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Pica Involves Eating Everything but Food: DSM-5, Causes, and Treatment

Pica example: 1,440 items found in one mental health patient's stomach.

Pica example: 1,440 items found in one mental health patient's stomach.

PICA: Diagnosis and Symptoms

America's psychiatric diagnoses manual, the DSM-5, published in 2013 and updated approximately once every two decades, shows eight types of eating disorders:

  • Anorexia Nervosa
  • Bulimia Nervosa
  • Binge Eating Disorder
  • Pica
  • Rumination Disorder
  • Avoidant/Restrictive Food Intake Disorder
  • Other Specified Feeding or Disorder (disorders that do not fit into the first seven)

I have worked largely with the diagnoses presented in the previous manuals (DSM IV and DSM IV-TR), but pica remains much the same, and I have seen a few cases of the disorder. The DSM-5 states that it often manifests itself in the presence of other mental disorders, and I have found that to be true thus far.

Source: Diagnostic and Style Manual of the American Psychiatric Association, DSM 5; 2013.

The criteria for a diagnosis of pica are listed below; however, if you or someone you know exhibits any of these symptoms, ask a doctor about them and possible treatments needed. We cannot actually make a diagnosis by matching a list of symptoms with a patient's behavior without the examination required for the condition.

  1. Strongly continuing to eat non-food items for at least one month.
  2. This eating in No. 1 above is inappropriate for the developmental level of the individual.
  3. The eating in No. 1 above is not part of a culturally or socially usual/customary practice.
  4. If the eating in No. 1 occurs in the presence of another mental disorder (autistic spectrum disorder) or during a medical condition (pregnancy) and is severe enough to warrant independent clinical attention, then it is diagnosed as pica.

Some of these unwanted behaviors accompanying pica can include syndromes of behaviors that include:

  • Abnormal language
  • Strange methods of play not used before
  • Strange relationships with friends of the child's own age (peer group)

Look for these things to occur and call your pediatrician or family doctor (general practitioner or internist), and discuss them with him or her. The child may also pull out his or her own hair and eyelashes, and that is part of another syndrome. If this happens, call the doctor right away.

Also, keep a diary or a daily log of the times when your child chews on paper and other nonfood items and when he/she does not. Make a note of what happened just before the behavior occurred and how soon it is after a meal or before the next meal. Write down anything that you think is important about each particular instance of pica behavior. The log or diary would be helpful to your doctor. Like so many puzzling situations, if you start writing things down, you begin seeing patterns.

A Magpie or Pica. This bird eats almost anything.

A Magpie or Pica. This bird eats almost anything.

Pica Means "Magpie" in Latin

Pica comes from the Latin word that means magpie, which is a bird that is known for a big appetite to eat anything and everything.

Here are some of the things that children and adults sometimes eat if they have been diagnosed with or show signs of pica or have yet been un-diagnosed with any mental illness:

  • Dirt / clay / mud; clay pottery shards
  • Rubber erasers
  • Pencil wood
  • Play-Doh
  • Paint chips
  • Plaster
  • Chalk
  • Cornstarch
  • Baking soda
  • Coffee grounds
  • Cigarette ashes / Burnt match heads / Cigarette butts
  • Feces
  • Ice
  • White Glue / White paste
  • Hair, from head or hair brushes. Cat hair is a newer item
  • Buttons
  • Pennies/nickels
  • Paper / cardboard
  • Sand
  • Toothpaste
  • Soap bars
  • News favorites among non-food eaters are the melamine sponge and foam pillow stuffing.

Note: Eating some non-food items, as is done in cases of pica, can result in bladder cancer.

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Read More From Healthproadvice

Melamine, a Non-Food Protein

Scientific American Magazine researchers found that melamine, a high-nitrogen-containing, non-food protein, is added to food illegally to boost protein content for the nutritional label. It was used as protein for cattle to eat from 1958 through 1978, when it was found that it does not metabolize efficiently enough to be as effective as desired.

When eaten by humans in quantity, the end result of this melamine can be bladder cancer.

