March 10, 2025 • 21 mins
LicensureExams.com
Dive into the fascinating world of Pica with us as we unravel this often-misunderstood condition characterized by the persistent eating of non-food items. Named after the magpie bird known for its indiscriminate eating habits, Pica affects people across all age groups and presents unique challenges for clinicians and families alike.
We break down the multiple theoretical foundations attempting to explain this behavior – from nutritional deficiencies and sensory-seeking to stress responses and learned behaviors. You'll discover why people with anemia or sickle cell disease are more than twice as likely to develop Pica, and why an astonishing 30% of pregnant women worldwide experience these unusual cravings during pregnancy.
The diagnostic criteria reveal surprising insights - children under two can't be diagnosed with Pica because putting objects in their mouths is developmentally normal. We explore how clinicians must carefully distinguish between cultural practices and pathological behavior, sharing examples like Guatemalan clay tablets embossed with religious imagery consumed for perceived health benefits. From dirt and paint chips to ice and pencil erasers, the variety of non-food items consumed reveals patterns that help unlock effective treatments.
Whether you're a clinician preparing for licensing exams or simply curious about this compelling disorder, our evidence-based discussion of behavioral interventions offers practical approaches for addressing Pica. We examine differential reinforcement techniques, response interruption, and nutritional supplementation while emphasizing the importance of comprehensive assessment that considers psychological, medical, and cultural factors. Join us for this enlightening exploration that challenges assumptions and deepens understanding of human behavior at its most puzzling.
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This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Linton (00:12):
Hey there, eric, and hey to everyone out there.
Today we're going to go throughtheory to therapy podcast, and
we had a therapist that emailedus who had never worked with
children before.
She ran across a diagnosis thatshe wasn't familiar with,
called PICA.
Eric (00:32):
Right and you pronounced it correctly, because sometimes
people think it should be PICA.
I don't know why, but it ispronounced PICA.
Linton (00:42):
You know, when I first heard it, the first thing I
thought about was a typeface, asa matter of fact they come from
the same derivation.
Eric (00:51):
Pica is the eating disorder, yeah, and it's
characterized by persistentcraving or actually eating
non-food items, and in the DSMit has to be for more than a
month.
Is that only for kids, oreverybody?
Or everybody, as a matter offact, except for under two,
(01:12):
which we'll talk about in alittle while.
But pica comes from the latinword for magpie come on, I know
magpie and the pie it meansspotted.
So pica for magpie is from thebird, because apparently magpies
eat anything.
Linton (01:30):
Well, let's talk a little bit about the theoretical
foundations.
Okay, yes, there's severaltheories that attempt to explain
pica behavior, and whenever youhear anyone say that there are
several theories, basically whatthey're saying is that they
don't know right exactly so whenit?
One of the theories they cameup with was it was a nutritional
(01:54):
theory.
It's like, okay, people thathave pica must have some kind of
vitamin or some kind ofdeficiencies.
Right, you dogs are like that.
They're missing something intheir diet.
Eric (02:06):
They'll go out and eat grass, eat grass or chew bark or
whatever yeah.
Linton (02:12):
And they did find out that people that do have pica,
there's like really two and ahalf times or odds that they are
anemic or they have low zinclevels.
So that was an idea of thereason people do pica is of
nutritional lack.
Eric (02:31):
Well, and there's also the physiological theory, which is
that they just need that texture, taste or smell like eating
pencils, which I think you wereright that they're reaching for
it.
Linton (02:44):
Okay.
I mean there's a little elementof truth in all of them.
There's a psychosocial theorythat attributes pica to stress,
and it's basically a way of anindividual dealing with whatever
anxiety or stress that they'rehaving as a coping mechanism
that alleviates their emotionaldistress.
Eric (03:06):
Well, and that sounds like the psychodynamic perspective,
which is all about theunderlying emotional content,
that I have unmet emotionalneeds, so I'm eating paint chips
.
Linton (03:19):
Okay, and then there's the behavioral perspective, that
it's suggested that pica is alearned behavior.
So if your mother used to eatdirt, chances are you may have
picked that up from her or fromyour peer group.
So, basically, if a childreceives attention after they
(03:39):
ate dirt or whatever thatbehavior may be, reinforced.
Eric (03:44):
You talk to little Jimmy now and he's like oh, I got
talked to, normally I'm ignored,so now hand me the dirt, okay,
okay.
And finally, the cognitivetheory that they just have a
distorted thinking pattern.
They have, you know, they thinkdirt's good and somehow they
got into that cognitive deficitand they just need to be taught
(04:04):
not to eat dirt, so you know itis in the dsm-5tr absolutely
isn't there yes, and there arecertain diagnostic criteria and
probably the most significant isthat the ingestion of
non-nutritive substances for atleast one month.
