Pica – This Disorder Must Not Be Overlooked

Pica is a psychological disorder characterized by the persistent ingestion of substances or objects that are not conventionally regarded as food and lack nutritional value, a behavior that is inconsistent with cultural norms and the individual’s developmental stage. For a formal diagnosis, symptoms must persist for at least one month, although episodes of consuming non-nutritive items need not occur with regular frequency. While the condition often follows a benign course, in severe cases it may pose an immediate threat to health or life—both due to the toxicity of ingested materials and the risk of mechanical injury to the gastrointestinal tract from sharp or abrasive objects. Prolonged engagement in such behavior can lead to significant nutritional deficiencies, and intriguingly, certain micronutrient or macronutrient deficiencies (such as iron or zinc deficiency) have been hypothesized as potential triggers or exacerbating factors for pica. Epidemiological research indicates that the disorder disproportionately affects individuals with lower cognitive functioning, including developing children, adolescents, and adults with intellectual disabilities. Despite its highly distinctive and conspicuous symptoms, pica remains one of the most underdiagnosed conditions. In the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), it is classified under feeding and eating disorders alongside anorexia nervosa and bulimia nervosa, whereas the International Classification of Diseases (ICD-10) does not recognize it as a discrete diagnostic entity. Estimating its prevalence is fraught with challenges due to the absence of standardized diagnostic criteria and a high rate of underreporting—many cases go unrecorded because patients or caregivers fail to disclose concerning behaviors, and clinicians frequently misattribute them to other underlying conditions. Assessing its frequency in children is particularly difficult, as experimenting with unconventional objects may be a normal part of exploratory development. As reported by R. Mishori et al. (2014), hospitalizations related to complications from ingesting non-food substances have surged by 93% in recent years, underscoring the growing public health significance of this phenomenon.