Materials like glass, plastic and metal are not changed in their passage through the bowel and might, in theory at least, be more hazardous than natural substances. Occasionally children or people in disturbed mental states swallow these sorts of things deliberately and it is remarkable how rarely they develop problems.

— Core Charity

Possible Causes of Pica

The act or habit of eating things that are not food is called "pica" in medical and psychological textbooks. For children, who learn about the world by putting things into their mouths, pica is really fairly common. I remember kids in elementary school eating pencils, erasers, paste... and a few crayons.

Some of the children were bored, and some did not realize they were chewing on nonfood items because they were thinking hard about a test question or a math problem. There were a lot of pencils with teeth marks on them in elementary school. I see them in libraries and college classrooms on occasion, even today, and they make me laugh.

Unfortunately, some children do not have breakfast at home, and they eat paper and other items just because they are hungry and need to survive. Hopefully, subsidized school and summer breakfast and lunch programs are reaching most of them, and they are receiving at least one or two meals a day in school. This initiative has helped a lot in the past 20 years.

One other serious possibility to consider is that pica can be—but not always is—associated with Obsessive-Compulsive Disorder (OCD), but a licensed doctor or other qualified practitioner needs to determine that, with the input of the patient.

Developmentally, babies—more than elementary school kids—have a period of growth in which they put just about everything they find into their mouths, even their own feet. They usually go on to something more exciting that catches their attention and forget what they had in their mouths. When a child has passed this developmental point and is older but suddenly begins to eat nonfood items once again, there may be a problem of some kind. In this case, there is likely some cause for it that can be found and eliminated, however.

Stress and Developmental Causes

Think about, and ask your child about, any new or recurring stresses in his life—a new baby at home, changing schools, a new job for a parent, a bully at school, etc. Remember that every time you move before the child is five years old will generally make him/her regress in maturity a bit for a while, but this will usually remedy itself. An example of this is bedwetting that begins with a move and ends when the child is more steeled in a routine.

If you suspect emotional or developmental problems, talk with your doctor ASAP. If everything seems fine and the blood tests are normal, ask your doctor if it is just a habit. If so, then try to keep paper and other nonfood items away from your child if he/she is very young.

Solutions

Fortunately, two very likely causes can be examined through a simple blood test. The first cause is easy to cure, and if either cause is found to be at fault, steps can be taken to correct both problems. These causes are curable, including:

  1. Low iron in the blood (anemia)
  2. High blood level of lead

Lead exposure is a problem for many children that live or visit for extended periods of time in older houses that have lead-based paint in them. These houses were built mainly before the 1970s, and lead paint was outlawed in 1978. However, other sources of lead include certain types of medications, some kinds of pottery, and several other sources. The blood test for lead and anemia will help you to begin to narrow down the cause of eating paper and plastic and such.

There are other possibilities for the manifestation of pica in children. Some kids develop pica as a symptom of emotional distress. Some others experience developmental disorders that lead to longer periods of time eating nonfood items or to returning to the behavior. Many of these problems would most likely not manifest only as pica, however. Other behaviors and symptoms would likely begin to appear.

Treatment

Treatment may not even be required, but talk to your doctor to be sure.

Pica treatment can involve several kinds of licensed professionals, depending on the reasons for the disorder and the various symptoms and related syndromes.

A medical doctor must first look for physical problems causing the pica—and then also look for physical problems that are being caused by it. It is vital that a medical practitioner be the first to enter the case.

If there are socioeconomic matters involved, a social worker will become involved to provide education and guidance to remedy underlying problems such as poverty and the factors that are associated with it.

If psychological conditions are present, a licensed therapist or psychiatrist will become involved.

This article is cited and quoted in the Journal of the International Society of Preventative and Community Dentistry: 2014 Jan-Apr; 4(1): 1–4.