(04:24):
Right, the month is the biggestone, so you just eat some paste
today.
Linton (04:29):
And the second one is the behavior must be
developmentally inappropriate.
Right, those were two of themain takeaways that you need to
remember when you're going totake your licensing exam.
Eric (04:44):
Well, and especially the developmentally inappropriate.
Because what do babies do?
Everything goes in their mouth,right?
So babies don't have pica,they're eating the same thing.
If you ate the same thing ababy did, then it's a problem.
But you know, babies stick apaint chip in their mouth.
Linton (05:02):
A paint your house, but B it's not developmentally
inappropriate well, I'msurprised you didn't do that at
the house that you lived in whenyou were growing up.
Who's who said I didn't?
Because there was nothing butlead paint, as I remember right.
Eric (05:19):
Well, it's true, and I think some of my friends have
suggested that that's why I'mnot as smart as I might be.
So you never know.
And the other part of thatdevelopmentally appropriate, is
also that it's not a culturalthing, that it can't have
cultural significance.
So that you lived out in thejungle and the doctor there said
(05:41):
oh, you should eat this barkfor your whatever problem.
You have To westernize.
That looks like pica, you'reeating tree bark, whereas it was
actually part of your culture.
So you have to be culturallysensitive.
Linton (05:56):
As you're looking at the criteria, so, instead of eating
the tree bark, what we do is wetake it, we grind it up, put it
in a pill and call it aspirin,right Well?
Eric (06:08):
yeah, exactly so.
Right, you eat it as a pill,it's all fine, and it could be
the same tree bark, but you putit in a gel cap and now it's
medicine.
It's true, yes, and so we didthe non-nutritive four-month.
You have to be developmentallyappropriate in your thing, which
(06:30):
meant nobody under two yearsold has pica, because you know,
you just can't tell.
And it has to be severe enoughto warrant clinical attention.
Linton (06:40):
Okay, so it's called.
You know it's basically eatingthe earth, so what's that called
?
Don't they have a term for that?
That's right.
Geophagia, geophagia, okay,geophagia.
That'd be something to rememberfor the exam too, wouldn't it?
Eric (06:55):
yes, probably so, because that is, you know, a cultural
thing in many places.
As it turns out, if you haveever had an upset stomach and
you've had kaopectate, it's amedicine you can get at your
local drugstore, right Well, kaorefers to kaolin, a kind of
clay.
So we ourselves are eating clay, only got to pay 10 bucks a
(07:19):
bottle for it.
Linton (07:20):
Really?
Yeah, well, there's certainmental health conditions.
Children with autism exhibitnutritional challenges,
including pica.
Schizophrenia, pica sometimesyeah, it's sometimes presented
as an impulsive consumption ofnon-food items, which are
associated with delusions.
Right?
Eric (07:41):
Obsessive compulsive disorder oh, I thought it was a
turkey and I ate this dirtbecause I okay, that makes sense
.
Obsessive compulsive disorderoh, I thought it was a turkey
and I ate this dirt because Iokay that that makes sense.
Linton (07:47):
Obsessive compulsive disorder.
Compulsive eating of non-fooditems to relieve stress is a
form of pica and you can seethat with OCD Individuals with
some kind of intellectualdisability.
It occurs with mental healthdisorders associated with
impaired functioningPost-traumatic stress.
(08:08):
There's a strong correlationbetween pica and PTSD.
Eric (08:14):
Really, yeah, okay now.
Now see, the schizophrenia madesense to me, but not so much
the ptsd okay I guess we'll haveto look into that.
Linton (08:23):
Other conditions, more medical conditions anemia pica
is associated with anemia anddeficiencies of iron, zinc and
other nutrients okay, that goesback to what you said earlier.
Eric (08:35):
That makes sense about the body knowing what it needs.
Linton (08:39):
Another one if an individual in the case study,
they say they have sickle cell,what's it called Sickle cell?
Eric (08:47):
disease, sickle cell disease, or it used to be sickle
cell anemia, but now they justcall it sickle cell disease.
Linton (08:52):
So it's really prevalent in individuals that have sickle
cell disease.
Like 34% of those people, manytimes will exhibit or
demonstrate PICA behaviors.
Eric (09:04):
Right, because they have iron deficiency and they need
the iron.
Linton (09:08):
Okay, that goes back to the nutritional theory.
Yeah, absolutely.
Eric (09:13):
And the last one is pregnancy so we all know about
them having cravings.
That's certainly true uh-huh.
Linton (09:19):
So pica is common in pregnant women, with worldwide
prevalence of about 30 percentduring pregnancy.
Eric (09:26):
Wow, so not just ice cream ?
Linton (09:29):
no, I, I knew someone.
