with nutrient supplementation,” she says. “Other eating disorders, such as anorexia or bulimia, are treated with mental health, medical, and nutrition interventions.”

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What causes pica?

As with all eating disorders, there is no single, definitive cause responsible for the development of pica. Eating disorders develop due to various biological, environmental, and social factors, and there are myriad explanations for why someone might experience pica symptoms.

“There are several different reasons why a person might develop pica,” Menzel says. “Sometimes pica is linked to a nutritional deficiency, like anemia. In this case, a person might be driven to eat non-food items due to a vitamin or mineral deficiency.” She explains that any condition that profoundly changes someone’s nutritional needs—like pregnancy or weight loss surgery—could also trigger pica.

According to Zanville, a few of the most common causes of pica are:

• Anemia or iron deficiency
• Zinc deficiency
• Low hemoglobin concentration in the blood
• Low hematocrit concentration in the blood

“Other times, pica is a compulsive behavior that can be triggered by stress or anxiety,” Menzel says. “Other people with pica eat because they find the sensations associated with the non-food object to be enjoyable or stimulating.”

Experts also theorize that pica may sometimes be related to autism spectrum disorder and intellectual disability, but anyone can develop the disorder, regardless of whether they have an additional diagnosis.

What pica eating disorder treatment looks like

Though pica is less well-known than other eating disorders and doesn’t share the same body image struggles or fears around weight gain, it’s no less serious. There are real, potentially life-threatening consequences to pica, and it requires professional treatment from specialized providers. Among the biggest risks associated with pica are poisoning (the most common type being lead poisoning), which can result in coma or death. Infections, parasitic infestations, gastrointestinal complications, and dental problems are also possible consequences of the disorder.

“Pica can be an incredibly dangerous condition if left untreated,” Menzel says. “Depending on what a person ingests, it can result in emergent, life-threatening medical complications.”

The good news is that there are effective, evidence-based treatment options for pica. These include:

Medical interventions

Pica eating disorder treatment typically starts with specific tests to identify and address any nutritional issues. “There isn’t a ‘medical’ cure for pica, with the exception of addressing vitamin or mineral deficiencies if they’re present,” Menzel says. “Psychiatric medications may also be helpful when used to treat co-occurring conditions that impact pica behavior.”

Zanville adds that nutritional therapy often distinguishes pica treatment from other types of eating disorder treatment. “Pica treatment often involves iron or zinc supplementation if a deficiency is discovered,” she says. “If the behaviors are not caused by malnutrition or nutrient deficiency, then working with a collaborative team to redirect consumption of non-food items is encouraged.”

Pica therapy

Once physical symptoms are addressed, the next step is pica therapy. Psychotherapy is a cornerstone of all eating disorder treatment, and pica is no different. “Overall, treatment for pica usually involves some form of psychotherapy,” says Menzel. “Therapy may involve treating the underlying cause of pica, such as trauma or stress or anxiety.”

Behavioral changes

While a patient is undergoing pica therapy, they’ll also work to stop disordered behaviors. Menzel notes that in younger children, using a reward system may be an effective way to address pica symptoms (i.e. praising and honoring when a child discards a non-food item instead of consuming it).

For people of all ages with pica, treatment will generally include becoming conscious of disordered habits and creating a plan for avoiding them. “Pica treatment may also involve learning awareness of urges and developing new coping strategies to deal with the urge or learning substitute behaviors that a person can engage in instead,” Menzel says.

If you’re worried that you or a loved one may be struggling with pica, it’s important to get help. Pica is a serious eating disorder that carries significant health risks, but with the right treatment, lasting recovery is possible for everyone.

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