Sources

Alison Snyder. "Protein Pretense." Scientific American Magazine. August 2007.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2007 Patty Inglish MS

Comments and Additions

Shannon on December 26, 2016:

I crave the taste of rubber. I chew rubber bands and love the smell. Even the rubber around a tennis shoe. The converse type. I don't swallow it. But it's so good and I don't know what is in rubber that I like it so much. The large postal brown rubber bands are the best thus far.

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on November 04, 2015:

@Che - I hope you never have any ill healty effects from eating those rollers. Lots of people say they enjoy the flavor and texture. Too bad real food doesn't have the same!

Che on November 04, 2015:

I am 34 and i am HOOKED on Foam hair rollers! Not just any kind, but they have to be Goody brand! It started as a child and i would stop when I run out, but then i would see them in a store and start again. Its shameful, no one knows, i snack on them and tell people its licorice when they ask what i am eating. It has a cardboard taste to it, that i LOVE! It also helps me poop! Its gotten so bad, that I order rollers off of ebay! I can eat a pack of 37 in a few days. I try to stop, but I can't! Just glad to know that I'm not alone

Jason Faith from Grand Rapids MN on December 04, 2014:

ty, very interesting article.

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on April 30, 2014:

Pica is still a bothersome eating disorder, but not without effective management and cures in many cases.

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on November 14, 2013:

@sandra - It is good to know that your techniques work for you and I think that they can help others. Substituting useful and good-tasting food items for non-food items is, in my opinion, much better than attempting to treat the symptoms with drugs. I will share these tips with as many people as I can.

sandra on November 13, 2013:

i had and do have pica. wax, paper, wood, string, plastic, foam ... not really too sure why ... maybe anxiety, the chewing seems to calm me, maybe nutritional deficiency as well ... it has improved since i have started to eat vegetables (i will only eat them raw, i prefer a harder texture). And have been taking medicinal herbal teas.

I also believe i have a bit of ADD and mild autism ... but all of my 'symptoms' can be alieviated by proper nutrition and calming environment. At least, they minimise immensely in these conditions ...

it may help to keep a diary as you say, to see patterns and times of triggers, etc.

I find chewing on licorice root is very satisfying, it is wood, very tasty and delicious, prevents cavities, nourishes the brain and eliviates stress. think this may help kids very much too as it is high in nutrients and they generally love it.

blessings

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on November 11, 2013:

I've known some and most were kids eating lead paint chips; we could stop then and have the paint removed from those houses through city block grants. This problem seems to be growing these days - especially with sponges.

Marcy Goodfleisch from Planet Earth on November 11, 2013:

I've know. Several people who had pica. It was sort of an unspoken observation I made, and was awkward to be around (yucky, too).

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on November 10, 2013:

@tillsontitan - Agreed; I also see it becoming worse, so its not our imaginations, I think - larger percentages of kids and adults seem to suffer form it. So many people tell me they eat the malamine sponges and furniture sponge material! I hope the substance is no longer in any of our food.

Mary Craig from New York on November 10, 2013:

Surprisingly I missed this hub a while ago. It seems to me this problem has become more noticeable and probably is on the rise in the last 20 to 30 years. It always existed but seems to be worse now.

Thanks for all the helpful information. It is certainly a distressing problem.

Voted up, useful, and interesting.

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on November 10, 2013:

UPDATE: After checking the recent studies, I find that melamine (sponges, etc.) is a non-food protein that has been illegally added to some foods in the past. Heavy ingestion of it can cause bladder cancer as an end result.

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on November 10, 2013:

Eating these light foam sponges reminds me of eating fast food - people eat and, not satisfied, conintue to eat more of it. I've added a video about sponge eating to this article.

I am hearing a lot about individuals eating these foam type materials and wonder if they contain some addictive substance. After you speak with your doctor about eating sponges, you might want to call one of the many addiction counselors that are available today. Best wishes!