I knew a pregnant woman who didthat all the time Really, and,
yeah, I had to keep her fromeating cat food.
You have any idea who that was?
Eric (09:40):
Ez, I have no idea.
You know a cat food eating.
Does she eat cat food now?
No, she doesn't, but she wasyour sister Really, and she ate
cat food?
Yeah, I had to keep her awayfrom that she snuck in the
little friskies and you had tokeep it away from her.
I did, I did.
Wow, if I'd known I'd havesnuck her some cans myself.
(10:05):
I didn't know you were, youknow, keeping it from her.
The common substances dirt, clay, sand stones, hair feces, vinyl
gloves.
I can't imagine vinyl gloves,plastic pencil erasers, which I
chewed on my pencil eraser inclass.
So there you go ice paper,paint chip and cat food.
(10:28):
I guess when you look atchildren over two that have pica
, that gives insights into thenormal and abnormal development
pattern.
So they actually study pica asa way of looking at normal as
opposed to abnormal developmentpatterns.
And of course they look at picato see if they can't stop lead
(10:52):
poisoning, because it is truethat lead, the metal lead, is
sweet, is it?
Yeah, that's why the Romansliked to drink wine out of lead
cups, because it actually madethe wine sweeter and they didn't
know they were poisoningthemselves back then.
Linton (11:09):
Yeah, well, let's say that you have a client that does
have pica.
All right, so let's look atsome behavioral interventions.
Differential reinforcement howmany of you out there know what
that is?
Eric (11:22):
Yes, I didn't see anyone raise their hand.
Linton (11:24):
Okay, Let me give you an example.
If a child tried to eat yourcarpet, you're in session.
They're trying to eat yourcarpet.
So instead of doing that, youwould provide them with some
kind of chewy toy yeah, the samekind that you gave to your dogs
and before they started to chewyour rug up, you would give
them the chewy toy.
And then you would praise themand say, oh, that's great job
(11:48):
that you're chewing on thechewing toy instead of the
carpet.
So if they attempt to do itagain to eat the carpet or your
desk, you block their access andredirect them to the toy, while
minimizing any attention thatyou might have for that
inappropriate behavior.
Eric (12:06):
You can't give them the attention right.
Linton (12:08):
Yeah, otherwise it just reinforces them eating your
carpet, sure.
Eric (12:12):
Right yeah, which is always a problem with that.
They do an inappropriate thing,you give them attention for it
and it tends to be a reinforcer.
Right yeah, exactly.
Linton (12:21):
Another one would be differential reinforcement of
alternative behaviors, and theycall that DRA.
I don't know why they don'tcall it DRAB drab.
Yeah, maybe that's why theydon't so that's providing
reinforcement for desiredresponses that are alternatives
(12:41):
to pica itself.
For example, you've got asix-year-old in your office.
They enter your office and theytry to eat some kind of
non-edible object let's saypaperclips or your diploma off
your wall.
You have to go through a wholeprocedure to deal with that.
You identify the function,determine that the pica behavior
(13:01):
is maintained by sensorystimulation.
You choose some kind ofalternative behavior to teach
the child to place non-edibleitems in a trash can.
So you have a pica can.
So whenever they go you set upthe environment with this pika
can.
So when they engage in pika,right, you prompt them to take
(13:24):
it and put it in the container.
So then you immediatelyreinforce them and praising them
for, instead of eating, youknow your diploma, you took it
off the wall and you put it inthe pica and so Huh, and that
works Well, I guess it does.
They wouldn't be using it.
Eric (13:43):
You know, I suppose that's true, yeah, true.
Linton (13:48):
So, and then there's differential reinforcement of
incompatible behaviors.
In other words, you give themsomething to do at the same time
they're trying to do pica, soyou have them fold their hands
and then they really can't eatwhatever the paper clips and
everything, because they can'tpick them up.
So that's another technique.
And then you, you know, givethem stars, or Okie doke.
Eric (14:10):
Well, I also read about one called non-contingent
reinforcement, NCR, which is oneof the most commonly used, as
it turns out.
Oh yeah, and that means thatyou're reinforcing other
behaviors other than the pica,so that they're doing something
(14:31):
positive.
You reinforce those andbasically ignore the pica.
Linton (14:35):
Okay yeah, okay yeah, yeah.
So like I'm doing right now iscalled response interruption.
There you go.
So this technique blocks theattempts to consume non-food
items and redirects theindividual to more appropriate
activities.
Eric (14:54):
Yes, okay, that makes perfect sense.
And then I guess the next stepup or down from that, I'm not
sure which I guess it depends onwhether you're on the receiving
end but mild aversive therapy,where you pair non-food items
with mildly unpleasantconsequences while rewarding
healthy eating behaviors.
