Pica: put your money where your mouth is

An upcoming article in the medical journal Clinical Toxicology reports on a man who suffered lead poisoning owing to his habit of eating roofing plates.

The tendency to eat the inedible is known as ‘pica‘. It is an established psychiatric diagnosis, is well-reported in the medical literature and has given us some of the more unusual case reports of recent years.

Although there is a specific diagnosis, the term is also used more widely as a general label for any eating behaviour that focuses on inedible objects.

Two of the most striking cases have involved coins. The x-ray on the right is from a case report from the New England Journal of Medicine where doctors discovered five and a half kilograms of coins, necklaces, and needles in a patient’s stomach.

In another case report from 1998, a British patient had swallowed £175.32 pounds worth of loose change and had a history of eating a wide range of curious objects:

At different times she has eaten tablets, coins, nuts, wire, plastic, ‘purple hearts’, Bob Martin’s dog conditioning powder and dried flowers. There is much comment made throughout her medical notes detailing vigorous negotiations about the colour, size, number, timing and supply of medication, including a large batch of hand-written letters to her doctor.

The behaviour in the more extreme cases in adults is usually associated with psychosis, as was the case with these two individuals.

It was also the case with one other gentleman, who had suffered lead poisoning after swallowing over 200 live bullets. The case report was rather wittily titled ‘Bite the Bullet’.

Normally, however, pica is most commonly seen in children with learning difficulties or autism spectrum diagnoses.

Perhaps giving partial support for the stereotype that pregnancy leads to unusual food cravings, it is known to occur more commonly in pregnant women, particularly from lower income families.

It’s not clear why it occurs, but interestingly, it has been linked to iron and zinc deficiencies.

Link to NEJM case report with x-ray.