Pica (eating disorder): Eating inedible substances

Pica (pica syndrome) is an eating disorder in which a patient repeatedly eats inedible substances. Patients suffering from the rare disease have the urge to consume all kinds of objects, such as furniture, dishes, coins, clothes and cigarette butts. Most patients have mental or psychological problems. Eating inedible objects can lead to infections, digestive tract problems, poisoning or nutritional deficiencies. Symptomatic treatment in combination with psychotherapy is therefore desirable. The name ‘pica’ comes from the Latin word for magpie, a bird known for having a large and indiscriminate appetite.

  • Epidemiology of eating disorders
  • Risk factors: Often psychological problems
  • Symptoms
  • Diagnosis and examinations
  • Treatment of pica
  • Complications
  • Infections
  • Digestive tract problems
  • Poisoning
  • Nutritional deficiencies
  • Forecast of eating inedible substances
  • Prevention


Epidemiology of eating disorders

An estimated 4% – 26% of institutionalized patients suffer from pica. Pica often develops at a young age and is more common in children, but adults sometimes suffer from the eating disorder as well. The condition is common in the Western world in patients with psychological problems, but the disease is also common in countries with poverty, where people have nothing to eat. This mainly takes place in poor countries, such as some parts of Africa or Haiti. There is a video on YouTube of an area in Haiti where people make cookies and eat dirt and mud.Pregnant women occasionally suffer temporarily from pica / Source: PublicDomainPictures, Pixabay

Risk factors: Often psychological problems

Patients with the following conditions are particularly affected by the strange eating behavior:

  • autism spectrum disorder (autism: problems with social interaction, communication and behavior)
  • a family history of pica
  • an obsessive-compulsive disorder (obsession and compulsions)
  • a developmental disorder
  • trauma and/or neglect
  • an intellectual disability
  • Kleine-Levin syndrome
  • malnutrition or other nutritional deficiencies
  • schizophrenia (disorder including delusions and hallucinations)
  • trichotillomania (recurrent urge to pull out hair)

Pregnant women can also sometimes temporarily crave non-food products, especially during the first trimester of pregnancy. Poverty is another risk factor .


In the eating disorder, the patient has a craving for inedible substances, which he eventually eats repeatedly.For example, patients eat:

  • her
  • clothing
  • clay
  • buttons
  • chalk
  • glue
  • furniture
  • coins
  • China
  • cigarette ash/cigarette butts
  • feces
  • paint
  • filthy
  • sand
  • soap

These substances contain no nutritional value. The strange eating behavior may lead to physical problems such as intestinal blockage, a build-up of toxins in other organs and anemia. Symptoms may increase when the patient is experiencing stress or anxiety.

Diagnosis and examinations

Diagnostic criterion Eating inedible substances must be present for at least one month before the doctor can diagnose pica.A blood test is needed / Source: Frolicsomepl, PixabayPhysical and diagnostic examination The doctor goes through the patient’s medical history. He wants to know whether the patient suffers from conditions that may result in pica. He also assesses the patient’s eating habits. If the doctor suspects that the patient is suffering from pica, it is important to perform a thorough physical and diagnostic examination. The absorption of the inedible substances may cause signs of anemia, intestinal obstruction (blockage of the intestines) or toxicity. The doctor uses various tests to detect these problems, such as a blood test or an X-ray. The blood test also reveals possible signs of an infection caused by eating objects contaminated with bacteria or other organisms.

Treatment of pica

The doctor treats the presenting complaints supportively. During the treatment, the doctor monitors the patient closely, because some strange eating behaviors only cause complications over time, such as lead poisoning. Furthermore, the patient needs psychological support in the form of cognitive behavioral therapy (form of psychotherapy). The psychotherapist teaches the patient behavioral strategies in which he learns which foods are edible and which foods are inedible. The caregiver uses positive reinforcement for this. Interpersonal psychotherapy, in which the patient talks about the condition with an expert, is also helpful for some patients. Nutritional counseling and cognitive analytic therapy are among the other options available. When developmental disorders are present, treatment is sometimes difficult.


Complications is associated with several potential complications.


Bacteria or parasites found on contaminated items sometimes cause serious infections. Some infections affect the kidneys or liver.

Digestive tract problems

Eating objects that are indigestible (e.g. stones) leads to constipation or blockages in the intestines. In addition, sharp objects (such as paper clips or metal scraps) sometimes tear open the lining of the stomach, esophagus or intestines.


Certain items, such as paint chips, contain lead or other toxic substances. Lead poisoning or another type of poisoning is possible. This leads more quickly to health problems such as learning disabilities and brain damage.

Nutritional deficiencies

Eating inedible objects may lead to nutritional deficiencies. A deficiency of iron in the blood (ferriprieve anemia) is the most common form of nutritional deficiency. Iron is common in many foods, including red meat. Menstruating women and people with absorption problems quickly run out of iron. A lack of iron leads to anemia, which often occurs with pica.

Forecast of eating inedible substances

Pica usually starts in childhood and usually lasts only a few months. However, it is difficult to treat in children with developmental disorders.


There is no preventive measure for pica. However, it is important to maintain good eating habits. The parents of children familiar with pica should closely monitor what they put in their mouths. This makes it possible to prevent complications in a timely manner.

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