So you have an unpleasantconsequence when they eat your
(15:17):
diploma and you have some grapesand then you give them positive
feedback for eating the grapesGreat.
Linton (15:25):
So of course, psychoeducation, but with small
children that's a little moredifficult.
Eric (15:30):
And then finally nutritional supplementation.
Linton (15:34):
Okay, now here's another thing in terms of cultural
practice.
Oh, like the geophagia.
Yeah, yeah, exactly so like,for example, people in Guatemala
will go ahead and make holytablets out of clay and they
emboss them with religiousimages and then they consume
(15:55):
them and they think that thatgives them additional health
benefits.
Eric (16:01):
Really.
So you've got the little claytablet which might have whatever
mineral.
Linton (16:06):
Yeah, it might have zinc .
Eric (16:08):
And then you put St Joseph on there.
And now you're not just eatinga mineral tablet, you're eating
St Joseph too.
I wonder what St Joseph thinksabout that.
Linton (16:17):
That will help you combining religious and health
benefits.
Huh, interesting.
How's that different fromingesting calcium that I know is
extracted from minerals?
Eric (16:28):
Oh well, not only extracted from minerals.
My cousin inherited a marblequarry.
Lucky him, I know I did feelthat he was lucky for having
done that, although good on him.
But he sold his marble not tomake headstones or countertops,
but they ground it up to makecalcium supplements.
(16:50):
So you go to the store and buya calcium supplement.
It might be just marble dust.
Yeah, a piece of marble thatdidn't look good, Right yeah, so
they ground it up into a powder, stuck it in a capsule, and
there you go.
So yeah, and I think the factis that if a big supplement
company went down to Guatemalaand was selling St Joseph clay
(17:14):
tablets, then all of a suddenit's good for us.
Linton (17:18):
Okay, eric.
What are some criticisms andlimitations here?
Eric (17:21):
Well, you know, as maybe you've picked up on some of my
skepticism about it, I did.
Yeah, the fact is that some ofthe definitions are inconsistent
.
So you go to Guatemala and yousee them eating the clay tablets
and some people say, oh, that'spica, that's clay.
And yet you dig further downand you realize that there, the
clay tablets and some people say, oh, that's pica, that's clay.
And yet you dig further downand you realize that there's a
(17:42):
you know a purpose behind it.
So there's an inconsistency inthe definitions and in the
cultural considerations.
So unless you've reallyburrowed down into those issues,
you know you risk labelingsomebody inappropriately, and
the fact is that there haven'tbeen many controlled studies
about it.
Linton (18:03):
Well, it's time for a knowledge check.
All right, I'm ready.
All right, this is maybe thekind of question that you might
find on a licensing exam.
Which of the following is nottypically considered an
evidence-based treatment forpica?
A cognitive behavioral therapy,B applied behavioral analysis,
(18:29):
C exposure and responseprevention or D psychodynamic
theory?
Eric (18:37):
Hmm, Okay, so we've talked about all of those
(19:02):
behavioral-based ones havingactual data behind them, which
we know behavioral therapy isall about.
The data is all aboutcollecting all of those data
points in order to find out.
So I'm going to guess that it'spsychodynamic theory.
D.
Linton (19:08):
Right.
All the other ones have showneffectiveness in treating pica,
but there's limited evidencesupporting the use of
psychodynamic therapy for picaand supporting the use of
psychodynamic therapy for PICA.
So, Az, through this wholething, why didn't you focus on
assessment instruments thatwould be used for assessing PICA
?
It seems like that might besomething that would be on a
(19:30):
licensing exam.
Eric (19:32):
Well, here we go the PICA screening questionnaire, the
direct observation PICAassessment protocol, the child
eating behavior inventory, thesensory profile.
You see where we're going withthis.
Okay, okay, I get it.
Yeah, you can go on and on.
I mean they're just gobs ofthem, but they all say PICA or
(19:52):
something about eating.
Linton (19:53):
Okay, yeah, okay.
So let's do a summary and keytakeaways for PICA.
Yes, yeah, okay.
So let's do a summary and keytakeaways for pica.
Yes, first, pica involvespersistently eating non-food
items for at least one month,and this behavior must be
developmentally inappropriateright over two years old.
Eric (20:11):
Second, pica can occur across different age groups and
populations and, as you pointedout so efficiently, co-occurs
with other mental health ordevelopmental conditions.
Linton (20:24):
The third evidence-based treatments for PICA include
cognitive behavioral therapy,applied behavioral analysis and
nutritional counseling.
Eric (20:34):
And PICA assessment should include psychological measures
and a medical evaluation tocheck for complications and if
there are any nutritionaldeficiencies.
