Incidence

The reasons for the practice of pica are almost as numerous as its types. The interpretation of data on the disorder is complicated because definitions of pica are unreliable and because there is a natural reluctance on the part of practitioners to admit to the ingestion of nonfoods. This is especially true of geophagy, since "dirt-eating" is generally considered to be degenerate behavior.

Pica has been closely associated with women and pregnancy since classical times, and until recently it was believed that pregnancy caused mental instability in a woman, and thus provoked her cravings for both food and nonfood substances. Recent studies, however, have indicated that changes in sense of taste are not a constant in pregnancy, despite the desire for sharp-tasting foods. There have been many studies of the incidence of pica among pregnant women in the United States since World War II, most carried out in rural areas. One of the most prominent of the few urban studies was done by Harry Roselle (1970), a New York medical doctor. He discovered that some of his nonpregnant patients consumed laundry starch or clay, and thought that this practice might be associated with iron-deficiency anemia. He prescribed iron for these patients, but their lack of cooperation did not allow him to form a firm generalization about the link between iron deficiency and pica. He did observe that hemoglobin values were unchanged while they were consuming clay and starch, which led him to believe that pica was a symptom, rather than a cause, of the anemia.

Most medical investigations of pica tend to be most concerned with children. The practice is usually associated with those in poverty, especially black children in rural areas or urban slums. Reports conflict as to whether pica in this group is nutritionally motivated. There seems to be no difference in prevalence between male and female children. However, during adolescence, girls are more likely than boys to take up or continue the practice.

As babies explore their environment, they put a variety of things in their mouths. The actual ingestion of nonfood substances seems to start as early as 6 months of age, but tends to decline with a developmental increase in hand-mouth activity and to drop sharply after the child reaches 3 years of age. Often, when pica is encountered after that age, the possibility of mental disturbance is explored.

Pica is usually described as rare among adult males, although some claim that it is merely under-reported and the most common picalike practice among men - chewing tobacco - is not generally viewed to be pica. A study, carried out in Columbus, Ohio, in 1968 by J. A. Halsted found that 25 percent of 302 general patients admitted to eating clay, starch, or dirt at one time or another. Of these, only 24 percent (18 patients) were male.

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