Pica in childhood: concurrent and sequential psychiatric comorbidity

Abstract Objective: Pica is the persistent eating of non-nutritive, nonfood substances and is associated with serious medical consequences. There has been a lack of research into the psychiatric comorbidities of pica, despite being important for informing clinical care. The current study examines psychiatric comorbidities of pica in childhood and the longitudinal relationship between childhood pica and adolescent eating disorders. Methods: We analyzed data from the Avon Longitudinal Study of Parents and Children study. Pica and psychopathology, assessed with the Development and Well-Being Assessment and the Strengths and Difficulties Questionnaire, were assessed at about 7- and 10-years of age, reported eating disorders (ED) at 14-, 16-, and 18-years of age. We conducted linear and logistic regression models, adjusting for covariates, to identify concurrent psychiatric comorbidities, as well as risk for later EDs. Results . Pica was associated with increased odds of any psychiatric disorder and behavioral disorders in early childhood [OR = 7.30, p < .001 and OR = 5.65, p < .001, respectively] and mid-childhood [OR = 5.75, p < .001 and OR = 10.66, p < .001, respectively], and greater concurrent hyperactivity, conduct problems, peer problems, prosocial and emotional difficulties ( p <.01 across analyses). We did not find evidence pica presence increased odds for concurrent emotional disorders nor for later ED risk. Discussion : The association between pica and psychiatric and behavioral disorders, indicates a likely shared aetiology. Our findings provide insight into the psychiatric characteristics of children with pica and highlight they may require complex behavioral support beyond their eating difficulties. [250] Public Significance (for IJED) This study investigated the relationship between pica (the eating of non-food substances) and mental health conditions in childhood. We found that in childhood, pica was associated with increased odds of having behavioral disorders (e.g., ADHD and conduct disorder) and mental disorder (e.g., anxiety or ADHD) but not emotional disorders (e.g., OCD and depression). Our findings suggest children with pica may require complex behavioral support beyond their eating difficulties.