Linton (20:46):
And finally, remember that treating PICA often
requires a multifaceted approach, addressing behavioral,
cognitive and, of course,environmental factors.
Yes, and with that we'll wrapup today's episode on pica.
We hope the information helpsyou on your exam preparation and
any future clinical work thatyou're doing.
Eric (21:08):
Absolutely.
Thanks for tuning in andremember, just because you're 18
month old, is running aroundeating crickets and popping in
the mouth like there's notomorrow, and popping in their
mouth like there's no tomorrowit's not pica, because they're
not over two and you knowcrickets are nummy.
So don't fret too much aboutyour toddlers.
They'll grow out of it and,let's face it, you'll have
(21:30):
bigger problems when they growup to be teenagers or beyond.
So until then, just rememberit's in there, in there, all
right.
Thanks for listening.
Hey there, eric, and hey to everyone out there.
Today we're going to go throughtheory to therapy podcast, and
we had a therapist that emailedus who had never worked with
children before.
She ran across a diagnosis thatshe wasn't familiar with,
called PICA.
Eric (00:32):
Right and you pronounced it correctly, because sometimes
people think it should be PICA.
I don't know why, but it ispronounced PICA.
Linton (00:42):
You know, when I first heard it, the first thing I
thought about was a typeface, asa matter of fact they come from
the same derivation.
Eric (00:51):
Pica is the eating disorder, yeah, and it's
characterized by persistentcraving or actually eating
non-food items, and in the DSMit has to be for more than a
month.
Is that only for kids, oreverybody?
Or everybody, as a matter offact, except for under two,
(01:12):
which we'll talk about in alittle while.
But pica comes from the latinword for magpie come on, I know
magpie and the pie it meansspotted.
So pica for magpie is from thebird, because apparently magpies
eat anything.
Linton (01:30):
Well, let's talk a little bit about the theoretical
foundations.
Okay, yes, there's severaltheories that attempt to explain
pica behavior, and whenever youhear anyone say that there are
several theories, basically whatthey're saying is that they
don't know right exactly so whenit?
One of the theories they cameup with was it was a nutritional
(01:54):
theory.
It's like, okay, people thathave pica must have some kind of
vitamin or some kind ofdeficiencies.
Right, you dogs are like that.
They're missing something intheir diet.
Eric (02:06):
They'll go out and eat grass, eat grass or chew bark or
whatever yeah.
Linton (02:12):
And they did find out that people that do have pica,
there's like really two and ahalf times or odds that they are
anemic or they have low zinclevels.
So that was an idea of thereason people do pica is of
nutritional lack.
Eric (02:31):
Well, and there's also the physiological theory, which is
that they just need that texture, taste or smell like eating
pencils, which I think you wereright that they're reaching for
it.
Linton (02:44):
Okay.
I mean there's a little elementof truth in all of them.
There's a psychosocial theorythat attributes pica to stress,
and it's basically a way of anindividual dealing with whatever
anxiety or stress that they'rehaving as a coping mechanism
that alleviates their emotionaldistress.
Eric (03:06):
Well, and that sounds like the psychodynamic perspective,
which is all about theunderlying emotional content,
that I have unmet emotionalneeds, so I'm eating paint chips
.
Linton (03:19):
Okay, and then there's the behavioral perspective, that
it's suggested that pica is alearned behavior.
So if your mother used to eatdirt, chances are you may have
picked that up from her or fromyour peer group.
So, basically, if a childreceives attention after they
(03:39):
ate dirt or whatever thatbehavior may be, reinforced.
Eric (03:44):
You talk to little Jimmy now and he's like oh, I got
talked to, normally I'm ignored,so now hand me the dirt, okay,
okay.
And finally, the cognitivetheory that they just have a
distorted thinking pattern.
They have, you know, they thinkdirt's good and somehow they
got into that cognitive deficitand they just need to be taught
(04:04):
not to eat dirt, so you know itis in the dsm-5tr absolutely
isn't there yes, and there arecertain diagnostic criteria and
probably the most significant isthat the ingestion of
non-nutritive substances for atleast one month.
(04:24):
Right, the month is the biggestone, so you just eat some paste
today.
Linton (04:29):
And the second one is the behavior must be
developmentally inappropriate.
Right, those were two of themain takeaways that you need to
remember when you're going totake your licensing exam.
Eric (04:44):
Well, and especially the developmentally inappropriate.
Because what do babies do?
Everything goes in their mouth,right?
So babies don't have pica,they're eating the same thing.
If you ate the same thing ababy did, then it's a problem.
But you know, babies stick apaint chip in their mouth.
Linton (05:02):
A paint your house, but B it's not developmentally
inappropriate well, I'msurprised you didn't do that at
the house that you lived in whenyou were growing up.
Who's who said I didn't?
