Pica (eating disorder)

Pica is a complex behavior and refers to excessive / abnormal craving for normal food or for other substances not commonly regarded as food such as earth, charcoal, raw rice, ice etc.

It has been around for more than 2000 years. First documented by Hippocrates as early as 4th century BC, pica is widespread across the globe and is associated with serious health problems. The disorder derives its name from a Latin word meaning magpie, a bird which, was known for its tendency to pick up a diversity of things to satisfy hunger or curiosity. 

Although the disorder has been around for some time now, our knowledge of pica is still poor. Most people who practice pica do not reveal it. Pica is mostly perceived as a mental illness by those who study it. Additionally, those who study pica are often biased and judgmental. Due to the above mentioned reasons, it continues to elude the treating physician and nutritionist. 

The most common type of pica known is intake of earth/soil. This list has now been extended to include substances like baby powder, ash, chalk, charcoal, ceramics, paper, paint, and ice. Next commonly observed pica phenomenon is the consumption of uncooked starch such as corn starch, raw wheat flour, laundry starch and uncooked rice. 

Children and pregnant women have been widely reported to exhibit pica behavior. Pica in adult men is relatively uncommon. The reason for low incidence of pica among males could be attributed to its victims converting to smoking or chewing tobacco. 

The list of typical pica substances is mentioned below: 

Uncooked food substances: This represents edible substances, consumed in uncooked form by those who practice pica such as corn starchflourice (ice and freezer frost) and uncooked rice. 

Non-food substances: This list includes substances that are normally non-edible and therefore, non-food items. Ashbaby powderchalkcharcoalearth/soil, pottery and plaster come under this category.

Pica Eating Disorder

Pica is a disorder that is related to eating. A person suffering from this disorder is compelled to eat things or substances that are not considered as “food”. These things or substances could be anything from chalk, plaster, clay, paint chips, dirt, ashes, leaves, gravel, to any kind of starch, rust, hair, feces, paper, buttons, soap, glue, and the like. Usually children under the age of two are seen eating these kinds of substances but this is mainly due to being at that stage in life where they are exploring the world around them. But if children continue eating these substances even after the age of two, it would be a good idea to get them examined by a qualified physician. Eating any of these substances on a regular basis can and will have an adverse effect on the overall health of the child and will impede the child’s growth. There is no known cause for this disorder; however, certain mineral deficiencies such as iron and zinc might be the reason for this disorder to take root. Other causes that might lead to Pica are poor eating habits, non-availability of food, mental disorders, and obsessive-compulsive disorders.

In elders, a person would be diagnosed as suffering from Pica if the compulsion to eat the “non-food” items lasts for over a month. Most of these items or substances are easily digestible and therefore harmless. However, there are some that are toxic and contaminated; consuming these will cause some kind of medical emergency or even death. Some people tend to hide this disorder, while other are not bothered about it. This compulsion to eat non-food item does not stop most people to eat a normal diet either. Most of the time, the existence of Pica is discovered when a person starts suffering from a health problem. Health problems such as intestines getting blocked, a tear appearing in the intestine, poisoning, injury to the teeth, and infection are some of the indicators of Pica. Therefore, if a person has had no health related problem for years, the existence of Pica will not be known. In order to treat this disorder, the physician will first need to determine the cause behind the compulsion to eat these things. Once the physician is able to determine whether the disorder is due to some kind of nutritional deficiency, medical problem, or due to some psychosomatic disorder, then an appropriate treatment can be devised and given to the person.

Dr Nahida M Mulla.

Pica is a disorder characterized by an appetite for substances largely non-nutritive, e.g. metal, clay, coal, soil, faeces, chalk, paper, soap, ash, gum etc. or an abnormal appetite for some things that may be considered foods such as flour, raw rice, starch, ice cubes, salt. In order for these actions to be considered Pica, they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate (above 18 to 24 months of age).

Pica is seen in all the ages particularly in pregnant women, small children and those with developmental disabilities and mental retardation.

Pica occurs throughout the world predominantly in people who live in poverty and people living in the tropics and in tribe oriented societies.

Pica in children, while common, can be dangerous. Children eating painted plaster containing lead may suffer brain damage from lead poisoning.