Cassandra1993 on November 10, 2013:

Hi patty, I am 20 and suffer from pica I mainly eat sponge foam, I've eaten mattresses, couches, kitchen sponges, car washing sponges but my favourite at the moment is melamine sponge I just can't get enough of it. I buy 200 packs off eBay constantly. I stopped eating foam for about a year but I can't stop now. I are foam through out my whole pregnancy and my child came out perfectly fine. But now his eating solids I want to stop Incase he try's to copy mums behaviour

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on July 15, 2012:

Note about borax, in case you are told you have a deficiency by a friend -- From health agencies worldwide: Borax is a toxic substance and poses an unacceptable risk to human health when used in food.

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on June 19, 2012:

People used to chew paraffin wax before there was chewing gum - I think crayons are mostly wax and vegetable colors these days and safe in that way, but eating a lot of them can make a ball of wax in the intestines in some people. Lots of people chew on pencils, but eating a lot of wood is probably not safe. What does your doctor say of all this?

Vanessa Malefahlo on June 19, 2012:

I have a problem with crayons and pencils, I eat them all the time, and I'm afraid I will never stop eating them, I am 20 years old and this has been going on for years now. Nobody at home knows that I eat crayons. Its killing me and I hate that.

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on May 01, 2012:

If you are serious, please find a medical specialist that knows about your disorder. Try calling your local hospital or the state medical board for this information and a referral.

Linda on May 01, 2012:

M 30 yrs old bt i crave for my fingers & nails d problem is i dnt suk em i chew dem i used 2 eat pens bt nw its ma fingerz n its affecting my earz n i've been 2 doctors twice wit because of my ears help m how do i stop d cravings my fingers r so ugly dey hv marks becoz of d chewing bt i cnt stop d cravings plz help.

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on April 05, 2012:

Thank you for sharing your experience! I hope you are having good meals now.

Patty Lavine on April 05, 2012:

Patty it is truly an honour to know now that i am not a freak of nature, eating all this non-food products has been a blast, but it is now of the past.

thank you

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on March 19, 2012:

I hope the test reveals something that the medical staff can address easily. I first heard of pica in a college class in which we were discussing malnutrition in the inner city, but it doesn't seem that pica is about malnutrition. Best of luck to you and your family!

Carla Louise B from Bracknell on March 19, 2012:

My 16 month old is getting tested for pica she eats everything in sight! and has been down A and E many times as she has eaten loads of different objects! when we sow our consultant he said to ME he wanted to test her i didn't even know anything about it! they have taken a blood text for vitamin, calcium and zinc deficiency. im trying to find out more info on it

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on February 23, 2012:

Irish Spring surely smells good, though :)

Karen on February 23, 2012:

I've had a craving for ice for about a month now. I sat on an 8-hour flight to France and had to ask the flight attendant (multiple times) for a glass of ice because the craving was so bad but I just thought it was funny... until 3 days ago when I noticed how good my bar of Irish Spring smells. I just wanted to lick it!!! I decided not to and I fought the urge to lick my soap until my shower this morning. I couldn't take it anymore... I just had to taste it, so I did! Tonight, the craving is back and knowing that I have never had an addictive personality, I decided to Google "why do I have the urge to lick my bar of soap" and I came upon this blog! I have never heard of Pica before tonight but I sure am grateful that I decided to check up on why I have this weird craving... Now I can follow up with my doctor and take steps to "nip it at the bud"! Thanks for sharing!!

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on February 17, 2012:

I recently saw a broadcast with a physician that believes pica is an addictive behavior that can be erased by replacing the eating of non-food items with behaviors that are more positive. However, I don't know how he does this. I believe the who was on CNN and may be on that website.

concernedmommy84 from Linden, North Carolina on February 17, 2012:

my 8 year old pulls out her hair strand by strand and eats erasers,metal off the penicles,glue,crayons, but her favorite thing is paper. I have got her in counsling and work with her dr. very closly. She has been diagnoised with adhd/add,ocd, and pica since the age of 5 yearsold. We still have not figured out why she does it but we keep trying.

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on January 23, 2012:

I wonder if that speaks to hormone changes?

Grandma Laura on January 16, 2012:

I craved ice in my teens and early 20's. I was anemic too, but the underlying problem was Celiac Disease. Once I eliminated all wheat, rye, barley, and oats from my diet I no longer craved ice at all.