Because there was nothing butlead paint, as I remember right.
Eric (05:19):
Well, it's true, and I think some of my friends have
suggested that that's why I'mnot as smart as I might be.
So you never know.
And the other part of thatdevelopmentally appropriate, is
also that it's not a culturalthing, that it can't have
cultural significance.
So that you lived out in thejungle and the doctor there said
(05:41):
oh, you should eat this barkfor your whatever problem.
You have To westernize.
That looks like pica, you'reeating tree bark, whereas it was
actually part of your culture.
So you have to be culturallysensitive.
Linton (05:56):
As you're looking at the criteria, so, instead of eating
the tree bark, what we do is wetake it, we grind it up, put it
in a pill and call it aspirin,right Well?
Eric (06:08):
yeah, exactly so.
Right, you eat it as a pill,it's all fine, and it could be
the same tree bark, but you putit in a gel cap and now it's
medicine.
It's true, yes, and so we didthe non-nutritive four-month.
You have to be developmentallyappropriate in your thing, which
(06:30):
meant nobody under two yearsold has pica, because you know,
you just can't tell.
And it has to be severe enoughto warrant clinical attention.
Linton (06:40):
Okay, so it's called.
You know it's basically eatingthe earth, so what's that called
?
Don't they have a term for that?
That's right.
Geophagia, geophagia, okay,geophagia.
That'd be something to rememberfor the exam too, wouldn't it?
Eric (06:55):
yes, probably so, because that is, you know, a cultural
thing in many places.
As it turns out, if you haveever had an upset stomach and
you've had kaopectate, it's amedicine you can get at your
local drugstore, right Well, kaorefers to kaolin, a kind of
clay.
So we ourselves are eating clay, only got to pay 10 bucks a
(07:19):
bottle for it.
Linton (07:20):
Really?
Yeah, well, there's certainmental health conditions.
Children with autism exhibitnutritional challenges,
including pica.
Schizophrenia, pica sometimesyeah, it's sometimes presented
as an impulsive consumption ofnon-food items, which are
associated with delusions.
Right?
Eric (07:41):
Obsessive compulsive disorder oh, I thought it was a
turkey and I ate this dirtbecause I okay, that makes sense
.
Obsessive compulsive disorderoh, I thought it was a turkey
and I ate this dirt because Iokay that that makes sense.
Linton (07:47):
Obsessive compulsive disorder.
Compulsive eating of non-fooditems to relieve stress is a
form of pica and you can seethat with OCD Individuals with
some kind of intellectualdisability.
It occurs with mental healthdisorders associated with
impaired functioningPost-traumatic stress.
(08:08):
There's a strong correlationbetween pica and PTSD.
Eric (08:14):
Really, yeah, okay now.
Now see, the schizophrenia madesense to me, but not so much
the ptsd okay I guess we'll haveto look into that.
Linton (08:23):
Other conditions, more medical conditions anemia pica
is associated with anemia anddeficiencies of iron, zinc and
other nutrients okay, that goesback to what you said earlier.
Eric (08:35):
That makes sense about the body knowing what it needs.
Linton (08:39):
Another one if an individual in the case study,
they say they have sickle cell,what's it called Sickle cell?
Eric (08:47):
disease, sickle cell disease, or it used to be sickle
cell anemia, but now they justcall it sickle cell disease.
Linton (08:52):
So it's really prevalent in individuals that have sickle
cell disease.
Like 34% of those people, manytimes will exhibit or
demonstrate PICA behaviors.
Eric (09:04):
Right, because they have iron deficiency and they need
the iron.
Linton (09:08):
Okay, that goes back to the nutritional theory.
Yeah, absolutely.
Eric (09:13):
And the last one is pregnancy so we all know about
them having cravings.
That's certainly true uh-huh.
Linton (09:19):
So pica is common in pregnant women, with worldwide
prevalence of about 30 percentduring pregnancy.
Eric (09:26):
Wow, so not just ice cream ?
Linton (09:29):
no, I, I knew someone.
I knew a pregnant woman who didthat all the time Really, and,
yeah, I had to keep her fromeating cat food.
You have any idea who that was?
Eric (09:40):
Ez, I have no idea.
You know a cat food eating.
Does she eat cat food now?
No, she doesn't, but she wasyour sister Really, and she ate
cat food?
Yeah, I had to keep her awayfrom that she snuck in the
little friskies and you had tokeep it away from her.
I did, I did.
Wow, if I'd known I'd havesnuck her some cans myself.
(10:05):
I didn't know you were, youknow, keeping it from her.
The common substances dirt, clay, sand stones, hair feces, vinyl
gloves.
I can't imagine vinyl gloves,plastic pencil erasers, which I
chewed on my pencil eraser inclass.
