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CHAPTER I THE PROBLEM AND ITS BACKGROUND INTRODUCTION Pica has been considered as the ingestion of inedible substances

or atypical food combinations. Pica has been reported widely in pediatric age group and often found to be co existing with obsessive compulsive or major depressive disorder. Reports of pica in elderly age group are relatively uncommon and rarely does it have an adult onset. In this article we present a case of adult onset pica. A young lady with unusual sensation in her abdomen was found to consume iron nails over years and there was history of dyspareunia since her marriage three months back. On uery it was known that the lady is having same sex relationship over years. !here uni ue conglomeration of cultural" psychodynamic and physiological determinants which together is responsible for this unusual habit of this lady. #oreover the onset of the disease at a late age and different psychodynamic issues make the case all the more interesting. $hether the pica is an eating disorder or obsessive compulsive disorder is still controversial. Pica is eating something that is not food%notably in large uantities and on a regular basis. $hat do people who have pica eat& !he list is a long one' ashes" balloons" chalk" metal" grass" crayons" insects" sand" soap" paste" string" plastic" baby powder" paint chips" wallboard" and more. (ome of these strange nonfood)food obsessions have names of their own. *eophagia is clay eating. Pagophagia is ice eating" Pica gets its name from the +atin word for magpie. #agpies eat just about anything" but humans who eat nonfoods are choosier. !he compulsion usually focuses on a single item. ,octors have operated on people whose intestines were blocked with nuts"

(ome pica behaviors involve substances that are foods but are not usually eaten alone or in large uantities. (ome reports estimate that clay eating is a daily practice in over two hundred cultures worldwide. 6or example" people in some parts of 7igeria eat kaolinite 8a form of clay9 to combat diarrhea. !he clay actually forms a protective coating in the lining of the intestine and binds bacteria there" thus relieving diarrhea. Ingesting one)half box or more of cornstarch daily releases enough sugar into the blood stream to send blood glucose levels rocketing. /lay eating and soil eating were common in the 0122s" especially among slaves in the (outh. (outherners mailed bags of hometown clay to their friends and relatives who moved north. . $hy do people eat nonfood substances& In some cultures" pica is practiced for medicinal purposes and may actually have some value. People with amylophagia may eat two or three boxes of cornstarch a week. In the 0342s and 0352s" the practice was so popular that clay)filled lunch bags were sold at Alabama bus stops as snacks for travelers. People who regularly consume twigs" newsprint" or bathroom deodori-ers are not as rare as you might guess. 6or example" small amounts of cornstarch thicken gravies and fruit pies. In the .nited (tates today" eating clay is considered pica" but in past centuries" it was not.bolts" or screws. BACKGROUND OF THE STUDY Pica is defined" in part" by cultural norms. !hat can trigger diabetes" especially in pregnant women.

!o find out how common pica truly is" . (ome pregnant women eat clay because they believe it will relieve morning sickness. (omewhere between a third and a half reported eating nonfood items. . !hey believed that failure to satisfy their pica cravings would lead to miscarriage" illness" or an unhappy baby.llen (impson and her colleagues in /alifornia asked pregnant <ispanic women about their eating habits. People don:t tell" either because they are embarrassed or because they see nothing odd about it. Others said they =couldn:t help themselves.= #ost thought the pica was good for them or for the babies they carried. !heir favorites included dirt" ashes" clay" and magnesium carbonate" a mineral sold in blocks in #exican pharmacies as a laxative.= REVIEW OF RELATED LITERATURE . (ome mental health professionals categori-e pica as an obsessive)compulsive disorder. =$omen who ate tar lived next door to women who ate laundry bluing who lived next door to women who ate dirt. !hat term describes people who feel powerless to stop a behavior they know is bi-arre" even risky. !he researchers could find no particular pattern in pica preferences. (ome of the women said they simply liked the taste" texture" or aroma of the nonfood substances.octors can:t always tell whether their patients are consuming nonfoods. Others claim pica behavior)such as crunching the frost that collects in the free-er)eases tension and anxiety.Other people say they eat clay" starch" or some other substance simply because they enjoy the taste" texture" or smell.

