Pica and dementia: Eating strange or inedible things

Pica (pronounced “pai-kuh”) is a type of eating disorder. It can happen to anyone, but the damage to the brain of people living with dementia can make pica a part of the condition. People with pica consistently eat things that aren’t food or have no nutritional value. This can be anything from paint to clothes to coins. The word pica is not an anacronym, it actually comes from the Latin word for magpie. It is not the same thing as PICA syndrome, which is a kind of stroke.

Some materials are so commonly eaten by people with pica that they have their own subtypes, such as:

• Sapophagia – eating soap
• Trichophagia – eating hair
• Hematophagia – drinking blood
• Geophagia – eating soil
• Xylophagia – eating paper or wood
• Hyalophagia – eating glass
• Emetophagia – eating sick
• Urophagia – drinking urine
• Coprophagia – eating poo

Eating the uneatable can be seen as light-hearted entertainment, from sword swallowing acts to TV programmes like Freaky Eaters, but pica can be really dangerous. As well as nausea and constipation, there can be serious side effects such as tears in the oesophagus or guts, stomach ulcers (which can sometimes lead to sepsis if they burst), suffocation and poisoning.

Tom Quinn, Director of External Affairs at eating disorder charity Beat, explains: “Often, pica isn’t revealed until medical consequences occur, such as metal toxicity, cracked teeth or infections, so it’s really important to look out for early warning signs. Clay, soil, chalk, plaster, plastic and raw food ingredients are just a few examples of items that may be eaten by somebody living with pica.”

What are the symptoms of pica in someone with dementia?

A person with pica will get overwhelming cravings to consume a non-food substance. This often happens when they are stressed or upset, just as many people use smoking, drinking or eating junk food as an emotional crutch. They may also eat the substance absentmindedly, falling into a habit of chewing, licking or playing with it as well as swallowing it.

It’s normal for people with pica to be secretive about their habit. For people with dementia, they may not be fully aware that they are eating something weird, so may be more open about it.

Symptoms you may spot could include:

• You catch them absent-mindedly eating the substance.
• They hide or steal a particular substance a lot.
• You find damage, such as human tooth marks on wooden items or plaster picked away.
• They are experiencing side effects such as severe abdominal pain, vomiting, evidence of intestinal bleeding, coughing and retching.
• They may be showing signs of nutrient deficiencies, such as feeling cold, weight changes, weakness and fatigue.

Mr Quinn says: “People affected by pica don’t usually avoid regular food, meaning they may still be getting all the nutrients that their body needs. However, some non-food items that they consume can be very dangerous, especially if eaten in large quantities. 

“If someone has eaten something that isn’t supposed to be eaten, medical help should be sought immediately. Some people with pica might have nutritional imbalances. If this is the case, it’s worth discussing this further with their GP, as a vitamin supplement might be necessary.”

Does dementia cause pica?

Pica is rare, particularly in adults. It is usually seen in young children. 

When it does happen to adults, it’s often to people who have impaired brain function. This could be due to an injury, disability, mental health issue or dementia.

It can also happen to people who are malnourished (particularly if they have an iron or zinc deficiency) or pregnant. 

A Japanese study found that pica was more prevalent in those with Alzheimer’s disease or semantic dementia, compared to those with another type of dementia.

While there’s not loads of research into pica and what causes it, a prevalent theory is that the damaged or malnourished brain fails to differentiate between edible and inedible substances. The compulsion to eat the substance has also been linked to obsessive compulsive behaviours and to relieving anxiety.

What can I do to stop someone with dementia eating weird stuff?

Mr Quinn assures: “It’s important that families have access to up-to-date information about pica, in order to best support their loved one whilst looking after their own mental health. Information about the person’s health should also be included in their care plans and records, with regular physical health checks in place, to manage the risks associated with pica.
 
“We’d like to reassure people that recovery from an eating disorder is possible. Beat has a variety of training courses about pica, and our helpline is also open 365 days a year for people affected by eating disorders as well as their loved ones.”

See their GP

Mr Quinn says: “If somebody is worried that their loved one may be experiencing pica, we’d recommend reaching out to their GP and/or healthcare provider as soon as possible. Their GP should then be able to refer them to a relevant service to assess their symptoms.

“In the meantime, we’d suggest keeping a look out for potentially dangerous items that their loved one might consume and ensuring these items are stored away safely.”

Remove harmful materials and find safe replacements

If possible, try to help your loved one to open up about why they eat the thing they do. This may take time and they may be embarrassed, but if you can find the honest reason they do it, you may be able to find an alternative, edible food of a similar texture for them to eat instead.

Mr Quinn says: “Providing safe alternatives can help people with pica, for instance food that they can chew, bite and eat which would not cause harm. Distraction and engagement in other activities can also help to keep people with pica manage urges to eat non-edible substances. 

“However, pica is a complex eating disorder which must be treated by specialist treatment, and updating their GP as soon as possible leads to the best chances of making a full recovery.”

Consider care

If you cannot stop your loved one eating dangerous things and you think they may be unsafe to be left alone, it may be time to look into home care or care homes. 

A good first step is to arrange a care needs assessment, these are free from their local council and can establish whether they would benefit from receiving care.

Helplines

If you’re worried about your own or someone else’s health, you can contact Beat, the UK’s eating disorder charity, 365 days a year:

England	0808 801 0677	help@beateatingdisorders.org.uk
Scotland	0808 801 0432	Scotlandhelp@beateatingdisorders.org.uk
Wales	0808 801 0433	Waleshelp@beateatingdisorders.org.uk
Northern Ireland	0808 801 0434	NIhelp@beateatingdisorders.org.uk

For help and support in living with or caring for someone with dementia

Age UK	0800 678 1602
Alzheimer’s Society	0333 150 3456
Dementia UK	0800 888 6678