Pica: Symptom or Eating Disorder? A Historical Assessment

Abstract

In DSM-III-R, pica, with anorexia nervosa, bulimia nervosa and rumination disorder of infancy, is accorded the status of a separate eating disorder. However, in the Draft of ICD-10, only anorexia nervosa and bulimia nervosa are listed under eating disorders. Pica in children, and feeding disorder in infancy and childhood, are incorporated with enuresis, encopresis, and feeding, movement and speech disorders in a separate "heterogeneous group of disorders". Extensive research on the history and terminology of eating disorders from the 16th to the 20th century suggests that, historically, pica was regarded as a symptom of other disorders rather than a separate entity. This paper aimed to locate and assess chronologically significant definitions and accounts of pica, to provide a fuller clinical description of a condition which, despite its current relevance, has received little detailed historical examination, and to give some consideration to the multiple aetiological theories which have been put forward. The historical findings are related to the descriptive criteria for pica in DSM-III-R and Draft ICD-10.

Da ópera-bufa ao caos nosológico: pica

“…A coprofagia, manifestação mais comumente relatada nesses indivíduos, parece estar relacionada à falta de noções higiênicas, que em geral ocorre nessa população 20 . Assim, esses pacientes teriam o hábito da pica não somente por uma preferência, mas, sim, pela indiscriminação de substâncias a serem ingeridas 5 .…”

“…Outros autores ainda falam em ingestão compulsiva de alimentos não nutritivos 3,4 . Ao longo da história, o comportamento de pica tem sido um enigma fascinante para seus estudiosos, uma vez que não existe consenso a respeito de sua etiologia, invocando fatores sociais, culturais, psicológicos, biológicos e comportamentais, embora, sem dúvida nenhuma, possua um componente ambiental importante 5 . A prevalência de pica também é difícil de determinar, uma vez que raramente o hábito é relatado em consultas 6,7 .…”

Modeling Eating Disorders of Cognitive Impaired People

“…We can assume it is abnormal in case of patients with the Alzheimer's disease (see axiom 15), whose behavior is likely to cause hallucinations. In contrast, in case of another disease like pica that causes just the continuous eating of nonnutritive substance, we know that such a kind of illnesses is diagnosed only when this anomalous eating is repeated for at least one month [6]. Such a condition may also be dangerous in case of ingestion of poisoning substances ( axiom 18).…”

Dysfunctional Eating Patterns and Symptoms of Pica in Children and Adolescents with Sickle Cell Disease

“…Probably the most researched etiologic factor for pica is a nutritional deficiency of iron. 16,17 Stress-induced eating has been proposed for pica, obesity, and other dysfunctional eating patterns, with the relationship mediated by dopamine and endogenous opioid peptides. [18][19][20] In addition, oral self-stimulation increases during periods of emotional upset, which suggests that the stimulation from the oral behaviors may be a calming technique to alleviate stress or discomfort.…”