Feeding and Eating Disorders I

The word Pica comes from the Latin word for ‘Magpie,’ a bird known for eating almost anything. A psychological disorder, it is characterized by an appetite for substances that are largely non-nutritive. The substance may be biological such as hair (trichophagia) or feces (coprophagia), natural such as ice (pagophagia) or dirt (geophagia), and otherwise chemical or manmade items. It can occur during pregnancy when the mother may develop specific cravings involving soil, chalk, or ice. An abused child who is not adequately nourished may eat nonfood substances.

It is developmentally normal for infants to put objects in their mouth, which may lead to accidentally ingesting a nonfood substance. For a diagnosis of Pica, a minimum age of 2 years is suggested, with the persistent eating of nonnutritive, nonfood substances over a period of at least one month. What constitutes a non-nutritive nonfood substance may vary by culture, so it is important to obtain a “culture history.”

Pica is often co-morbid with other mental disorders and may be seen in Autism Spectrum Disorder, Schizophrenia, Anorexia Nervosa, and non-suicidal self-injury. Individuals feigning a Factitious Disorder may ingest nonfood items in order to imitate the symptoms of a more serious disorder. 

Rumination Feeding Disorder is a functional gastroduodenal disorder in which food is brought up, then re-chewed and re-swallowed, or spat back out. It may be diagnosed when repeated regurgitation of food occurs over a period of at least one month. The repeated regurgitation is not attributable to an associated gastrointestinal or other condition. If the symptoms occur in the context of another mental disorder (e.g., intellectual disability or intellectual developmental disorder, or another neurodevelopmental disorder), they usually warrant additional clinical attention. 

The cause of rumination syndrome is not always clear, but an increase in pressure within the abdominal area is known to play a role. When an individual’s rumination syndrome goes untreated, damage to the esophagus may occur. 

Unlike eating disorders that involve weight management, rumination disorders can affect young infants as well as children and adults with mental disabilities. Young infants often arch their backs and make sucking movements with their tongue to stimulate regurgitation. In a large study done in Sri Lanka, rumination peaked in boys at age 14 while symptoms peaked in girls at age 16. Overall, the rates were relatively consistent between age and sex.

Avoidant/restrictive Feeding Disorder, sometimes called selective eating disorder, is a condition in which people eat only within an extremely narrow spectrum of foods. It is a serious mental health condition that causes the individual to restrict food intake by volume and/or variety. This may be based on appearance, smell, taste, texture, brand, presentation, fear of aversive consequences, lack of interest in food, or a past negative experience with the food. It may lead to nutritional deficiencies, failure to thrive, or other negative health outcomes. 

Avoidant/restrictive Feeding Disorder does not appear to be caused by a concern for body appearance or in an attempt to lose weight. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder or by lack of available food or by an associated culturally-sanctioned practice. 

A diagnosis of Avoidant/Restrictive Feeding Disorder may be made due to behaviors that include:

• An apparent lack of interest in eating food 
• An avoidance based on the sensory characteristics of food
• A significant nutritional deficiency
• A dependence on enteral feeding or oral nutritional supplements
• A marked interference with psychosocial activities
• A concern about aversive consequences of eating, which may be exhibited as significant weight loss or failure to achieve expected weight gain or faltering growth in children

Social Anxiety is an anxiety disorder characterized by an irrational fear or discomfort of being in unfamiliar social situations or social situations outside one’s own home. Individuals may be afraid that they will be judged or criticized by others so would rather stay home. Others become almost panic-stricken simply at the thought of any social setting where they might become the “center of attention,” such as at a birthday or anniversary party. A few may even isolate themselves, stop dating, refuse a proposal of marriage, drop out of school, or even quit a job.