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Eating Disorder, Pica: Treatment & Medication

Author: Cynthia R Ellis, MD, Director of Developmental Medicine, Associate Professor, Department of Pediatrics and Psychiatry, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center
Coauthor(s): Connie J Schnoes, MA, PhD, Psychologist, Director of Training, Supervising Practitioner, Father Flanagan's Boys' Home, Boys Town
Contributor Information and Disclosures

Updated: Jun 4, 2009

Treatment

Medical Care

  • Although pica in children often remits spontaneously, a multidisciplinary approach involving psychologists, social workers, and physicians is recommended for effective treatment.
  • Development of the treatment plan must take into account the symptoms of pica and contributory factors, as well as the management of possible complications of the disorder.
  • No medical treatment is specific in the treatment of patients with pica.

Consultations

  • Psychologist/psychiatrist
    • Careful analysis of the function of pica behavior in individuals is critical to effective treatment.
    • Currently, behavioral strategies have been most effective in treating pica.
    • Among the behavioral strategies that have been effective are antecedent manipulation; discrimination training between edible and nonedible items; self-protection devices that prohibit placement of objects in the mouth; sensory reinforcement; differential reinforcement of other or incompatible behaviors, such as screening (covering eyes briefly), contingent aversive oral taste (lemon), contingent aversive smell sensation (ammonia), contingent aversive physical sensation (water mist), and brief physical restraint; and overcorrection (correct the environment, or practice appropriate alternative responses).
  • Social worker
    • In toddlers and young children, pica behavior may provide environmental or sensory stimulation. Assistance in addressing these issues may prove beneficial, along with managing economic problems and/or deprivation and social isolation.
    • Assessment of cultural beliefs and traditions may reveal the need for education regarding the negative effects of pica.
    • Removal of toxic substances from the environment, particularly lead-based paint, is important.
  • Dentist: Attention to oral health is important in managing the detrimental effects pica may have on teeth beginning at a young age.5

Diet

  • Assessment of nutritional beliefs may be relevant in the treatment of some patients with pica.
  • Address any identified nutritional deficiencies; however, nutritional and dietary approaches have demonstrated success related to the prevention of pica in only a very limited number of patients.

Medication

Few studies have been performed using pharmacologic treatments for pica; however, the hypothesis that diminished dopaminergic neurotransmission is associated with pica suggests that drugs that enhance dopaminergic functioning may provide treatment alternatives in individuals with pica that is refractory to behavioral intervention.4 In addition, a single case report found that an antipsychotic with prominent dopaminergic, serotoninergic, adrenergic, and cholinergic effects described reduced pica behaviors.6 Medications used in the management of severe behavioral problems may have a positive impact on comorbid pica.

More on Eating Disorder, Pica

Overview: Eating Disorder, Pica
Differential Diagnoses & Workup: Eating Disorder, Pica
Treatment & Medication: Eating Disorder, Pica
Follow-up: Eating Disorder, Pica
References
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References

  1. Barker D. Tooth wear as a result of pica. Br Dent J. Sep 10 2005;199(5):271-3. [Medline].

  2. Johnson CD, Shynett B, Dosch R, Paulson R. An unusual case of tooth loss, abrasion, and erosion associated with a culturally accepted habit. Gen Dent. Sep-Oct 2007;55(5):445-8. [Medline].

  3. Young SL, Wilson MJ, Miller D, Hillier S. Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. PLoS ONE. Sep 5 2008;3(9):e3147. [Medline].

  4. Singh NN, Ellis CR, Crews WD, Singh YN. Does diminished dopaminergic neurotransmission increase pica?. J Child Adolesc Psychopharmacol. 1994;4:93-9.

  5. Dougall A, Fiske J. Access to special care dentistry, part 6. Special care dentistry services for young people. Br Dent J. Sep 13 2008;205(5):235-49. [Medline].

  6. Lerner AJ. Treatment of pica behavior with olanzapine. CNS Spectr. Jan 2008;13(1):19. [Medline].

  7. American Psychiatric Association. DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, Text Revision. American Psychiatric Press;2000:103-105.

  8. Binder BJ, Goodman SL, Henderson P. Pica: a critical review of diagnosis and treatment. In: The Eating Disorders. 1988:331-44.

  9. Ellis CR, Singh NN, Crews WD Jr. Pica. In: Singh NN, ed. Prevention and Treatment of Severe Behavior Problems: Models and Methods in Developmental Disabilities. Wadsworth Pub Co; 1997:253-69.

  10. Florin TA, Brent RL, Weitzman M. The need for vigilance: the persistence of lead poisoning in children. Pediatrics. Jun 2005;115(6):1767-8. [Medline].

  11. Lyons-Ruth K, Zeanah CH, Benoit D. Disorder and risk for disorder during infancy and toddlerhood. In: Mash EJ, Barkley RA, eds. Child Psychopathology. Guilford Press; 1996:457-91.

  12. McAdam DB, Sherman JA, Sheldon JB, Napolitano DA. Behavioral interventions to reduce the pica of persons with developmental disabilities. Behav Modif. Jan 2004;28(1):45-72. [Medline].

  13. Motta RW, Basile DM. Pica. In: Phelps L, ed. Health-Related Disorders in Children and Adolescents: A Guidebook for Understanding and Educating. American Psychological Association; 1998:524-7.

  14. Piazza CC, Fisher WW, Hanley GP, et al. Treatment of pica through multiple analyses of its reinforcing functions. J Appl Behav Anal. Summer 1998;31(2):165-89. [Medline].

  15. Van Zeeland AA, Simons JW. Linear dose--response relationships after prolonged expression times in V-79 Chinese hamster cells. Mutat Res. Apr 1976;35(1):129-37. [Medline].

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Further Reading

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Keywords

geophagia, eating clay, eating soil, eating dirt, pagophagia, eating ice, plumbophagia, eating lead, amylophagia, eating laundry starch, coprophagia, eating feces, cautopyreiophagia, eating burnt matches, eating burnt match heads, trichophagia, eating hair, lithophagia, eating stones, geomelophagia, eating raw potatoes, acuphagia, eating sharp objects, inappropriate eating, eating of nonnutritive substances, eating nonfood items, eating disorder, pica, GI tract complications, hyperkalemia, toxoplasmosis, toxocariasis, mechanical bowel problems, constipation, intestinal ulcerations, intestinal perforations, intestinal obstructions, mental retardation, autism, lead toxicity, lead encephalopathy, soil-borne parasitic infections, trichuriasis, bezoar formation, zinc deficiency syndromes, iron deficiency syndromes

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Contributor Information and Disclosures

Author

Cynthia R Ellis, MD, Director of Developmental Medicine, Associate Professor, Department of Pediatrics and Psychiatry, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center
Cynthia R Ellis, MD is a member of the following medical societies: Nebraska Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Connie J Schnoes, MA, PhD, Psychologist, Director of Training, Supervising Practitioner, Father Flanagan's Boys' Home, Boys Town
Disclosure: Nothing to disclose.

Medical Editor

Angelo P Giardino, MD, PhD, Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc
Angelo P Giardino, MD, PhD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, Helfer Society, and International Society for Prevention of Child Abuse and Neglect
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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