One of our Members asked about a patient with pretty bad pica and whether medications have a role in treating pica. We will provide an answer for our Member on another page on this website. But first, on this page, let’s answer the question: When should we diagnose pica as a DSM-5-TR™ Feeding and Eating Disorder?
DSM-5-TR™ diagnosis of pica
Three of the disorders in the chapter on Feeding and Eating Disorders in DSM-5-TR™ (American Psychiatric Association, 2022) are very well-known: anorexia nervosa, bulimia nervosa, and binge-eating disorder.
The other three are less well-known, especially to mental health clinicians who don’t work with children: pica, rumination disorder, and
avoidant/restrictive food intake disorder (American Psychiatric Association, 2022).
DSM-5-TR™ diagnosis of pica
In DSM-5-TR™, pica is diagnosed when:
1. A person eats nonnutritive, nonfood substances persistently (meaning, over a period of at least one month).
2. This behavior is not consistent with the patient’s developmental level or cultural/ social context
3. If the behavior occurs in the context of another condition—another mental disorder, a non-psychiatric medical condition, or pregnancy—we would still make a diagnosis of pica if the eating behavior is severe enough to “warrant additional clinical attention” (American Psychiatric Association, 2022).
Substances consumed during pica
A whole range of “non-nutritive, nonfood” items may be consumed by patients with pica. Here are only a few of the common ones:
– Mud/ clay/ sand
– Ice
– Paper
– Hair
– Chalk
– Paint chips
– Raw starches (for example, cornstarch, flour, and uncooked rice)
Next, let’s look at what else we should look for in a patient with pica: other mental disorders, non-psychiatric medical conditions that are well-known to be associated with pica, and, importantly, potential complications due to pica.
Please see the following articles on this website:
Which comorbid conditions and complications should be looked for in patients with pica?
Do medications have any role in the management of pica?
Related Pages
Pica
When should we diagnose pica as a DSM-5-TR™ Feeding and Eating Disorder?
Which comorbid conditions and complications should be looked for in patients with pica?
Do medications have any role in the management of pica?
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2022.
Dinkler L, Bryant-Waugh R. Assessment of avoidant restrictive food intake disorder, pica and rumination disorder: interview and questionnaire measures. Curr Opin Psychiatry. 2021 Nov 1;34(6):532-542. doi: 10.1097/YCO.0000000000000736. PMID: 34402460.
Leung AKC, Hon KL. Pica: A Common Condition that is Commonly Missed – An Update Review. Curr Pediatr Rev. 2019;15(3):164-169. doi: 10.2174/1573396315666190313163530. PMID: 30868957.
Miranda Paulo I, Marques C, Serra M, Âmbar Botelho C, Alcoforado A, Pires CM. A Spongy Appetite: A Case of Pica. Cureus. 2024 Aug 7;16(8):e66399. doi: 10.7759/cureus.66399. PMID: 39246937; PMCID: PMC11379449.
McNaughten B, Bourke T, Thompson A. Fifteen-minute consultation: the child with pica. Arch Dis Child Educ Pract Ed. 2017 Oct;102(5):226-229. doi: 10.1136/archdischild-2016-312121. Epub 2017 May 9. PMID: 28487433.
Patil M, Gharde P, Shinde RK, Navandhar PS. Rapunzel Syndrome: Diagnostic Challenges and Multidisciplinary Treatment Strategies. Cureus. 2024 May 29;16(5):e61294. doi: 10.7759/cureus.61294. PMID: 38947636; PMCID: PMC11212015.
Rose EA, Porcerelli JH, Neale AV. Pica: common but commonly missed. J Am Board Fam Pract. 2000 Sep-Oct;13(5):353-8. PMID: 11001006.
Schnitzler E. The Neurology and Psychopathology of Pica. Curr Neurol Neurosci Rep. 2022 Aug;22(8):531-536. doi: 10.1007/s11910-022-01218-2. Epub 2022 Jun 8. PMID: 35674869.
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