HISTORICAL OVERVIEW !he term pica comes from the +atin word meaning magpie" presumably named after this bird:s peculiar eating behaviors. (ome docters say it is a response o stress " or a habit disorder . It can also cuase you to need dental work " phosphors intoxication cuased by the match heads " or environmental poising from the led or mercury . (ome of the cravings that you get from this disorder are clay " dirt " cornstarch " laundary starch " baking soda " chalk " buttons ice " paper " dried paint " ciggerette buts " burnt matches " ashes " sand " soap " toothpaste " oyster shells " or ven broken crockery . !he most common time for the disease to acuarr is while a woman is pregnant or nursing . If Pica is detected you might have iron deficiency " spooning of the nails " which is the nail getting thinner " and the edges start rising . It also craves the substances that the Pica patients do . !he eating of clay and dirt has been known to relieve nausea " control diarrhea " increase salivation " remove toxins " and alter odor or taste perception . !his disease can cuase iron deficiecny .Pica is a serious eating disorder that can cuase you to need surgery . (ome of the other symptoms that aren:t as obvious are fatigue " lightheadedness " or shortness of breath . (tarch is also linked to iron deficiency because t lacks minerals . !he magpie shows an indiscriminate preference . !he woman who get this disease craves 5 out of the 01 things that are craved with this disease . !hey named this disease after the latin word magpie " magpie is a bird " they named it after the bird because they have a weird eating habit .

FOREIGN STUDIES +ittle is known about what causes the disorder" and researchers said they can only speculate as to why pica hospitali-ations have jumped. !hirty)one percent of childhood pica cases in @223 were found in autistic children" said study researcher $illiam . /urrently" one of every 002 children in the . Pica behavior still occurs almost ritualistically in some contemporary cultures. ?etween @22@ and @225" the number of 1)year)olds diagnosed with autism rose 4B percent" according to the /enters for . It has been practiced as part of religious ceremonies" magical beliefs" and attempts at healing. !he increase .for foods and nonfoods. /lay ingestion has been used for medicinal purposes by many cultures" possibly to influence the microorganisms in the gut or to help relieve intestinal spasms.nited (tates has an autism spectrum disorder.ncinosa" senior economist with the Agency for <ealthcare Research and Auality. Pica was first addressed in a medical book in 045>" where geophagia was described in pregnant women and in children. *eophagia has been described as a universal act throughout the 0122s in the southern . Pica of dirt and clay was acknowledged by the *reeks and the Romans and was recorded in a 0>th century +atin work. ?ut it may be due" at least in part" to the recent rise in the number of diagnosed autism cases. .uring the 0342s and 0352s" geophagia was so common in the south that one could purchase small brown bags of clay outside bus stops.isease /ontrol and Prevention.nited (tates" principally among slaves" and is still a conventional behavior in numerous cultures.

!here were about @3"422 such hospitali-ations in @221)23" up @C percent from the years 0333)@222. .ncinosa said. . THEORETICAL FRAMEWORK Pica' facts and theories • !he person must regularly eat these craved substances for a month or more before a diagnosis is given. =!hat population wasnDt really affected by the big movement from the eating disorder centers= to reduce hospitali-ations" he autism may be due to an increase in diagnosis" or it may be because more children are in fact developing autism. <ospitali-ations involving eating disorders in general have increased over the last decade" the study showed.ncinosa said. ?ut with pica" =it:s a different population"= .ncinosa said these decreases were probably due to a big effort from the outpatient rehabilitation clinics to reduce hospital admissions and readmissions for eating disorders. #eanwhile" hospitali-ations over the decade decreased 0> percent for anorexia" and 0C percent for bulimia" according to the study. #ost of the patients found to have eating disorders entered the hospital for other reasons" including depression and alcohol)related disorders. !he new study includes data from about 32 percent of the hospital records in the country" .

(tress may be a precipitating factor" especially the stress of dieting when the person tries to relieve hunger and cravings with non)food substances. • In some cases" pica is related not to dietary deficiencies but to folk traditions passed on in families or ethnic groups. !hose in lower socioeconomic groups seem to have more of these cravings. • . • Others believe that eating dirt will help them incorporate magical spirits from the .epending on the population" -ero percent to sixty)eight percent of pregnant women have pica.arth into their bodies. • (till others believe that certain kinds of clay will suppress morning sickness when eaten. • Perhaps ten to twenty percent of children have pica at some time before adulthood.• !he name =pica= comes from the +atin word for magpie" a bird that is famous for eating anything and everything. • • (ome children with pica may be imitating a pet dog or cat. . • (ome people treat clay or dirt eating as a part of daily routine" somewhat like smoking.

!he person must be alert for symptoms 8pain" lack of bowel movements" abdominal bloat and distention9 that suggest the substance has formed an indigestible mass that has blocked the intestines. Pregnant women" for example" have given up pica after they were treated for iron)deficiency anemia. If such is the case" immediate medical attention is necessary.• !here is evidence to support the hypothesis that at least some pica is a response to dietary deficiency. . • ?ut other cases of pica can cause dietary deficiencies because the consumed substances block absorption of essential nutrients in the intestines. • If pica is a lifestyle choice that does not harm the individual" and if it is not part of an underlying eating disorder" it can go untreated" but care should be taken to protect against toxic substances 8such as lead in paint and plaster chips9.