Common sense leads us to consider a typical phase of child development that in which children tend to put anything (objects, materials, foods) in the mouth. We must not forget that our development, including the cognitive one, starts from the body. The mouth and orality therefore become a sensory highway through which to know and learn.
However, there are particular conditions in which the behavior to insecse non -edible substances Does it represent a divergence compared to the normal trajectory of child development?
We will try to shed light on picacism (also defined as Allatrioophagia or Pica), a rare disorder of eating behavior. The prevalence is in fact not known, although it seems more widespread among the pregnant women he is children In the population bands with low socio -economic level (Rose et al., 2000).
We will explain what Pica syndrome is, we will describe its causes and deepen the relationship with autistic spectrum disorders and other eating disorders, and we will consider possible treatments.
Picacism: meaning and differences with other DCAs
Picacism has its etymology in Latin. In fact, the term “pica” indicates the Jazza Ladraknown for his tendency to steal and swallow anything understood within the reach of Becco (Iorio et al., 2014).
La Pica is a food disorder characterized by:
“Non-episodic ingestion, for a sufficiently long period (at least a month) of non-edible substances (fabric, sand, land etc.), which appears in age in which the typical behavior of the very small child should have disappeared, which tends to bring everything to the mouth” (Fagiani, 2009, pp.122-123).
The DSM-5-TR (APA, 2023) In addition to these two criteria, it specifies that the behavior of ingestion must not be part of a socially regulated ritual practice or culturally sanctioned And, in the presence of other mental disorder or other medical condition, it must have such a gravity as to justify specific clinical attention.
Differential diagnosis may concern:
- Anorexia Nervosa: the ingestion of non -nutritional substances (such as paper tissues) can be implemented to reduce appetite. In this case the diagnosis of anorexia nervosa should be formulated
- Fitty disorder: in this case objects can be ingested to cause physical symptoms within falsification patterns
- Personality disorders: there may be self -elevation -free self -intentions that provide for the ingestion of objects.
Picacism can present itself in comoribility with:
- Autistic spectrum disorder
- intellectual disability
- schizophrenia
- tricotillomania and bruising disorder: in this case hair and skin are torn and then ingested
- obsessive compulsive disorder.
Picacism and rumination disorder
The pica stands out from another DCA known as rumination disorder. In this condition, there is a repeated regurgitation of food (for at least a month) not attributable to specific medical condition or the course of anorexia, bulimia, binge eating, avoidant-rescuing eating disorder. The regurgitated food can have remained, ingested again or spit.
Picacism: psychological and medical causes
Picacism can have various causes, both medical and psychological.
For example, Picacism and anemia they often go hand in hand. In several studies it has been demonstrated how the care of anemia allows to reduce and resolve behavioral manifestations related to the ingestion of non -food substances (Johnson et al, 1982; Shapiro et al., 1985).
Among the Psychological causes Of the Pica, on the other hand, we find psychosocial stress, trauma and deprivation.
In some cultural contexts, the ingestion of land or other substances is part of socially regulated rituals and practices. For example, among the Australian Aborigines, clay ingestion is used to encourage fertility and protect pregnancy (Iorio et al., 2014). In these cases it is not possible to diagnose the disorder.
The symptoms of picacism
The fundamental feature of this eating behavior disorder is the persistent ingestion of non -food substances in an inappropriate period compared to the development stage.
The DSM-5-TR establishes a minimum of 2 years as a watershed age to distinguish between the disorder and the physiological gesture of bringing any object to the mouth typical of children.
But What to eat who suffers from pica? Ingredit non -edible objects can vary according to age and include:
- paper
- soap
- fabric
- hair
- plaster
- paint
- metal
- eraser.
The subjects they do not present aversion to food And often they come to medical attention for intestinal obstructions or poisoning related to ingested substances. The debut, although more frequent in childhood, can also occur in adolescent or adult age.
Picacism and Autism
Among the neurodirangences that present comorbidity with picacism we find autism spectrum disorders and the ADHD. In fact, the ingestion of non -nutritional substances is among the problem behaviors that are found both in intellectual disability and in neurodiversity such as autism (Iasa & Cramerootti, 2003).
A study demonstrates the presence of Pica disorder in 23.2% of the 1426 subjects with autism of the sample (Fields et al., 2021). The prevalence of this disorder in the sample of 1578 subjects, assumed as control of the general population, is 3.5%.
The consequences of the allelotrioophagy
The ingestion of non -food substances can lead to serious consequences on health of the subjects presenting the disorder.
These people can meet:
- poisoning
- intestinal occlusions
- parasitic infection
- teeth damage
- death, in the most serious cases.
From a psychological point of view, depression and anxiety may be present in subjects with picacism.
The diagnosis of picacism
In some cases the diagnosis of the pica takes place with instrumental exams. Radiographies and ultrasounds can highlight the intestinal occlusions caused by ingested substances. Blood tests can, on the other hand, bring out the presence of poisoning.
A careful screening should be performed in cases of intellectual disability and neurodiversity connected to autistic spectrum disorder, since the Pica disorder can be frequently present in comorbidity.
In the case of children under the age of 24 months, it is complex to make a diagnosis, given the frequency of the behavior to bring objects to the mouth. Subsequently it can be useful to contact a specialist in the event that behaviors related to the ingestion of land, sand, paper or other materials are observed during the game.
Management and treatment of the Pica
How to treat picacism?
Cognitive behavioral therapy can be useful in transforming schemes of thought and action connected to dysfunctional food conduct and in the management of symptoms.
There drug therapywhich must be rigorously prescribed and supervised by a doctor, may provide for the use of antidepressants and anxiolytics. Furthermore, in the event that the deficiency of iron or zinc is present, the prescription of suitable supplements can be useful.
Dietists and nutritionists can intervene in promoting a different approach to food by promoting the adequate contribution of the mineral substances that can be lacking.
There primary prevention With the identification of subjects at risk and the secondary one with the limitation of access to the substances sought for ingestion are an integral part of the treatment.
In all these phases, the psychological support by a professional, even online, can guarantee support, psychoeducation and adequate understanding of the discomfort deriving from the behavior problem on the subject or in the family system.