So there you go ice paper,paint chip and cat food.
(10:28):
I guess when you look atchildren over two that have pica
, that gives insights into thenormal and abnormal development
pattern.
So they actually study pica asa way of looking at normal as
opposed to abnormal developmentpatterns.
And of course they look at picato see if they can't stop lead
(10:52):
poisoning, because it is truethat lead, the metal lead, is
sweet, is it?
Yeah, that's why the Romansliked to drink wine out of lead
cups, because it actually madethe wine sweeter and they didn't
know they were poisoningthemselves back then.
Linton (11:09):
Yeah, well, let's say that you have a client that does
have pica.
All right, so let's look atsome behavioral interventions.
Differential reinforcement howmany of you out there know what
that is?
Eric (11:22):
Yes, I didn't see anyone raise their hand.
Linton (11:24):
Okay, Let me give you an example.
If a child tried to eat yourcarpet, you're in session.
They're trying to eat yourcarpet.
So instead of doing that, youwould provide them with some
kind of chewy toy yeah, the samekind that you gave to your dogs
and before they started to chewyour rug up, you would give
them the chewy toy.
And then you would praise themand say, oh, that's great job
(11:48):
that you're chewing on thechewing toy instead of the
carpet.
So if they attempt to do itagain to eat the carpet or your
desk, you block their access andredirect them to the toy, while
minimizing any attention thatyou might have for that
inappropriate behavior.
Eric (12:06):
You can't give them the attention right.
Linton (12:08):
Yeah, otherwise it just reinforces them eating your
carpet, sure.
Eric (12:12):
Right yeah, which is always a problem with that.
They do an inappropriate thing,you give them attention for it
and it tends to be a reinforcer.
Right yeah, exactly.
Linton (12:21):
Another one would be differential reinforcement of
alternative behaviors, and theycall that DRA.
I don't know why they don'tcall it DRAB drab.
Yeah, maybe that's why theydon't so that's providing
reinforcement for desiredresponses that are alternatives
(12:41):
to pica itself.
For example, you've got asix-year-old in your office.
They enter your office and theytry to eat some kind of
non-edible object let's saypaperclips or your diploma off
your wall.
You have to go through a wholeprocedure to deal with that.
You identify the function,determine that the pica behavior
(13:01):
is maintained by sensorystimulation.
You choose some kind ofalternative behavior to teach
the child to place non-edibleitems in a trash can.
So you have a pica can.
So whenever they go you set upthe environment with this pika
can.
So when they engage in pika,right, you prompt them to take
(13:24):
it and put it in the container.
So then you immediatelyreinforce them and praising them
for, instead of eating, youknow your diploma, you took it
off the wall and you put it inthe pica and so Huh, and that
works Well, I guess it does.
They wouldn't be using it.
Eric (13:43):
You know, I suppose that's true, yeah, true.
Linton (13:48):
So, and then there's differential reinforcement of
incompatible behaviors.
In other words, you give themsomething to do at the same time
they're trying to do pica, soyou have them fold their hands
and then they really can't eatwhatever the paper clips and
everything, because they can'tpick them up.
So that's another technique.
And then you, you know, givethem stars, or Okie doke.
Eric (14:10):
Well, I also read about one called non-contingent
reinforcement, NCR, which is oneof the most commonly used, as
it turns out.
Oh yeah, and that means thatyou're reinforcing other
behaviors other than the pica,so that they're doing something
(14:31):
positive.
You reinforce those andbasically ignore the pica.
Linton (14:35):
Okay yeah, okay yeah, yeah.
So like I'm doing right now iscalled response interruption.
There you go.
So this technique blocks theattempts to consume non-food
items and redirects theindividual to more appropriate
activities.
Eric (14:54):
Yes, okay, that makes perfect sense.
And then I guess the next stepup or down from that, I'm not
sure which I guess it depends onwhether you're on the receiving
end but mild aversive therapy,where you pair non-food items
with mildly unpleasantconsequences while rewarding
healthy eating behaviors.
So you have an unpleasantconsequence when they eat your
(15:17):
diploma and you have some grapesand then you give them positive
feedback for eating the grapesGreat.
Linton (15:25):
So of course, psychoeducation, but with small
children that's a little moredifficult.
Eric (15:30):
And then finally nutritional supplementation.
Linton (15:34):
Okay, now here's another thing in terms of cultural
practice.
Oh, like the geophagia.
Yeah, yeah, exactly so like,for example, people in Guatemala
will go ahead and make holytablets out of clay and they
emboss them with religiousimages and then they consume
(15:55):
them and they think that thatgives them additional health
benefits.
Eric (16:01):
Really.
So you've got the little claytablet which might have whatever
mineral.
Linton (16:06):
Yeah, it might have zinc .
