What is pica and rumination disorder? diagnosis and treatment approaches

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KLINIK PSIKIYATRI DERGISI-TURKISH JOURNAL OF CLINICAL PSYCHIATRY, vol.22, no.3, pp.347-354, 2019 (ESCI) identifier identifier


Pica and rumination disorder are described under the heading of nutrition and eating disorders in Diagnostic and Statistical Manual of Mental Disorders 5th ed. In children and adolescents there is limited epidemiological data for both disorders. Psychosocial and biochemical factors come to the forefront in etiology. Particularly low socioeconomic level, neglect, abuse, inadequate maternal-child interaction and strong association of disorders have been shown. The relationship between pica and micronutrient deficiencies, including iron, calcium and zinc, is well defined. Children with developmental disabilities are more at risk for many problem behaviors, but pica is especially important because it can result in life-threatening medical consequences. It is thought that oesophageal reflux may be a predisposition to ruminating behavior but is the main cause of psychosocial problems and / or impairment of operant conditioning. Even though spontaneous remission is frequent in rumination disorder, secondary complications such as progressive malnutrition, dehydration and resistance to diseases may develop. Currently, no evidence-based treatment protocol exists specifically for pica and rumination disorders. The treatments emphasize psychosocial, environmental, behavioral and family guidance approaches. There is a need for randomized controlled trials to develop strong clinical recommendations for the treatment of these disorders. Suggestions for future research include identifying supported therapies and prevention programs focused on early determinants of nutrition and eating disorders. This review, based on recent research, summarizes diagnostic criteria, clinical features and treatment options for both disorders.