Pica disorder refers to the ingestion of different substances that do not have any nutritional value to the body. Such elements include papers, dust, plastic, clay, stones, wood, fingernails, fecal matter, and pebbles among others. It is important that pica disorder could be gentle or may have serious consequences that may threaten the life of the affected individual. Research on the frequency of this eating disorder indicates that the most common people affected are children and individuals with developmental disabilities, for example, relating to the brain (Wolraish, 2008). Eating disorders are also common among women during pregnancy as most of them consume stones with the belief that they provide calcium to their unborn babies. More research on pica indicates that individuals who consume non-nutritional substances like pebbles are likely to have impairment in their physical functioning. However, there is evidence showing that pica does not have any detrimental impact on people’s social functioning, which is linked to comorbid disorders like intellectual disability, obsessive-compulsive disorder and autism spectrum disorder (Kasper et al., 2015). Consuming solid substances may also result in chronic medical complications. For example, relating to the obstruction of the digestive system. Intestinal obstruction is a chronic complication in the sense that, the affected individual may need to undergo surgery (MacFadyen, 2003).
Although much research has been conducted on pica disorder among children, not much has been done to study the disorder among women, especially during pregnancy (Lopez et al., 2004). The authors further argue that available research articles that have explored the practice have contradicted each other and do not present substantial evidence relating to its prevalence and possible causes. The main reason as to why pica practice remains understudied relates to the fact that it is seen merely as something not important enough to research further (Lopez et al., 2004). It would be reasonable to argue that there is a need for further research on the disease to identify the most vulnerable people and to determine effective preventive and treatment strategies to put into place. The following paper will explore the prevalence of pica disorder and identify some of the factors that have led to its increase, especially among women and children in the United States of America. The paper will also outline some of the effective and non-effective treatments for the disorder. Additionally, it will suggest some of the measures that should be put in place to prevent the further occurrence of the disorder. It will begin with a brief history of Pica behavior.
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History of the Pica Disorder
Geophagia (eating soil-like substrates) was first observed among slaves living in America during the 1800s (Brynie, 2011). Researchers of this time were concerned with the risks involved when one consumes solid substances like stones and clay (Brynie, 2011). Soranus of Ephesus, a Greek physician, described how the eating disorder was useful in alleviating symptoms and unpredictable appetite associated with pregnancy (Todman, 2008). The physician noted that most women began craving extraordinary items within the first two months of pregnancy and this habit, in most of them, continued for more than four months. He argued that the consumption of extraordinary substances has a likelihood of causing harm on the fetus as well as the pregnant woman’s stomach. Pica’s description associated with pregnancy was first documented and presented in 6th century AD by Aerius, the Royal Physician to Justinian I. Most Europeans adopted the pica behavior in the 18th century, following the realization that the Sultan of Turkey was consuming special clay obtained from ‘Lemnos’ island (Walker, 1997).
Global Prevalence of Pica
Research indicates that pica behavior exists in almost every country in the world but is more prevalent in the African nations (Roberts, Layde & Balon, 2013). The disparity in the definition of pica and patients’ reluctance of admitting to ingest extraordinary substances has hindered the establishment of its prevalence not only in the United States but also elsewhere around the world (Tharpe, Farley & Jordan, 2017).
One important thing to note is that the prevalence of pica internationally varies from one region to the other depending on the population being investigated. For example, Halsted (1968) summarized various research studies on pica practice and found out that the prevalence of the disorder was 40% among the low income-earning African women whereas the prevalence was much lower among the white women. In another study conducted by Walker et al. (1997), the prevalence of pica practice among the Indian pregnant women was approximately 2.2% and that of the Caucasian pregnant women was about 1.6%. This is a clear indication the Indians are more likely to develop pica behavior than Caucasians. A high prevalence of geophagia has also been reported in studies conducted in various nations in the African continent. In one study by Walker et al. (1985), for example, the prevalence of pica among pregnant women in the urban areas of South Africa was approximately 38.3%, and the prevalence of those living in the rural areas was 44%.
Prevalence of Pica in the United States of America
The evidence that exists relating to the prevalence of pica in the US shows that the disorder is most common among children, women, and people with mental disabilities (Wolraish, 2008). Lacey (1990), for instance, carried out a study which involved 128 antenatal women living in Greenville, South California and reported about 38% prevalence of pica behavior among the study population. His study further confirmed that pica behavior was most prevalent among the African-American women. In the case of children, available data shows that pica behavior is rare among the healthy children aged two years and below. However, the prevalence of the behavior is high among Detroit children undergoing sickle cell anemia treatment (Hartmann et al. 2012).
Although pica eating in America is prevalent, there is a lack of sufficient information on the prevalence of the eating disorder among the children and women population (Hartmann et al. 2012). Insufficient information on pica practice in the US can be attributed to the lack of enough studies investigating the issue and the reluctance of people admitting to having the disorder. It is this lack of lack of information that hinders government’s efforts in providing enough resources for addressing the issue. Therefore, having clear data on the children and women with pica eating would be useful in determining the most appropriate intervention measures for the same.
