DSM-III

Diagnostic Criteria

A. Repeated eating of a nonnutritive substance for at least one month.

B. Not due to another mental disorder, such as Infantile Autism or Schizophrenia, or a physical disorder, such as Klein-Levin Syndrome.

Differential Diagnosis

Infantile Autism, Schizophrenia, and physical disorders

In Infantile Autism, Schizophrenia, and certain physical disorders, such as Klein-Levin syndrome, nonnutritive substances may be eaten. In such instances, Pica should not be noted as an additional diagnosis.

DSM-IV

Diagnostic Criteria

A. Persistent eating of nonnutritive substances for a period of at least 1 month.

B. The eating of nonnutritive substances is inappropriate to the developmental level.

C. The eating behavior is not part of a culturally sanctioned practice.

D. If the eating behavior occurs exclusively during the course of another mental disorder (e.g., Mental Retardation, Pervasive Developmental Disorder, Schizophrenia), it is sufficiently severe to warrant independent clinical attention.

Differential Diagnosis

Developmental level

Before approximately ages 18-24 months, mouthing and sometimes eating of nonnutritive substances are relatively common and do not imply the presence of Pica. Pica is diagnosed only when the behavior is judged to be persistent (i.e., present for at least 1 month) and inappropriate given the individual's developmental level.

Pervasive Developmental Disorder, Schizophrenia, delusional beliefs, and Kleine-Levin syndrome

Eating of nonnutritive substances may occur during the course of other mental disorders (e.g., in a Pervasive Developmental Disorder, in Schizophrenia as a result of delusional beliefs, and in Kleine-Levin syndrome). In such instances, an additional diagnosis of Pica should be given only if the eating behavior is sufficiently severe to warrant independent clinical attention.

Other eating disorders

Pica can be distinguished from other eating disorders (e.g., Rumination Disorder, Feeding Disorder of Infancy or Early Childhood, Anorexia Nervosa, and Bulimia Nervosa) by the consumption of nonnutritive substances.

DSM-5

Diagnostic Criteria

A. Persistent eating of nonnutritive, nonfood, substances over a period of at least 1 month.

B. The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual.

C. The eating behavior is not part of a culturally supported or socially normative practice.

D. If the eating behaviors occurs in the context of another mental disorder (e.g., intellectual disability [intellectual developmental disorder], autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is sufficiently severe to warrant additional clinical attention.

Specify if:

  • In remission: After full criteria for pica were previously met, the criteria have not been met for a sustained period of time.

Differential Diagnosis

Eating of nonnutritive, nonfood substances may occur during the course of other mental disorders (e.g., autism spectrum disorder, schizophrenia) and in Kleine-Levin syndrome. In any such instance, an additional diagnosis of pica should be given only if the eating behavior 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, nonfood 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 such cases, when the eating of nonnutritive, nonfood substances is primarily used as a means of weight control, anorexia nervosa should be the primary diagnosis.

Factitious disorder

Some individuals with factitious disorder may intentionally ingest foreign objects as part of the pattern of falsification of physical symptoms. In such instances, there is an element of deception that is consistent with deliberate induction of injury or disease.

Nonsuicidal self-injury and nonsuicidal self-injury behaviors in personality disorders

Some individuals may swallow potentially harmful items (e.g., pins, needles, knives) in the context of maladaptive behavior patterns associated with personality disorders or nonsuicidal self-injury.

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