Pica, as we have observed, is included as an eating disorder (along with anorexia nervosa, bulimia, and rumination in infancy) in the classification systems of the DSM-III-R of the American Psychiatric Association (APA) (1987) and the ICD-10 of the World Health Organization (1992). Pica is defined by the APA as the repeated consumption of nonnutritive substances for a period of at least one month, when the behavior is not attributable to another mental disorder.
It is interesting to note that psychological literature on eating disorders discusses pica in early childhood as a risk factor for bulimia in adolescence (Marchi and Cohen 1990). Moreover, some aspects of pica, such as excessive consumption of ice, ice water, lemon juice, and vinegar, are linked with anorexia nervosa (Parry-Jones 1992; Parry-Jones and Parry-Jones 1994). Pica has also been associated with rumination in children and persons with mental retardation; in such cases, the behavior may be interpreted as a regressive behavior reflecting oral needs that have not been met (Feldman 1986). Poor feeding and weaning practices are more frequently observed in children with pica than in those without (Singhi, Singhi, and Adwani 1981). In addition, comparisons of children who have iron-deficiency anemia and who practice pica and children with anemia who do not practice pica show that the former score higher on measures of stress, including that caused by maternal deprivation, child abuse, and parental separation (Singhi et al. 1981).
It is important to understand that psychological explanations themselves tend to reflect cultural beliefs in the Western industrialized world, in contrast to religious and spiritual beliefs of cultures in other areas. To view all types of pica behavior as pathology risks a failure to recognize other important issues, such as cultural variation in food preference, indigenous medicinal and nutritional knowledge, and the very real question of the effects of nutritional deficiencies.
World History
