Symptoms and Treatment of Pica

What it means when pregnancy cravings get out of control. When cravings during pregnancy escalate beyond ice cream and pickles to things such as chalk or clay, pica may be to blame.

Nearly everyone has heard of the strange food cravings and aversions pregnant women experience—including the proverbial ice cream and pickles. But many people are unfamiliar with pica, a disorder in which pregnant women feel the insatiable urge to eat much more extraordinary—and sometimes dangerous—nonfood items, such as clay, chalk, or even cigarette butts.

What Is Pica?

The word pica is derived from the Latin for magpie—a bird known for its curious eating habits. The Diagnostic and Statistical Manual of Mental Disorders defines pica as, “The persistent eating of non-nutritive substances for a period of at least one month, without any association with an aversion to food.”

Pica in humans has many different subgroups, explains Stefanie B. N. Dugan, MS, in a paper published in the Gale Encyclopedia of Medicine. Each of these subgroups are defined by the substance ingested. Some of the most commonly described types of pica are eating earth, soil, or clay (geophagia); ice (pagophagia); and starch (amylophagia). However, dozens of other substances, including cigarette butts and ashes, hair, paint chips, and paper have also been reported.

Kristina M. Donatelli, RD, LDN, a registered dietitian in Bethlehem, Pennsylvania, agrees. She says that the most common items consumed by patients with pica are clay and corn starch, but she goes on to list other common items often consumed: balloons, baby powder, baking soda, chalk, cloth, coffee grounds, crayons, detergents, grass, insects, newspaper, pencils, soap, string, and toilet tissue, to name but a few.

Who Experiences Pica and Why?

Although pica occurs in women all over the world, in countries such as Australia, South Africa, and Jamaica women have been experiencing it in greater numbers than previously thought by health care providers. Unfortunately the prevalence of pica in the United States is relatively unknown because not only is the disorder frequently unrecognized, but often women won’t report these strange cravings due to embarrassment and fear of ridicule.

Karen Sugden’s uncontrollable urge to eat dry sponges started when she was three months pregnant with her son Trevor. “We were visiting friends, and I went into the bathroom and spotted a sponge on the bath. I couldn’t help picking it up and taking a bite out of it—to me it was like an Aero chocolate. I would rub my tongue over the piece in my mouth and feel all the holes, which were like bubbles. From then on wherever I was I couldn’t help myself if there were sponges nearby.”

Donatelli says there are many theories as to why pica exists. Major theories include eating nonfood items to satisfy a psychological need (such as a response to stress or an oral fixation); cultural influence or traditions that have been passed on for religious, medicinal, or magical reasons; sensory relief to help with nausea, hunger, or to appease the appetite when food is scarce; nutritional needs when the body isn’t taking in adequate nutrients, such as iron (which pica items are believed to contain); or for microbiological purposes (the belief that clay, for instance, may promote a favorable pH for good microflora in the body).

Dugan suggests that one widely held theory points to iron deficiency as a major cause of pica. Several reports describe pica in individuals with documented iron deficiency, although it is uncertain in these cases whether iron deficiency was a cause of pica or a result of it. However, in Sugden’s situation this theory wasn’t true—there was no rhyme or reason for the addiction, and even her OB-GYN couldn’t understand her craving. In fact, her doctor had never heard of this obsession, and his only advice was not to swallow the pieces. Sugden took his counsel, “I would spit it out when it eventually got soggy” and then start all over again. The craving lasted right through her pregnancy and, surprisingly continued after her son was born. Sugden suffered a brief bout of “baby blues” and found that the sponges comforted her. Once she was over the baby blues, her addiction abated and has not returned.

Complications of Pica

“Because the eating behaviors of pica are not usually detected or reported,” Dougan says, “it is the complications of the behavior that bring it to attention. Complications vary, depending on the type of pica. Geophagia has the potential side effects that most commonly affect the intestine and bowel. Complications can include constipation, cramping, pain, contamination, and infection from soil-dwelling parasites.”

Dougan also explains that with amylophagia, ingestion of corn or laundry starch—with its high calorific content—can cause excessive weight gain and also lead to malnutrition (starch is filled with “empty” calories lacking in vitamins and minerals).

“Ingestion of other substances such as lead-based paint or paper containing mercury can cause symptoms of toxic poisoning, and compulsive consumption of even seemingly harmless substances like ice (pagophagia) can have negative side effects including decreased absorption of nutrients by the gut,” she adds.

Treating Pica

According to Donatelli, “If pica is confirmed, medical care and treatment must begin immediately. A multi-disciplinary approach is the best course of action and must involve a psychologist, registered dietitians, physicians, and possibly even social workers.” She continues, “There is no specific treatment, or preventative measure for pica, but one must take into account the specific symptoms … and address any nutrient deficiencies and toxicities immediately.”

If you find yourself moved to eat unusual nonfood items, be sure to tell your physician. Pica is becoming more and more well-known in medical circles, and chances are your OB-GYN can help you either find ways to curb your cravings or deal with them safely.

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