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on December 21, 2011:

kelleyward - I'd not heard of that one before, so thanks!

random - Many, many reasons. Each case may be different.

random reader... =D on December 21, 2011:

so one of the main reasons of pica is iron deficency..... Is there any other reasons?

kelleyward on December 21, 2011:

When I worked as a pediatric nurse I had patients who ate cotton. They often had anorexia which is included in the OCD type disorders. Very interesting hub.

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on December 21, 2011:

That is important and interesting news! - Thanks, Sez. Congratulations on your pregnancy!

Sez on December 21, 2011:

I'm 6.5 month pregnant and have eaten paper in the last couple of months. Funnily enough my recent blood test suggests that my iron count is very low so I have to take supplements. Thank goodness there is a cause! As it isn't that satisying!

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on December 20, 2011:

Yikes! - Thanks for that warning, PR!

P.R on December 20, 2011:

Important!!! just found out that injesting the burnt ends of matchsticks is very dangerous to your health. It is called cautopyreiophagia and leads to a condition called hyperkalaemia which can cause cardiac arrest.

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on December 19, 2011:

That's pretty bad! There are some lousy doctors out there and I have met some. I think I know 2-3 good ones.

I sometimes joke that I went into preventive medicine in order to prevent doctors :)

Ghost32 on December 19, 2011:

Got it. Understand that (the bad track record on unlicensed dentists). I avoided LICENSED dentists as much as possible, back in the day--can't imagine the challenge of facing an unlicensed one of those.

On the other other hand, there's the damage some of the licensed practitioners do. As a commercial insurance underwriter in the early 1970's, I handled (among other things) a book of business that included professional liability insurance for physicians. When a "really bad" doctor would become known to be in our region, we'd get notified--so we didn't stupidly and accidentally insure the guy (at that point, they were all guys).

The worst of the lot was a California surgeon who'd left the state on a high lope with 32 outstanding malpractice claims and/or lawsuits on his record.

He ended up in "my" territory for a while, too, actually practicing medicine in southwestern Montana. But--fortunately--none of our agents ever sent us an application for him, so that was good.

Patty Inglish MS (author) from USA and Asgardia, the First Space Nation on December 19, 2011:

Earthworms! hahahaha. Cute.

And well, I've helped prosecute some folks incorrectly diagnosing others without a license and causing big, big harm. In those cases, too bad it was just a misdemeanor here until the 4th time felony. I would have hanged them for the amount of damage they did - BUT doctors need to listen to patients about their opinions on diagnosis. Patients know themselves better than doctors do. That's not like diagnosing somebody else and they die as a result - An unlicensed dentist did that here in the 1970s and a woman died. At the dentist's office. Bad track record on dentists here.

Ghost32 on December 19, 2011:

Patty, I love your writing but disagree with your statement about OCD claiming, "only a licensed doctor (or) therapist can diagnose that".

It's a personal issue. Neither my wife nor I are licensed, but 98% of the time it's been one or both of us--NOT the licensed doctor or therapist--who has initially, correctly diagnosed her various and numerous ailments. The vast majority of the time, we've had to tell the licensed professional, "We believe THIS is Pam's (latest) problem; check it out please."

[Got a chip on my shoulder against paper proof of competence; can ya tell?]

That said, I'd never heard of pica (except as a typeface) until reading this Hub. Great info...and it triggered a memory.

My final go-round in college was at Montana State U. in Bozeman. In the married housing apartments, we all got along despite the population density...except for one couple across the street from us and down a bit in a nearby building.

In the dictionary under "jerk", it says, "See that guy."

One day a number of us in fine spring weather noticed their two-year-old (if he was that) out alone on the sidewalk...eating earthworms he was finding in cracks in the sidewalk. None of us intervened; the child was in no immediate danger, the father would have ranted at us for even going near the kid, and besides, to us (half a dozen or more observers) it was sweet if juvenile revenge.