Uncovering the Compulsion Behind Pica: A Case of Obsessive Compulsive Disorder and Geophagia: A Case Report

INTRODUCTION

“Mad with desperation, Rebeca got up at midnight and ate handfuls of earth in the garden’, crying with pain and fury, chewing tender earthworms and chipping teeth with snail bones.”^[1] Pica is defined as the consumption of nonnutritive, nonfood substances for at least one month. It is culturally unacceptable, and the subject must have normal mentation.^[2]

The disorder is named after the magpie (Pica Pica), which is known to store all kinds of nonfood materials. Aristotle named the disorder “Geophagia,” which is the habit of eating earth materials.^[3] A type of pica called Geophagia is frequently linked to iron and zinc deficiencies. But there are also a lot of cultural, psychological, and environmental elements at play. Pica is a prevalent condition in children with intellectual disabilities. It is most frequently connected to pregnancy in adults. Although there are no specific screening tests for pica, a quick and accurate diagnosis can prevent numerous nutritional and psychological consequences. Even after it is diagnosed, there are no recognized cures for pica.^[4]

CASE REPORT

A 15-year-old girl presented to the Psychiatry outpatient department with the chief complaint of eating dried mud and wall paint at home. One year back, after a quarrel with her mother, she was noticed eating mud; she started roughly with two to three pinches for about a year until she felt the urgency to increase the quantity of mud she used to have every day. Conflicts with family and friends triggered her mud consumption. After that, the quantity of mud increased to 40–60 g daily of dry mud. According to her, the mud eating was preceded by a strong desire and relief after eating mud. She increased the consumption to about 100 g of mud every day to manage her anxiety. Although she knew it was inappropriate to eat mud, her craving was so intense that she could not resist eating the mud, which caused her agitation. Over the previous six to seven months, she had reduced appetite. Before, she used to have three meals a day, along with a midday snack. During every meal, she would have two chapattis served with a bowl each of rice, vegetables, and lentils. But now, she simply takes one chapatti and a bowl of vegetables and lentils.

Owing to the increasing frequency and intensity of the problem, her relationship with family members and friends has been disturbed. She has started to remain withdrawn and does not enjoy going out with friends like before. Her appetite has decreased too. She had increasingly developed this habit over the last few years; to such an extent in the last few months that her parents resorted to physical punishment, but with no use. The clinical interview revealed that she has repeated thoughts and images of eating mud and wall scrapings, which are alien, intrusive, and distressing in nature; this does not go away until she does the act. She acknowledged that she doesn’t really enjoy the experience, but is unable to put an end to the activity. The important negative histories elicited to rule out other diagnoses included the absence of childhood trauma, and a detailed description of the patient’s mother’s history of consuming raw lentils and grains was insignificant. Specifically, depression was considered due to the patient’s withdrawal and decreased socialization, which was secondary to obsessive thoughts but was ruled out during the assessment as there was no persistent low mood.

DISCUSSION

Pica is more common in children with nutritional deficiency, psychosocial stress, maternal deprivation, and impoverished family situations. In adults, pica is associated with pregnancy, severe mental impairment, and psychosis.^[5,6] However, there is no single theory accepted universally to explain the etiology of pica. The role of the most widely recognized factor, that is, iron deficiency, is also controversial.^[7] Adolescents without developmental delay raised the possibility that some form of it fit under the umbrella of obsessive–compulsive (OC) spectrum disorder. Both the phenomenology, negative history, and the successful treatment with selective serotonin reuptake inhibitor (SSRI) in our case indicate that it was indeed a case of OCD, which mirrors the findings in some case reports which support the possibility that pica can present as OCD itself.^[7-9] Pica and OCD, along with the manifestation of iron deficiency anemia, underscore the need for comprehensive clinical investigations to elucidate the underlying etiological factors.^[10]

CONCLUSION

As far as I am aware, this may be the first recorded case of OCD with pica in the pediatric age group within the Eastern region of our country. Pica is still a phenomenon whose cause and course of treatment are poorly known. Sometimes, pica may be seen as OCD, especially in individuals who exhibit it immediately.