BDC #34 - Pica: How could we have appetite over non food items?

Yesterday was a boring day in the lab. I had done my to do list, but it was still a broad daylight. Kinda weird to go back home too early. Then, I re-watched 'My strange addiction' from TLC via youtube (I know.... I know... I am bad!! But, who cares?? I really didn't have anything to do in the lab!!). 
At the end of my surf, I eventually bumped to an episode of a person with a particularly disturbing appetite over pottery and cigarette ashes. I thought, "OK, human appetite has overcome real food!!" It was such a bizarre idea for me. 
I watched the whole episode with dry eyes and throat. It was highly disturbing, as the child started to mimic her mother's eating habit. I felt like slapping that person for showing her unnatural habit in front her infant kid. 
 
Suddenly, I remembered I saw a similar case from my own country, broadcasted in national TV, about a girl who loves eating red brick. It irked my sense and made me searched more about it. Later I found that it's one of eating disorders. 

If you love eating, licking, and tasting non-nutritious (but still edible items such as baking soda, starch, ice) and/or non-food items (such as chalk, clay, plaster, paint, glue, rust, coffee grounds, cigarette ashes, etc), and you have been doing it for at least 6 months in regular basis (at least twice a week), then most probably you are suffering an eating disorder known as Pica.

Pica is considered as a mental disorder phenomenon, a spectrum of obsessive-compulsive disorder (OCD), where people would feel anxious and powerless if they stop their routine. Schizophrenia and autism patients, or people with poverty or childhood trauma history may also lead to pica behaviour. 

Pica acts may also happened due to cultural reason, called culture-bound syndrome. In some cultures, pica is practiced for medicinal purposes and may actually have some value. For example, people in some parts of Nigeria eat kaolinite (a form of clay) to combat diarrhea. The clay actually forms a protective coating in the lining of the intestine and binds bacteria there, thus relieving diarrhea.

However, most of the pica cases, which are unrelated to cultural or mental problem reasons, are happened due to mineral or vitamin deficiency. The easiest example is pica on pregnant women due to iron or zinc deficiency.  This deficiency sometime hooked together with the socioeconomic condition, create a new cultural behaviour. For example, pregnant women on some region in sub-Saharan Africa also eat clay as mineral supplement (check it here or here).

The prevalence of pica is difficult to be estimated, not only due to the fact that pica is highly bound to cultural system, but also because not every people will admit they have an odd eating habit. Pica is usually observed on infants up to 36 months-old, and the tendency will decrease as the age gets older. However, around 10% of those will keep their pica habit until around 12 year-old.       


The complication of Pica is highly related to what kind of non-food item the patient eats. 

• Certain items may contain toxic substances and eating them can lead to poisoning. Certain poisonous material might increase the risk of complications including learning disabilities and brain damage. This is the most concerning and potentially lethal side effect of pica. Co-existing developmental disabilities can make treatment difficult.
• Eating non-food objects interferes the patient to eat healthy food, which usually lead to nutritional deficiencies.
• Eating objects that cannot be digested causes constipation or blockages in the digestive tract, including the intestines and bowels. Also, hard or sharp objects can cause tears in the lining of the intestines.
• Bacteria or parasites from dirt or other objects can cause serious infections. Some infections can damage the internal organs.

There is not specific guideline to treat patient with pica. We have to firstly determine the main cause of the behaviour. Looking at the bigger picture, we have to approach from various aspects; including developmental, behavioural, and environmental therapy along with family education. Sometimes treatment can succeed when the individual experiences negative consequences after eating a non-food substance, and then gets positive reinforcement for consuming proper food.

On the other hand, certain tests can be a good start toward determining physical treatment; including haemoglobin to check for anaemia, poisonous material level,  and gastrointestinal track test. As a first step, treatment should replace missing nutrients if applicable and address any other health issues.

 In short, if you  are OR you know somebody who might have pica disorder.. PLEASE SEEK FOR HELP.. for (at least) physical health purpose.
 
Reference
http://www.something-fishy.org/whatarethey/other.php
http://www.webmd.com/mental-health/mental-health-pica
http://www.psychiatrictimes.com/articles/update-pica-prevalence-contributing-causes-and-treatment
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1284110/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070964/
http://www.psychologytoday.com/blog/brain-sense/201109/little-known-eating-disorder-is-the-rise