Pica: A Dangerous Eating Disorder

Categories: ASD and DD, Adult-focused; ASD and DD, Child-focused

By Jennifer Zarcone, Ph.D., BCBA-D                                                                                                                                                                                

Pica (pronounced “pike-ah”) is a very dangerous disorder characterized by craving or ingesting inedible items. Pica is not as rare as you might think. The disorder has been diagnosed in 27-68% of pregnant women and in up to 50% of very young children. Pica behavior may also be seen in about 10% of individuals with autism and other developmental challenges. 

A person with pica may eat dirt, rocks, screws, nails, hair, crayons, glue, cleaning supplies, plastic, erasers, buttons, paint chips, chalk, wood, glass, needles, rubber bands, cigarette ends, and/or pieces of metal. While some of these items may not lead to significant medical complications, others can cause poisoning, bowel obstructions or perforations, malnutrition, and even death.

The exact cause of pica is not known, but it may be associated with certain medical conditions (gastric parasites, sickle cell disease, iron deficiency), genetic disorders, and mental health conditions such as obsessive-compulsive disorder. For example, people with iron deficiency may crave and eat clay, chalk, and dirt. Simply treating the iron deficiency may successfully reduce the behavior.

Sometimes pica occurs by accident when an individual “mouths” an item and then accidentally swallows it. This occurs in both young children and individuals with disabilities who like the sensation of putting things in their mouths. Other times, pica occurs in a purposeful way when the individual seeks out the item to ingest. These accidental and purposeful situations should be handled in different ways.

If you are caring for a person who engages in pica accidentally due to mouthing, it is critical to keep the environment clear of items that could be mouthed and/or swallowed. It is also important to carefully supervise the individual to block or stop mouthing or pica when it first occurs. You may need to put locks on cabinets, drawers, or the refrigerator. It is helpful to make everyone who comes into contact with that individual aware of the dangers of pica and enlist their assistance in providing supervision and keeping the environment safe.

For those individuals who purposefully seek out items to ingest, it is a good idea to obtain a medical consultation to identify any underlying conditions such as iron deficiencies that may be causing the behavior. In addition, behavioral support should be sought not only to prevent the occurrence of pica, but to potentially treat the behavior as well.

It is also important to identify the circumstances in which pica is mostly likely to occur. For example, if the behavior occurs prior to meals, it may be due to a vitamin deficiency or hunger. If it occurs at times when adults or caregivers are busy, it may be to get a reaction or attention from others. If it occurs during times of stress or anxiety, it may serve as a coping or calming mechanism. To reduce occurrences of pica, provide safe, healthy, and appropriate alternative food items and help the individual find other ways to get attention and reduce stress.

Unfortunately, pica is often discovered after an individual has already ingested the inedible item. In many cases, it is diagnosed in a hospital emergency room after a person has been transported there because of a physiological reaction such as vomiting, constipation, fever, or rectal bleeding caused by the ingestion of the inedible item. If you think anyone has ingested something dangerous, it is critical to immediately call 911 if the person is in distress or shows signs of illness. In instances where the individual does not exhibit signs of distress or illness, call Poison Control to determine next steps. Post the number for Poison Control near landlines, or program it into your cell phone. 

As family, friends, and caretakers of young children and individuals with intellectual disabilities, it is our responsibility to provide safe and healthy living environments. By implementing effective safety measures, providing access to healthy alternative food items, increasing supervision, and teaching appropriate ways to communicate, we can protect the individuals we support, and help them live long and productive lives.
Jennifer Zarcone, Ph.D., BCBA-D, is May Institute’s Chief Clinical Officer. She can be contacted at

About May Institute
May Institute is a nonprofit organization that is a national leader in the field of applied behavior analysis and evidence-based interventions, serving autistic individuals and individuals with other developmental disabilities, brain injury, neurobehavioral disorders, and other special needs. Founded nearly 70 years ago, we provide a wide range of exceptional educational and rehabilitative services across the lifespan. May Institute operates five schools for children and adolescents with autism spectrum disorder (ASD) and other developmental disabilities, including one in West Springfield, Mass. For more information, call 800.778.7601 or visit