(PS5-66) Pica in childhood: concurrent and sequential psychiatric comorbidity

Abstract Text:

Objective: Pica is the persistent eating of non-nutritive, nonfood substances and is associated with serious medical consequences. Although case studies and hypothesized theoretical models have linked pica to psychopathology, including potentially as a compulsive behavior in obsessive compulsive disorder (OCD) or an impulsive behavior associated with attention-deficit/hyperactivity disorder (ADHD), there is a lack of empirical large-scale studies investigating the association between pica and psychopathology. Large scale studies assessing psychological comorbidities of pica are critical 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. In the current study, pica corresponded to the greatest mean difference in hyperactivity out of the behavioral subscales measured by the SDQ. These findings supports the theory that pica may be associated with greater ADHD and impulsivity, as children with pica in the current study reported greater hyperactivity—a key trait of ADHD—than children without pica. The current study shows stronger support for a relationship between hyperactivity and pica rather than compulsivity and pica, as cross-tabulation cells counts were low between pica and OCD and did not permit logistic regression analyses potentially indicating low-comorbidity. The current results also suggest pica is associated with broad effects on psychopathology including peer relations, pro-sociality, emotional, and behavioral health. Our findings provide preliminary evidence of the association of pica with behavioral disorder diagnoses and a broad range of childhood psychopathology. This furthers our knowledge of the clinical presentation of this understudied feeding & eating disorder and highlights the complex needs of individuals living with pica and indicates the need for psychiatric screening when pica presents clinically.