Pica (disorder) - Treatment

Treatment

Treatment for pica may vary by patient and suspected cause (e.g., child, developmentally disabled, pregnant or psychotic) and may emphasize psychosocial, environmental and family-guidance approaches, (iron deficiency) may be treatable though iron supplement through dietary changes. An initial approach often involves screening for and, if necessary, treating any mineral deficiencies or other comorbid conditions. For pica that appears to be of psychotic etiology, therapy and medication such as SSRIs have been used successfully. However, previous reports have cautioned against the use of medication until all non-psychotic etiologies have been ruled out.

Looking back at the different causes of Pica related to assessment, the clinician will try to develop a treatment. First, there is Pica as a result of social attention. A strategy might be used of ignoring the person’s behavior or giving them the least possible attention. If their Pica is a result of obtaining a favorite item, a strategy may be used where the person is able to receive the item or activity without eating inedible items. The individual’s communication skills should increase so that they can relate what they want to another person without engaging in this behavior. If Pica is a way for a person to escape an activity or situation, the reason why the person wants to escape the activity should be examined and the person should be moved to a new situation. If Pica is motivated by sensory feedback, an alternative method of feeling that sensation should be provided. Other non-medication techniques might include other ways for oral stimulation such as gum. Foods such as popcorn have also been found helpful. These things can be placed in a “Pica Box” which should be easily accessible to the individual when they feel like engaging in Pica.

Behavior-based treatment options can be useful for developmentally disabled and mentally ill individuals with pica. These may involve using positive reinforcement normal behavior. Many use aversion therapy, where the patient learns through positive reinforcement which foods are good and which ones they should not eat. Often treatment is similar to the treatment of obsessive compulsive or addictive disorders (such as exposure therapy). In some cases treatment is as simple as addressing the fact they have this disorder and why they may have it. A recent study classified nine such classes of behavioral intervention: Success with treatment is generally high and generally fades with age, but it varies depending on the cause of the disorder. Developmental causes tend to have a lower success rate. Pregnancy craving causes tend to have higher success rates.

Treatment techniques include:

• Presentation of attention, food or toys, not contingent on pica being attempted
• Differential reinforcement, with positive reinforcement if pica is not attempted and consequences if pica is attempted
• Discrimination training between edible and inedible items, with negative consequences if pica is attempted
• Visual screening, with eyes covered for a short time after pica is attempted
• Aversive presentation, contingent on pica being attempted:

1. oral taste (e.g., lemon)
2. smell sensation (e.g., ammonia)
3. physical sensation (e.g., water mist in face)

• Physical restraint:

1. self-protection devices that prohibit placement of objects in the mouth
2. brief restraint contingent on pica being attempted
3. Time-out contingent on pica being attempted
4. Overcorrection, with attempted pica resulting in required washing of self, disposal of nonedible objects and chore-based punishment
5. Negative practice (non-edible object held against patient's mouth without allowing ingestion)