People Who Eat Dirt

A look at the psychiatric disorder pica


In Haiti, poor people are forced to quash hunger pangs with cookies made of dirt. Unfortunately, yellow dirt mixed with salt and shortening is the only "food" many of these people can afford. The United Nations estimates that nearly 800 million people worldwide don't have enough to eat, and Haitians who eat dirt cookies are among them.

Few Haitians who eat dirt cookies do so by choice. However, there is a psychiatric disorder called pica that compels otherwise healthy people who have access to real food to instead eat dirt, stones, soap, paint, ice, hair, animal feces and a variety of other substances with no nutritional value ...

stuff that should never be consumed.

Pica is diagnosed in people more than 2 years of age who eat one or more non-food substances for a month or longer.  Pica usually affects children, pregnant women, and people living in institutionalized settings.

In order to be diagnosed with pica, a person must not consume nonfood substances on account of cultural beliefs or as a symptom of a nutritional deficiency.

People with pica have no basic aversion to food rather they prefer to eat dirt, clay, ice, ash, paper, or so forth. 

Between 10 and 32 percent of all children have pica or exhibit pica-like behaviors with a majority of these children expressing preference for dirt (geophagy).

Pregnant women with pica routinely fall into four categories: those who prefer to eat ice (pagophagia), those who prefer to eat clay or dirt (geophagy), those who prefer to eat starch (amylophagia), and those who eat sourdough.

In 2004, researchers at the University of Alabama examined the eating patterns of 3000 pregnant women and found that 4 percent of the study participants had pica.

Although experts are unsure what causes pica, they do have at least two theories. First, pica may be caused by iron deficiency which results in an appetite for minerals.

Second, in children, pica may be represent delayed development. More specifically, infants typically explore the world with their mouths, and children with pica may have yet to grow out of this stage. Pica in children is most commonly observed among those who are socially disadvantaged or those with mental retardation.

Of note, it's unclear whether pica is caused by iron deficiency or causes iron deficiency. Nevertheless, iron deficiency anemia is observed among many--but not all--people with pica.

Plenty of bad things can happen to people who routinely eat nonfood items including:

  • lead poisoning (think paint)
  • malnutrition
  • intestinal obstruction
  • malabsorption
  • intestinal perforation
  • weight gain
  • infection
  • bezoars (hairballs or concretions of other indigestible substance found in the stomach)

Treatment for pica should first focus on correcting any underlying nutritional deficiencies--most notably iron deficiency anemia. Initial treatment should also deal with any consequences of pica, such as lead poisoning or infection.

The psychiatric treatment of pica is tricky. Psychotherapy should focus on behaviors, the environment and education of family members. Specifically, mild aversion therapy has proven somewhat helpful when treating pica and entails negative consequences for eating nonfood stuffs and reward for eating real food.

For some people with pica, the disease abates after several months--essentially going away on its own. In pregnant women, iron supplementation to fix the iron deficiency anemia can also work to stop pica. However, in those with developmental disorders who first develop in pica in childhood, the disease usually continues through adulthood.

If you or someone who love like your child is experiencing pica, it's important to inform your primary care physician or OB-GYN and visit with a psychiatrist. If left unmonitored and untreated, pica can be dangerous. Please remember that the treatment of pica often requires the participation, support, and help of all family members.

Selected Sources

Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS. Prenatal Care. In: Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS. eds. Williams Obstetrics, Twenty-Fourth Edition. New York, NY: McGraw-Hill; 2013. Accessed December 15, 2015.

Lacey EP: Phenomenology of pica. Child Adolesc Psychiatr Clin N Am 1993;2:75.  Accessed December 15, 2015.

McAdam DB,Sherman JA,Sheldon JB,Napolitano DA: Behavioral interventions to reduce the pica of persons with developmental disabilities. Behav Modif 2004;28:45–72.  Accessed December 15, 2015.

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