Eric (16:08):
And then you put St Joseph on there.
And now you're not just eatinga mineral tablet, you're eating
St Joseph too.
I wonder what St Joseph thinksabout that.
Linton (16:17):
That will help you combining religious and health
benefits.
Huh, interesting.
How's that different fromingesting calcium that I know is
extracted from minerals?
Eric (16:28):
Oh well, not only extracted from minerals.
My cousin inherited a marblequarry.
Lucky him, I know I did feelthat he was lucky for having
done that, although good on him.
But he sold his marble not tomake headstones or countertops,
but they ground it up to makecalcium supplements.
(16:50):
So you go to the store and buya calcium supplement.
It might be just marble dust.
Yeah, a piece of marble thatdidn't look good, Right yeah, so
they ground it up into a powder, stuck it in a capsule, and
there you go.
So yeah, and I think the factis that if a big supplement
company went down to Guatemalaand was selling St Joseph clay
(17:14):
tablets, then all of a suddenit's good for us.
Linton (17:18):
Okay, eric.
What are some criticisms andlimitations here?
Eric (17:21):
Well, you know, as maybe you've picked up on some of my
skepticism about it, I did.
Yeah, the fact is that some ofthe definitions are inconsistent
.
So you go to Guatemala and yousee them eating the clay tablets
and some people say, oh, that'spica, that's clay.
And yet you dig further downand you realize that there, the
clay tablets and some people say, oh, that's pica, that's clay.
And yet you dig further downand you realize that there's a
(17:42):
you know a purpose behind it.
So there's an inconsistency inthe definitions and in the
cultural considerations.
So unless you've reallyburrowed down into those issues,
you know you risk labelingsomebody inappropriately, and
the fact is that there haven'tbeen many controlled studies
about it.
Linton (18:03):
Well, it's time for a knowledge check.
All right, I'm ready.
All right, this is maybe thekind of question that you might
find on a licensing exam.
Which of the following is nottypically considered an
evidence-based treatment forpica?
A cognitive behavioral therapy,B applied behavioral analysis,
(18:29):
C exposure and responseprevention or D psychodynamic
theory?
Eric (18:37):
Hmm, Okay, so we've talked about all of those
(19:02):
behavioral-based ones havingactual data behind them, which
we know behavioral therapy isall about.
The data is all aboutcollecting all of those data
points in order to find out.
So I'm going to guess that it'spsychodynamic theory.
D.
Linton (19:08):
Right.
All the other ones have showneffectiveness in treating pica,
but there's limited evidencesupporting the use of
psychodynamic therapy for picaand supporting the use of
psychodynamic therapy for PICA.
So, Az, through this wholething, why didn't you focus on
assessment instruments thatwould be used for assessing PICA
?
It seems like that might besomething that would be on a
(19:30):
licensing exam.
Eric (19:32):
Well, here we go the PICA screening questionnaire, the
direct observation PICAassessment protocol, the child
eating behavior inventory, thesensory profile.
You see where we're going withthis.
Okay, okay, I get it.
Yeah, you can go on and on.
I mean they're just gobs ofthem, but they all say PICA or
(19:52):
something about eating.
Linton (19:53):
Okay, yeah, okay.
So let's do a summary and keytakeaways for PICA.
Yes, yeah, okay.
So let's do a summary and keytakeaways for pica.
Yes, first, pica involvespersistently eating non-food
items for at least one month,and this behavior must be
developmentally inappropriateright over two years old.
Eric (20:11):
Second, pica can occur across different age groups and
populations and, as you pointedout so efficiently, co-occurs
with other mental health ordevelopmental conditions.
Linton (20:24):
The third evidence-based treatments for PICA include
cognitive behavioral therapy,applied behavioral analysis and
nutritional counseling.
Eric (20:34):
And PICA assessment should include psychological measures
and a medical evaluation tocheck for complications and if
there are any nutritionaldeficiencies.
Linton (20:46):
And finally, remember that treating PICA often
requires a multifaceted approach, addressing behavioral,
cognitive and, of course,environmental factors.
Yes, and with that we'll wrapup today's episode on pica.
We hope the information helpsyou on your exam preparation and
any future clinical work thatyou're doing.
Eric (21:08):
Absolutely.
Thanks for tuning in andremember, just because you're 18
month old, is running aroundeating crickets and popping in
the mouth like there's notomorrow, and popping in their
mouth like there's no tomorrowit's not pica, because they're
not over two and you knowcrickets are nummy.
So don't fret too much aboutyour toddlers.
They'll grow out of it and,let's face it, you'll have
(21:30):
bigger problems when they growup to be teenagers or beyond.
So until then, just rememberit's in there, in there, all
right.
Thanks for listening.
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