Some people live with pica, a psychiatric condition in which people ingest items that are not typically thought of as food and which do not contain significant nutritional value.
Such items include hair, dirt, pebbles, paint chips, clay, chalk and paper.
Consultant psychiatrist Prof Dr Ramli Musa from the International Islamic University Malaysia said pica is classified as an eating disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Having peculiar eating habits, especially in young children, does not necessarily mean one has pica.
What is pica?
According to Prof Ramli, the diagnosis of pica is made mainly based on the presence of persistent eating habits of non-nutritive substances, like the examples given above, for a period of at least a month.
The US-based National Eating Disorders Association (Neda) also stated that pica is not diagnosed if the ingesting of such substances is part of a socially normal practice.
For instance, some cultures promote eating clay as part of a medicinal practice.
Prof Ramli also stressed that a toddler’s act of putting objects into his or her mouth does not necessarily indicate pica.
“It is common for children to put objects into their mouths as a form of exploring their surroundings.
“Such actions, like thumbsucking, may also be caused by anxiety.
“In such cases, it is not considered as being a pica disorder,” he said.
Therefore, in order to exclude developmentally-normal mouthing, children under two years of age should not be diagnosed with pica, according to Neda.
Prof Ramli said the onset of the disorder is commonly in the paediatric age group, with adult onset being rare, but still possible.
“If the onset is in childhood, it could be prolonged into adulthood if no psychological intervention is done,” he said, adding that mild cases of pica may be resolved naturally and symptoms may fade over time.
He explained that those with mild cases of pica may simply be seeking to obtain self-gratification by eating non-food objects.
In severe cases, he said, patients may eat dangerous objects that could endanger their lives and health, such as scissors or needles.
“The problem arises when the objects they ingest cause serious health issues such as bowel blockage, bowel perforation and toxic effects.
“In such cases, the blockage of intestines would lead to surgical intervention.”
Treatment and cause
Prof Ramli said that cognitive behavioural therapy (CBT) could correct the patient’s wrong belief that eating non-food materials is beneficial.
“However, people with severe pica would require some form of medication in order to treat and manage the disorder,” he said.
Antipsychotic drugs, he added, may also be useful in severe cases as pica is associated with having wrong beliefs or delusions.
He also said that treatment runs more easily and with better results if there is the cooperation and involvement of family members.
As to what causes pica disorder, Prof Ramli said there is no single cause, although there are some risk factors that may cause a person to be predisposed to developing it.
“Both genetic and environmental factors contribute to the development of pica,” he said, adding, however, that environmental factors play a relatively more important role than genetics.
“Environmental factors could include emotional distress, anxiety and a rigid parenting style.
“A rigid or authoritarian parenting style has been reported as being the predisposing factor to any eating disorder.
“The behaviour of eating non-nutritious objects may be viewed as a form of retaliation to the rigidity of such a parenting style,” he explained.
Neda states between 4% and 26% of institutionalised individuals are believed to have pica.
However, Prof Ramli said there is no large population-based study done in Malaysia to determine the prevalence of any eating disorders, including pica.
“The incidence of such eating disorders have been reported as individual case reports,” he said.
He noted that the need to invest effort in research of the disorder may not be as compelling as other more common mental disorders.
“This is because the incidence of pica is rare and the impact of the condition is relatively small on society.
“The study of the disorder may be limited to case studies as a starting point,” he said.