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Pica Syndrome

Persistent ingestion of non-nutritive non-food substances beyond developmentally appropriate age.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Psikiyatri department. Book Appointment →

What is Pica Syndrome?

Pica is the persistent eating of non-nutritive, non-food substances over a period of at least 1 month, that is inappropriate to developmental level and not part of culturally supported or socially normative practice. It is classified under feeding and eating disorders in DSM-5-TR. Common substances include earth/clay (geophagia), ice (pagophagia), starch (amylophagia), paper, hair (trichophagia), paint, soap, chalk, metal, and small objects.

Prevalence is highest in young children (10-30% of those aged 1-6), pregnant women (especially with iron deficiency), and individuals with intellectual disability or autism spectrum disorder. Pica may signal underlying iron, zinc, or other micronutrient deficiency, mental health conditions, or coping with stress and trauma. Cultural practices (e.g., kaolin clay during pregnancy in some regions) require careful contextualization.

Complications can be serious: lead poisoning from paint or contaminated soil, parasitic infections, gastrointestinal obstruction, perforation, dental damage, and electrolyte disturbances. Trichobezoars from hair ingestion can cause Rapunzel syndrome. Management combines nutritional repletion, behavioral therapy, treatment of co-occurring psychiatric conditions, environmental safety, and monitoring for complications.

Symptoms

Eating non-food substances persistently
Geophagia (earth, clay)
Pagophagia (ice)
Trichophagia (hair)
Amylophagia (raw starch)
Eating paper, paint chips, chalk, soap
Abdominal pain, vomiting, constipation
Iron deficiency anemia signs (fatigue, pallor)
Lead toxicity signs (developmental delay, irritability)
Dental damage and tooth wear
Bowel obstruction symptoms
Trichobezoar with abdominal mass
Parasitic infection symptoms
Behavioral concerns reported by family

Risk Factors

Iron, zinc, calcium deficiencies
Pregnancy with anemia
Intellectual disability or autism spectrum disorder
Mental health conditions (anxiety, OCD, schizophrenia)
Stress and trauma history
Family or cultural practice of geophagia
Low socioeconomic status, food insecurity
Young age and developmental immaturity
Sickle cell disease and pagophagia
Dialysis dependence (pagophagia)
History of eating disorders

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent eating of non-food items beyond age 2
  • Pregnancy with cravings for non-food
  • Symptoms of iron deficiency
  • Abdominal pain or constipation with pica
  • Suspected lead exposure
  • Behavioral or developmental concerns
  • Pica plus history of intellectual disability or autism
  • Visible weight loss or other eating disorder features
  • Bowel obstruction symptoms

Treatment Methods

01
Comprehensive history including substance, frequency, duration, triggers, cultural context
02
Mental health assessment for co-occurring conditions
03
Laboratory: CBC, ferritin, iron studies, zinc, lead level, electrolytes, calcium
04
Stool ova and parasites if relevant
05
Imaging if obstruction suspected
06
Repletion of iron and other deficiencies
07
Lead chelation if blood lead 45 mcg/dL or higher (succimer, calcium EDTA)
08
Behavioral interventions: differential reinforcement, response interruption, redirection
09
Functional analysis to identify reinforcers and replace with safe alternatives
10
Caregiver and parent training on environmental modification
11
Treat underlying psychiatric conditions (anxiety, OCD, autism behaviors)
12
Cognitive behavioral therapy for older children and adults
13
Family-based therapy in pediatric cases
14
Address food insecurity and nutritional counseling
15
Cultural sensitivity in counseling pregnant women with geophagia
16
Surgical intervention for bowel obstruction or trichobezoar
17
Dental evaluation and treatment
18
Multidisciplinary follow-up: pediatrics, psychiatry, nutrition, social work
19
Periodic monitoring of nutritional status and behavior
20
Discharge planning with safety in environment

Which Department to Visit?

You can visit our Psikiyatri department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.