107 - 6B84 Pica

6B84 Pica

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Boundary with other mental disorders Individuals experiencing a depressive episode may present with a lack of appetite or reduced interest in eating, and weight loss associated with depressed mood and other cognitive-behavioural or neurovegetative symptoms of a depressive episode. Similarly, individuals experiencing manic, mixed or hypomanic episodes may exhibit reduced interest in eating together with other features of a bipolar disorder. Avoidance or restriction of food intake with effects on weight and nutrition can also be present in schizophrenia and other primary psychotic disorders due to loss of appetite or due to paranoid ideas (e.g. fear of being poisoned). Motivations for restricted eating should be investigated carefully as a part of a complete mental health assessment in order to distinguish among these conditions. An additional diagnosis of avoidant-restrictive food intake disorder is generally not warranted if the restriction of food intake is fully accounted for by another mental disorder. Boundary with other medical conditions Avoidant-restrictive food intake disorder should not be diagnosed if the eating disturbance is entirely accounted for by a gastrointestinal disorder or another medical condition that leads to reduced hunger, restricted eating or weight loss (e.g. food allergies, infectious diseases, cancer, hyperthyroidism). Pica Essential (required) features • Regular consumption of non-nutritive substances, such as non-food objects and materials (e.g. clay, soil, chalk, plaster, plastic, metal and paper), or raw food ingredients (e.g. large quantities of salt or corn flour) is required for diagnosis. • The ingestion of non-nutritive substances is persistent or severe enough to require clinical attention. That is, the behaviour causes damage or significant risk to health or impairment in functioning due to the frequency, amount or nature of the substances or objects ingested. • Based on age and level of intellectual functioning, the individual would be expected to distinguish between edible and non-edible substances. In typical development, this occurs at approximately 2 years of age. • The symptoms or behaviours are not a manifestation of another medical condition (e.g. nutritional deficiency). Boundary with normality (threshold) • It is normal for infants and very young children to put non-food objects in their mouths as a means of sensory exploration. The diagnosis of pica should not be applied to this phenomenon. 6B84 Feeding and eating disorders | Pica

415 Feeding and eating disorders • Many pregnant women crave or eat non-nutritive substances (e.g. chalk or ice). In addition, the eating of non-nutritive substances is a culturally sanctioned practice among certain groups. A diagnosis of pica should only be assigned to such behaviour if it is persistent or potentially dangerous enough to require specific clinical attention. Course features • Pica can be episodic and variable, or chronic and continuous. When variable, consumption of non-nutritive substances may be associated with increased levels of stress or anxiety. Developmental presentations • Onset of pica can occur across the lifespan, but is most commonly observed in childhood. Culture-related features • In some cases, eating of non-nutritive substances may be a culturally sanctioned practice. In these cases, consumption of the non-nutritive substance is thought to have some health, spiritual or social benefit. In parts of Africa and certain rural areas of the United States and India, for example, the eating of clay or earth (geophagia) can be a culturally accepted practice. Pica should not be diagnosed in such cases unless the quantities ingested are large enough to require clinical attention. Sex- and/or gender-related features • The prevalence of pica is similar among males and females. • Although females can be diagnosed with pica during pregnancy and the postpartum period, a diagnosis should only be assigned if consumption of non-nutritive substances is persistent or potentially dangerous enough to require specific clinical attention. Feeding and eating disorders | Pica