Pica syndrome

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Classification according to ICD-10
F98 Other behavioral and emotional disorders that begin in childhood and adolescence
F98.3 Pica in childhood
F50 eating disorder
F50.8 Pica in adults
ICD-10 online (WHO version 2019)

As Pica or pica - to lat .: pica (Magpie) - is a rare eating disorder called, take in the human things to be commonly referred to as inedible or even nauseous be considered. The term picacism , which is also common , was previously used for unusual cravings in pregnant women . The term allotriophagy (from the Greek allotrios 'foreign' and phagein 'to eat') is a term for this syndrome.

In contrast to anorexia and bulimia, the pica syndrome is not a "quantitative" but a "qualitative" eating disorder.

Symptoms and ailments

Things are eaten that are not primarily for human consumption, such as earth, ashes, lime, clay, sand, stones, paper, paint snippets or parts of plants. The three most common substances are earth , starch (both cornstarch and laundry starch ) and (water) ice . Sometimes things are also consumed that are generally considered to be nauseating, such as excrement, dust, and garbage.

Diagnostic criteria

Salvaged stomach contents

The DSM-IV describes the pica with 307.52 as an eating disorder in which no food but other things are consumed and does not make any further classification, but requires the following criteria to be met:

  1. Substances with no nutritional value are consumed for at least a month;
  2. this does not correspond to an age-appropriate level of development ( psychological , spiritual);
  3. the eating behavior does not correspond to culture-related standard;
  4. The disorder is so serious that it requires special attention (i.e. also in the case of other, usually causal disorders that exist at the same time, such as: schizophrenia , cognitive disability , extreme neglect as a result of neglect and abuse in early childhood , etc.)

The disorder is sufficiently serious if the objects eaten lead to serious health impairments such as poisoning , injuries or mechanical impairments in the digestive tract - such as an ileus ( intestinal obstruction ) - or if malnutrition occurs.

It is not a pica if, for example, pointed or other objects are swallowed by prisoners solely for the purpose of forcing treatment and thus transfer from a penal institution (see also self-harm and suicide ).

Eating hair (a "trichophagia") is mainly observed in trichotillomania , which is counted among the disorders of impulse control . If trichotillomania fully explains the symptoms of eating behavior and the sufferer does not eat any other inedible items besides hair, then pica syndrome will not be additionally diagnosed. However, trichotillomania and pica share many similarities.


A neuropathological basis is suspected to be the cause of the pica syndrome. It relatively commonly affects mentally disabled people , schizophrenics , pregnant women and otherwise healthy children. People with dementia , autism , people with other mental illnesses and the neglected also suffer from this eating disorder more than the average.

In extreme cases, a deficiency can also lead to a pica, for example a pronounced iron deficiency or a mineral deficiency. The pica is therefore not a disease that is undoubtedly purely psychological, but can also have somatic causes.

As early as the 1980s, various psychosocial risk factors for the development of pica in children were identified. These include stressors such as parental separation, abuse (beating), and various forms of neglect.

Consequences and complications

Picacism can have serious consequences, for example constipation , digestive tract complaints ( ileus and other diseases) and poisoning from poisonous plants or plant parts . Even the consumption of relatively “harmless” things like earth , clay or ash can lead to infections . Long-lasting picacism is considered to be malnutrition and can lead to an iron and vitamin deficiency through malnutrition ( e.g. when eating earth by binding minerals ) ; this is particularly serious in pregnant women and children.


Surgical removal of objects

Surgical removal of swallowed objects may be necessary as this can damage the digestive tract. It is unclear how frequent such interventions are overall. A forensic report references a study by Decker (1993) that looked at a sample of people with developmental delay and pica. Three quarters of the pica episodes in this special group of people required surgery, 11% of those affected died as a result.

Behavior therapy

The behavioral therapy provides at Pica is an effective treatment option in general, and various behavioral methods can be used.

Pharmacological treatment

Successes with psychotropic drugs are based only on individual case studies ; there are no systematic studies. For example, a single case study reports the treatment of an adolescent autistic person with Pica syndrome using aripiprazole , an atypical antipsychotic. With appropriate treatment, pica often improves along with the psychotic symptoms in psychotic people. However, cases have also been reported in which pica only appeared or worsened after taking antipsychotics (here: risperidone and olanzapine ). Successes with selective serotonin reuptake inhibitors , ADHD drugs and baclofen are also based on individual case studies .

Other treatment and supervision

Other psychotherapeutic measures can also be considered. However, some of these require the person concerned to be able to reflect sufficiently. In some cases, dietary supplements such as iron supplements are indicated. Otherwise, appropriate supervision is necessary, and if your own life is at risk, accommodation is required.

