These circumstances are disparate enough to reduce the likelihood that one underlying abnormality accounts for all pica. There are four major circumstances in which an eating behavior can be considered a pica. Close questioning of eating habits, especially related to mouthing activities, is done explicit questions with examples may be necessary. Pica in children is different, and the technique for eliciting information is directed to the parent rather than the child. Understanding of what a pica means may indicate to the patient that investigation is necessary should the craving return.
Also, persons with a pica often crave the same object if iron deficiency occurs again. This is a natural response and indicates that therapy is successful. In fact, the patient may actually develop an aversion to or disgust with the object craved previously. For instance, when treatment for iron deficiency is begun, the pica resolves rapidly, often within days. Once a pica is identified, other information should be relayed to the patient. In most cases, however, embarrassment by the patient makes it more convenient and successful to interview the patient by himself or herself. By introducing the topic of pica, one permits discussion of eating behaviors that may be viewed as harmless by the patient but are additional clues to the physician.īecause a pica often involves disruption of daily activities (awakening at night to eat or other surreptitious behavior), questioning of a family member may be necessary. Regular ingestion of something, for example, ice cubes, might not be recognized as a behavior having a pathophysiologic basis. Under other circumstances, a person may not recognize that a "habit" in fact may be a pica. Often there is a sense of relief at having an explanation for the behavior. Examples of objects eaten by other people may permit the patient to answer in the affirmative. A more leading question could then be phrased in a nonjudgmental way, such as, "Are there things you feel you simply must eat?" or, "Do you find yourself craving certain foods?" The object is to allow the patient to admit to this behavior.Ī productive approach is to explain the reason for the questions ("Many people with low iron have different eating habits").
One begins with questions about usual food intake, the time of day the patient eats, how much is eaten, when and what is taken for snacks. The topic can be introduced as part of the dietary history. A permissive, nonjudgmental line of questioning by the physician is clearly important when a pica is suspected.īecause the patient rarely presents with a pica as the chief complaint, circumspect interviewing technique may be used. More frequently, patients believe that their behavior represents a disordered psyche and are reluctant to admit to this symptom. Hence, only a few patients come to the physician complaining of their unusual eating habit. Yet compulsive eating, especially of inedible objects, can be a source of considerable embarrassment or ridicule. The pica is usually a manifestation of an underlying medical condition, most often iron deficiency anemia. Although it is a compulsive behavior, most adults with a pica do not have a psychologic disorder.
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