Reasons why Pica is or is not developed
This section will discuss some of the factors that contribute to the development of pica disorder in the US and elsewhere around the world. They include pregnancy, mental retardation, and iron deficiency. From the evidence presented by the various research studies described above, it is clear that some people are more likely to develop pica eating than others. For instance, pregnant women are more likely to develop the eating disorder than women who are not pregnant. The positive correlation between mental retardation and pica eating implies that people with mental disabilities are more likely to develop the practice than individual without mental related illnesses. The fact that mental retardation and any other brain disorder causes pica disorder lies on the premise that people with developmental disabilities have difficulties in distinguishing food items and would, therefore, consume non-food items whenever they feel hungry (Mahan et al. 2012). Knowing the information of the people who are more likely to develop pica eating is important because it would help develop programs to address their needs accordingly.
Other than pregnancy and mental retardation, people may develop pica behavior due to iron deficiency (Fogel & Woods, 2008). Anemia is a medical condition that occurs when the human blood has lower levels of red blood cells (Burket et al. 2008). Lack of consuming iron-rich foods like eggs, meat, and green leafy vegetables, causes iron deficiency anemia (Burket et al. 2008). Iron is one of an essential mineral for the growth and development of the fetus. Pregnant women, thus, consume extraordinary substances with the belief that they provide iron mineral (Fogel & Woods, 2008).
It is important to note that the first trimester of pregnancy causes nausea and dizziness in most women. The dizziness experienced during pregnancy occurs as a result of hormonal increase that causes the relaxation and widening of the blood vessels thereby increasing the flow of blood from the mother to the fetus. This action, however, reduces the rate at which blood returns to the mother’s veins. Blood pressure lowers, and flow of blood to the brain decreases, hence causing dizziness. Therefore, due to the influence of culture and tradition, most pregnant women consume such substances as stones, clay, and pebbles with the belief that they help relieve dizziness, nausea, and headaches (Fogel & Woods, 2008). As part of cultural influence, most pregnant women consume extraordinary items like freezer frost as they believe that it helps in relieving stress (Fogel & Woods, 2008). Other women consume clay with the belief that it would clean the intestinal tract of the fetus (Marc, 2005). The argument raised from this section is that pregnant women, mentally ill and people with iron deficiency are likely to develop pica behavior than people without such conditions. However, this is not to mean that normal people may not develop pica eating.
Effective and Non-effective Treatment Approaches for Pica Eating
One important thing to note is that the treatment of pica varies by patient and depends on its causes (Edwards et al. 1994) This implies that treatment measures used, for example, in children are different from those used on pregnant women or developmentally disabled people. One treatment method that seems to be effective in addressing the issue of pica behavior among the various populations in the United States is the supplementation of iron supplements. Supplementing with iron-rich vitamins helps in subsidizing the unusual cravings of eating extraordinary items like rocks and papers (Rose et al. 2000). The treatment of pica with zinc supplements has also proven to be effective (Young, 2012).
More successful treatment approaches than medication include family guidance, education, and nutritional management. Another successful treatment approach is the mild aversion therapy whereby the patient learns to distinguish between good and bad food through positive reinforcement (McAdam & Sherman, 2004). One treatment approach that seems not to be effective is treatment through counseling. The reason as to why counseling seems to be ineffective relates to the fact that most people deny having pica disorder and, therefore, ignore any advice given to them by their physicians (Dovey, 2010).
Eliminating Pica Behavior
First and foremost, it is important to acknowledge the fact that pica behavior has serious consequences to the individuals affected. Consumption of non-food items by a pregnant woman, for instance, can cause serious medical complications not only to the mother but also to the fetus (Hartmann et al. 2012). Other infections to the mother may include dental injury, nutritional deprivation, constipation, inherent toxicity and obesity due to excessive intake of calories (Edwards et al. 1994). Dental injury and constipation could occur as a result of consumption of non-food items like rocks. Inherent toxicity occurs as a result of consumption of items containing heavy metals like lead (Hartmann et al. 2012).
Pica behavior has become a serious health problem in the United States given that the number of hospital visits by patients with pica eating has increased (Brynie, 2011). As such, there is a need to address the issue to prevent the occurrence of serious medical complications especially among children and pregnant women in the country. Institutions that should play a part in the elimination of pica behavior and its consequences include health care facilities, schools, and the government. In the health care facilities, for instance, physicians should carry out a thorough physical examination on any patient suspected to have pica behavior. This would be important in determining the most appropriate treatment approach to be administered. When dealing with pregnant women, physicians should interview them to identify whether or not they have any pica behavior or dietary habits. This way, the physician will be in a better position to diagnose the patient if she has pica behavior.
Learning institutions have a significant role to play in the elimination of pica behavior in the United States. Schools should formulate educational programs to enlighten children and young teens on the dangers of eating non-food items. Educators should also encourage parents to monitor their children at home to ensure that they do not consume extraordinary substances that would cause medical complications. Children suspected to have pica behavior should seek medical assistance promptly.
One way in which the government can take part in eliminating pica behavior in the country is by encouraging schools to develop educational programs that would be useful in creating awareness of the disorder. It should also provide resources to established school-based health care facilities and support the educational programs developed by public schools. In the case of pregnant women, the government should also encourage health care facilities in the public and private sector to develop programs for training the staff on how to deal with women suspected to have pica behavior. This strategy would be instrumental in reducing mortality rates relating to ingestion of chemicals and heavy metals during pregnancy. Finally, the Ministry of Health should gather sufficient data on the prevalence of pica among different populations in the country to determine which treatment and preventive strategies will be implemented to address the problem.
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