Handbook of DSM-5 Disorders in Children and Adolescents by Sam Goldstein & Melissa DeVries

Author:Sam Goldstein & Melissa DeVries
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Summary and Outlook

Pica is a disorder that appears to mainly occur in children , pregnant women , and individuals with intellectual disabilities. However, representative epidemiological data is rare and, for the general population, nonexistent. It is characterized by eating substances that are considered nonfood and nonnutritive. It can occur within the context of other mental disorders such as neurodevelopmental disorders, schizophrenia, eating disorders, non-suicidal self-injury, and factitious disorder and is not diagnosed separately unless needing additional medical attention or if not fully explained by the other disorder (e.g., not only eating a nonnutritive, nonfood substance to substitute for real food but also for other reasons in the case of eating disorders). In some cases, pica may be mistaken for a substance use disorder or OCD. Pica is also associated with severe medical impairments (e.g., intestinal perforation or obstruction, infections, or asphyxiation), while little is known about associated psychological impairment. The extremely relevant topic of developmental challenges associated with pica has not been researched to date, beyond our current understanding of potential factors impacting developmental delay, such as shame, withdrawal, depression, and medical hospitalization. Currently, there is no unified etiological model of pica; instead, single theories exist that explain pica behavior with a limited number of substances and/or subgroups. Psychological treatment in children is limited to techniques of behavior modification that are only supported by case studies. In case of pica behavior as part of another mental disorder, the latter should receive treatment first, possibly also leading to a remission of pica behavior. Pharmacological treatment of individuals with pica is scarce, but there is some limited support for the use of SSRIs. And, of course, medical complications should be treated immediately, in most cases needing surgical procedures.

Apart from television shows that feature individuals with pica as a popularized anomaly or weird addiction, pica has not received much attention in the general community. Importantly, general knowledge of pica is scarce in the medical and mental health professional community. In order to inform the public as well as health-care providers, more research is needed to elucidate prevalence rates across populations as well as the longitudinal course of pica. Moreover, experimental studies will help to elucidate etiological mechanisms. Current approaches based on the Research Domain Criteria (RDoC) might be useful to investigate underlying neurological, genetic, and behavioral mechanisms making use of multiple methods investigating the different domains (cognition, social processes, arousal/regulator systems, and negative as well as positive valence systems) (for an overview over RDoC, see, e.g., Morris & Cuthbert, 2012). Furthermore, future research could utilize models from phenotypically related disorders (e.g., impulse control disorder, substance abuse). These findings will then allow us to develop treatment strategies. Eventually, new treatment strategies can be developed and tested in larger scale randomized controlled trials.

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