PICA

Oral interview: A thoughtful conversation with the consumer is the only way to gain an insight into pica practices. While doing so, it is very important to be non-judgmental and avoid comments or inappropriate questions. Tolerance and compassion are key elements of the interview.

Once the respondent feels comfortable, further questions regarding the type of pica substance taken, the source of the substance, the associated cost can be raised. It is essential to obtain maximal information regarding the substance consumed, in an accurate manner. The consequences of toilet tissue paper consumption are notably different from that of eating pages of a novel. In the above scenario, if the pica substance is typically described as paper, it is of no value either for diagnosis or treatment.

The amount of money spent on getting hold of a pica substance reflects the intensity of desire and the extent of craving in a particular individual. It is not uncommon to see persons from low income families spend enormously large amounts of money on purchasing pica substances.

It is also important to know how a pica substance is prepared before consumption. Most people sift, grind, pan-fry, bake or moisten the substance before eating. This step is valuable in understanding the potential consequences / health risks that may result from pica behavior.

Depending on the level of comfort between the respondent and interviewer, further questions can be addressed either at the same session or in a subsequent meeting. Knowledge regarding the storage of the material is crucial to understand the nature of microbial or parasitic profile. For example, storage of clay in a moist form makes it ideal for maintaining hookworm eggs in a viable state and promoting fungal growth. On the other hand, minimal or no storage implies immediate availability.

It is often impossible to elucidate reasons for consumption of a pica material and factors that make it appealing to the consumer. Although seemingly straightforward, this question is frequently difficult and often impossible to answer – possibly because the individual may be too embarrassed to discuss about it or simply because may have never tried to find an answer!!! Most people report that they “don’t know” or just brush it off with an “I like to eat it because I crave it” response, when confronted.

Factors such as age, gender and other specific health details of the pica individual (example pregnancy status) have to be taken into consideration. Infact, the association between pregnancy and pica is so strong that the craving for earth may even be regarded as a sign of pregnancy. Pregnant women and children who present with anemia should be thoroughly evaluated for accompanying nutrient deficiencies and pica tendencies. Identification of such at-risk-individuals is crucial in the diagnosis and treatment of pica.

Last but not the least, it is also imperative to understand about other non-food substances that pica individuals crave and if so, under what circumstances? Typically, those who eat earth are frequently consumers of other non-food substances.