Pica disorder in children with autism spectrum disorder and other developmental disorders
introduction
Pica is defined in the Diagnostic and Statistical Manual of Developmental Disorders. Fifth edition (DSM-5) as:
- Continuous intake of non-food and non-nutritive substances over a period of not less than one month such as eating clay, pebbles, hair, paper, cloth, Or any other non-food item
- The intake of these substances is not appropriate for the individual’s developmental level
- Eating behavior is not part of a culturally or socially supported practice
- It may be present with other feeding and eating disorders
The name “pica” in abnormal eating disorder goes back to the Latin word “pica pica”. It refers to the behavior of birds in collecting and ingesting a variety of materials, The term “pica” has been used in medical literature and clinical description to refer to an abnormal appetite for non-food substances.
In the eighteenth century, The names of affected individuals have been used to describe cases of abnormal eating disorder, Such as “wax eaters”, “garbage eaters”, “chalk eaters” and “pebble eaters”.
It is important to note that these ancient designations reflect the general concept of abnormal appetite for non-food items at the time, It reflects the historical dimension of the use of the term “pica” in medical literature. However, More specific and precise definitions are used according to recent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Pica can be found in people of all ages and genders. However, It occurs most commonly in the following groups:
1-Young children: Pica disorder may be common in young children who are developing normally and outgrow this stage in development over time.
2- Children with special needs: Children diagnosed with autism spectrum disorder and other developmental disorders suffer from pica disorder.
3- Pregnant women: Some pregnant women may feel a strong desire to eat non-food items. This includes gravel or clay. It is believed that this strange feeling may be caused by a certain deficiency of vitamins or minerals in the body. In this case, it may be referred to as “pica gravidarum.”
4- People with psychological disorders or people who abuse narcotic substances: Both people with mental disorders or who abuse substances may have abnormal reactions to food and cravings for non-food items.
It should be noted that these groups are not an exhaustive list. Anyone can suffer from pica, regardless of age or gender. Pica should be evaluated and diagnosed by a mental health professional or doctor to determine the causes and factors associated with this disorder and develop an appropriate treatment plan.
If the behavior occurs in the context of another psychiatric disorder or medical condition (such as schizophrenia, autism spectrum disorder, or pregnancy), It warrants sufficient independent clinical attention, It is suggested that the minimum age for diagnosis is two years. Whereas children between the ages of 18 months and two years, Licking non-food items and putting them in the mouth is common and is not considered pathological. This disorder may be mild or the results may be negative.
Etiology
Doctors still don’t know the specific cause of pica disorder. But they were able to identify some factors that may increase the risk of diagnosis, It may include the following:
- Cultural or learned behaviors.
- Stress or anxiety.
- Adverse circumstances during childhood, such as poverty or neglect, Especially when one or both parents are absent for any reason.
- nutritional deficiency, People who show signs of pica disorder often suffer from mineral deficiencies. Such as iron, calcium and zinc deficiency.
- People with certain mental health disorders, Such as schizophrenia and obsessive-compulsive disorder.
- Having medical conditions, such as pregnancy and sickle cell anemia, It may be anemia, Which usually occurs due to iron deficiency, It is the underlying cause of pica disorder in pregnant women.
Health risks and complications associated with pica disorder
Pica disorder is considered a serious problem because it can lead to significant medical complications. It is determined by the nature and quantity of the substance ingested. Especially in the case of lead poisoning. Eating strange or unfamiliar substances, It may also lead to other poisonings that may threaten the individual’s life, Such as hyperpotassium concentration after eating burnt sulfur heads, Exposure to disease-causing agents through ingestion of contaminated materials poses a health risk.
Eating some non-food items can lead to serious conditions, May include:
- poisoning, like: Lead poisoning.
- Parasitic infections: Such as (toxocariasis and Ascaris worms).
- Occurrence of digestive system disorders such as: (Intestinal problems – constipation – ulcers – perforations – intestinal obstruction).
- Choking.
- Dental problems occur, including: (Severe tooth erosion, tooth loss, and cracked teeth).
How to diagnose
There is no specific test to diagnose binge eating disorder (pica). Therefore, the doctor will diagnose the condition based on the medical history and several other factors, You should be honest with your doctor about the non-food items you have eaten. This helps the doctor make an accurate diagnosis.
It may be difficult for your doctor to determine if you have pica unless you tell them what you have taken. This also applies to children or adults with autism and other developmental disorders.
The doctor may perform tests:
- Evaluate the possibility of anemia and low zinc or iron levels.
- stool samples, Which tests for gastrointestinal bleeding from damage resulting from the ingestion of non-food substances.
- Performing an X-ray or other imaging tests to evaluate bowel obstruction.
- measuring lead levels; To find out whether the patient has lead poisoning or not.
- Tests to check for parasites or bacteria caused by eating dirt or other items.
- Weight loss assessment.
- Nutritional deficiency testing.
treatment
Your doctor will likely begin by treating any complications you acquired from eating non-food items. For example:
If you suffer from severe lead poisoning from ingesting parts of wall paint, Your doctor may prescribe chelation therapy, which is the use of chelation agents to remove heavy metals from the body. In this procedure, You’ll get medicine that sticks to the lead. This will allow you to excrete lead in your urine.
This medicine can be taken orally, Or your doctor may prescribe intravenous medications for lead poisoning, Such as ethylenediaminetetraacetic acid (EDTA).
If your doctor finds that your intake of these substances is due to nutritional imbalances, He may prescribe vitamin or mineral supplements for you. For example, It will be recommended to take iron supplements regularly if you are diagnosed with iron deficiency anemia.
Your doctor may also order a psychological evaluation to determine if you have obsessive-compulsive disorder or another psychological condition. Depending on your diagnosis, They may prescribe medications, non-pharmacological interventions, or both.
If the person has pica disorder and has an intellectual disability or mental health condition, Medications to treat behavioral problems may help reduce or eliminate their desire to eat non-food items.
Pica disorder in pregnant women may disappear on its own. The same goes for children as well, especially when they are taught the difference between edible and inedible items and things.
As for children with intellectual disabilities (or those who suffer from other problems that interfere with learning), Elements that may cause problems must be removed from the environment, and they must be supervised. These are two very important things.
How can pica disorder be prevented?
Pica occurs unexpectedly; Therefore, there is no specific way to prevent the development of the disorder or reduce the risk of being diagnosed with it.
What can be done regarding pica disorder is to ensure that you eat a balanced diet and do not have any deficiencies in essential vitamins or minerals. However, this does not completely prevent or reduce the risk of being diagnosed with pica; Because nutritional deficiency is not counted toward the diagnosis of the disorder, However, this may be important in general.
the reviewer
A fatal outcome of pica: an unusual case of delayed asphyxia (bg.ac.rs)