text of another mental disorder, a separate diagnosis of pica should be made only if the eating
behavior is sufficiently severe to warrant additional clinical attention (Criterion D).
Associated Features Supporting Diagnosis
Although deficiencies in vitamins or minerals (e .g., zinc, iron) have been reported in some
instances, often no specific biological abnorm alities are found. In some cases, pica comes
to clinical attention only following general medical complications (e.g., mechanical bowel
problems; intestinal obstruction,  such as that resulting from  a bezoar; intestinal perfora-
tion; infections such as toxoplasmosis and toxoca riasis as a result of ingesting feces or dirt;
poisoning, such as by ingestion of lead-based paint).
Prevalence
The prevalence of pica is unclear. Among in dividuals with intellectual disability, the prev-
alence of pica appears to increase with the severity of the condition.
Development and Course
Onset of pica can occur in childhood, adolesce nce, or adulthood, although childhood onset
is most commonly reported. Pi ca can occur in otherwise normally developing children,
whereas in adults, it appears more likely to o ccur in the context of intellectual disability or
other mental disorders. The ea ting of nonnutritive, nonfood substances may also manifest
in pregnancy, when specific cravings (e.g., chalk or ice) might occur. The diagnosis of pica
during pregnancy is only appropriate if such  cravings lead to the ingestion of nonnutri-
tive, nonfood substances to the extent that th e eating of these substances poses potential
medical risks. The course of th e disorder can be protracted an d can result in medical emer-
gencies (e.g., intestinal obstruction, acute weight loss, poisoning). The disorder can poten-