See also


  • T. Knecht: Pica - a qualitative appetite disorder. (PDF; 86 kB) In: Schweiz Med Wochenschr. 1999; 129, pp. 1287-1292.
  • EP Lacey: Broadening the perspective of pica: literature review. In: Public Health Rep. 1990 Jan – Feb; 105 (1), pp. 29-35. Review. PMID 2106702

Individual evidence

  1. zeno.org
  2. ^ Sera L. Young: Craving Earth. Understanding pica. The urge to eat clay, starch, ice, and chalk . Columbia University Press, New York 2011, ISBN 978-0-231-51789-8 , pp. 5-13 .
  3. ^ A b Jon E. Grant, Brian L. Odlaug: Clinical Characteristics of Trichotillomania with Trichophagia . In: Comprehensive psychiatry . tape 49 , no. 6 , 2008, ISSN  0010-440X , p. 579-584 , doi : 10.1016 / j.comppsych.2008.05.002 , PMID 18970906 , PMC 2605948 (free full text).
  4. a b c Noel I. Dumaguing, Indra Singh, Mohammad Sethi, DP Devanand: Pica in the Geriatric Mentally Ill: Unrelenting and Potentially Fatal . In: Journal of Geriatric Psychiatry and Neurology . tape 16 , no. 3 , June 29, 2016, p. 189–191 , doi : 10.1177 / 0891988703256049 ( sagepub.com [accessed July 31, 2017]).
  5. ^ Rainer Tölle, Klaus Windgassen, Reinhart Lempp & Reinmar Du Bois: Psychiatry . 13th updated edition. Springer-Verlag, Berlin / Heidelberg 2003, ISBN 3-540-43444-5 , pp. 108 .
  6. Iron deficiency anemia, description of the symptoms ( memento of the original from May 14, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , Working Group of Scientific Medical Societies @1@ 2Template: Webachiv / IABot / www.awmf.org
  7. a b Sunit Singhi, Pratibha Singhi, Gul as Adwani: Role of Psychosocial stress in the Cause of Pica . In: Clinical Pediatrics . tape 20 , no. 12 , July 2, 2016, p. 783-785 , doi : 10.1177 / 000992288102001205 ( sagepub.com [accessed July 31, 2017]).
  8. ^ Roger W. Byard, A Review of the Forensic Implications of Pica . In: Journal of Forensic Sciences . tape 59 , no. 5 , September 1, 2014, ISSN  1556-4029 , p. 1413-1416 , doi : 10.1111 / 1556-4029.12520 ( wiley.com [accessed August 15, 2017]).
  9. a b c d Nichole R. Kelly, Lisa M. Shank, Jennifer L. Bakalar, Marian Tanofsky-Kraff: Pediatric Feeding and Eating Disorders: Current State of Diagnosis and Treatment . In: Current Psychiatry Reports . tape 16 , no. 5 , May 1, 2014, ISSN  1523-3812 , p. 446 , doi : 10.1007 / s11920-014-0446-z ( springer.com [accessed August 15, 2017]).
  10. Kenneth E. Bell, David M. Stein: Behavioral treatments for pica: A review of empirical studies . In: International Journal of Eating Disorders . tape 11 , no. 4 , May 1, 1992, ISSN  1098-108X , pp. 377-389 , doi : 10.1002 / 1098-108x (199205) 11: 4 <377 :: aid-eat2260110412> 3.0.co; 2-i ( wiley.com [accessed August 15, 2017]).
  11. Arzu Hergüner, Sabri Hergüner: Pica in an Adolescent with Autism Spectrum Disorder Responsive to Aripiprazole . In: Journal of Child and Adolescent Psychopharmacology . tape 26 , no. 1 , January 18, 2016, ISSN  1044-5463 , p. 80–81 , doi : 10.1089 / cap.2015.0184 ( liebertpub.com [accessed August 15, 2017]).
  12. SujitaKumar Kar, Rajesh Kumar, Abhilove Kamboj: Pica and psychosis - clinical attributes and correlations: A case report . In: Journal of Family Medicine and Primary Care . tape 4 , no. 1 , January 1, 2015, doi : 10.4103 / 2249-4863.152277 ( jfmpc.com [accessed August 15, 2017]).
  13. Nishtha Chawla, Deepak Charan, Saurabh Kumar, Raman Deep Pattanayak: Pica associated with initiation of atypical antipsychotic drugs: Report of two cases . In: Psychiatry and Clinical Neurosciences . tape 70 , no. 8 , August 1, 2016, ISSN  1440-1819 , p. 363-364 , doi : 10.1111 / pcn.12408 ( wiley.com [accessed August 15, 2017]).

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