  1. Mineral deficiency specially iron deficiency
  2. Traumatic events/ stress:
  • Maternal deprivation
  • Parental separation/ neglect
  • Child abuse
  • Disorganized family structure
  • Poor parent-child interaction
  1. Low socio-economic status

Clinical Features:

  1. Child with habit of eating substances like clay, dirt, stones, pebbles, hair, faeces, lead, plastic, pencil, erasers, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette, wire and burnt matches etc.
  2. A case with history of PICA may present with symptoms of:
    • Constipation
    • Chronic or acute, diffuse or focused abdominal pain
    • Nausea/ vomiting
    • Loss of appetite
  3. On examination findings like :
  • Abdominal distension
  • Pallor
  • Iron deficiency anaemia which could be the cause of PICA
  1. Clinical presentation of PICA is variable and is associated with the specific nature of the resulting medical conditions and the indigested substances.
  2. Parasitic infestations are usually associated with PICA. Ascariasis is commonly seen in children with Pica. 


  1. Amylophagia – consumption of starch
  2. Coprophagy – consumption of faeces
  3. Geophagy – consumption of soil, clay or chalk
  4. Hyalophagia – consumption of glass
  5. Pagophagia – pathological consumption of ice
  6. Trichophagia – consumption of hair or wool
  7. Urophagia – consumption of urine
  8. Xylophagia – consumption of wood.

Homoeopathic Management:

  1. Antimonium crudum:
    • Craving for raw food and vegetables
    • Loss of appetite
    • Bloating of abdomen after eating
    • Inability to bear heat of sun, verse from over exertion in the sun and from over-heating
    • Aversion to cold bathing and aggravation therefrom
    • Tendency to grow fat
    • Thick milky white-coated tongue
    • Thirstlessness
    • Craving and intolerance for acids, pickles and bread
    • Peevish, irritable, cannot bear to be touched or looked at
  1. Alumina:
    • Craving for starch, chalk, charcoal, cloves, coffee or tea grounds, raw rice, acids
    • Alumina is one of the chief antidotes for lead poisoning (complication of pica)
    • Thin delicate children
    • Dryness of mucus membranes and skin
    • Constipation, no desire for stools for number of days and soft stool requires great straining
    • Exhausted physically and mentally
    • Aversion to potatoes
    • Mild, cheerful disposition
  1. Calcarea carbonica:
    • Craving for chalk, charcoal, coal and pencils
    • Chilly patient, takes cold easily
    • Fat, fair, flabby
    • Pale, weak, easily tired
    • Head sweats profusely while sleeping
    • Tendency for lymphatic glandular enlargement
    • Desire for eggs, aversion to meat and milk
    • Sour smelling discharges
    • Fearful, shy, timid, slow and sluggish
    • Longing for fresh air
  1. Culcaria phosphorica:
    • Desires lime, slate, pencils, earth, chalk, clay etc
    • Colicky pain in abdomen while eating
    • Distended abdomen
    • Feeble digestion
    • Chilly patient, thin, emaciated, unable to stand, rickety
    • Easy perspiration
    • Slow in learning to walk
    • Aggravation from damp, cold weather, change of weather, mental exertion
    • Desires raw salt and smoked things
    • Restless, dissatisfied, desire to wander
  1. Cicuta virosa:
    • Abnormal appetite for chalk, charcoal, coal, cabbage, which are relished
    • Grinding of teeth
    • Chilly patient
    • Convulsive with tendency to bend backward
    • History of suppressed skin eruptions
    • Stupid, singing, dancing, crazy, makes strange gestures
  1. Natrum muriaticuam:
    • Craving for salt
    • Takes long time for food to digest
    • Worse from eating
    • Hot patient
    • Poorly nourished
    • Great emaciation (marked on neck), losing flesh while eating well
    • Oily, greasy face
    • Aversion to bread and fatty things
  1. Nitricum acidum:
    • Craving for lime, slate, pencil, papers and charcoal
    • Cracks in muco-cutaneous junction especially fissures in rectum and corners of mouth
    • Chilly patient, takes cold easily
    • Thin built, sickly
    • Desires fat and salt
    • Disposed to diarrhoea
    • Strong smelling urine
    • Head-strong, irritable, fearful, vindictive, sensitive to noise and light
  1. Nux vomica:
    • Craving for charcoal, pepper, chalk
    • Chilly patient, thin
    • Craves fats, spicy food
    • Tongue coated yellowish in the posterior part
    • Over sensitive to noise, odors, light or music
    • Nervous disposition
    • Quick, active, zealous and irritable
    • Impatient, spiteful with violent action
  1. Silicea:
    • Craving for lime, sand, raw foods
    • Extremely chilly patient, all symptoms worse by cold except stomach complaints which are better by cold
    • Profuse, offensive discharges
    • Sweats profusely especially on feet
    • Easy suppuration, glandular affinity
    • Large head and distended abdomen
    • Weak ankles, slow in learning to walk
    • Obstinate, head strong, cries when spoken kindly to
    • Nervous, apprehensive, over sensitive, irritable, fearful