Pica 331
Culture-Related Diagnostic Issues
In some populations, the eating of earth or other seemingly nonn utritive substances is believed
to be of spiritual, medicinal, or  other social value, or may be a culturally supported or socially
normative practice. Such  behavior does not warrant a di agnosis of pica (Criterion C).
Gender-Related Diagnostic Issues
Pica occurs in both males and females. It ca n occur in females during pregnancy; however,
little is known about the course of pica in the postpartum period. 
Diagnostic Markers
Abdominal flat plate radiography, ultrasound, and other scanning methods may reveal
obstructions related to pica. Blood tests and other laboratory tests can be used to ascertain
levels of poisoning or the nature of infection. 
Functional Consequences of Pica
Pica can significantly impair physical functioning,  but it is rarely the sole cause of impair-
ment in social functioning. Pica often occu rs with other disorders associated with im-
paired social functioning.
Differential Diagnosis
Eating of nonnutritive, nonfood substances may occur during the course of other mental
disorders (e.g., autism spectr um disorder, schizophrenia) an d in Kleine-Levin syndrome.
In any such instance, an additional diagnosis of pica should be given only if the eating be-
havior is sufficiently persistent and severe to warrant additional clinical attention.
Anorexia nervosa. Pica can usually be distinguished from the other feeding and eating
disorders by the consumption of  nonnutritive, nonfoo d substances. It is important to note,
however, that some presentations of anorexia nervosa include ingestion of nonnutritive,
nonfood substances, such as paper tissues, as a means of attempting to control appetite. In