Strange apetite

I always thought that I was fairly well-balanced. I had a good social life, I ate well and I exercised. That’s all well and good, but the same could be said for many people who (probably unwittingly) are suffering from a medical disorder called pica—an appetite for substances that are largely non-nutritive such as clay, chalk, soap, flour, ice cubes and blood. Turns out my secret predilection for eating small pieces of paper puts me in this category. Actually, the more I thought about it, the more I realised I was ingesting all sorts of weird stuff: pencil erasers, wrist-watch bands, hangnails.

Thankfully, I was by no means a bad case. In 2007, The New England Journal of Medicine reported on an otherwise healthy 18 year-old woman who presented with a five month history of pain in her abdomen. She had lost 18 kg. A physical examination and a subsequent oesophagogastroduodenoscopy (a diagnostic, endoscopic procedure that visualises the upper part of the gastrointestinal tract) revealed an enormous mass occluding almost all of her stomach. The patient had a habit of chewing her hair and what she had swallowed had accumulated over many years. The resulting mass (or bezoar) weighed 4.5 kg and was almost 40 cm in length.

That, however, is nothing. The accompanying photograph shows the stomach contents of an inmate from the State Lunatic Asylum #2 in St Joseph, Missouri (which closed its doors in the early 20th century). The patient died from her wounds during surgery as the doctors attempted to remove the 1446 nails, screws, safety pins, spoon tops and buttons (pictured right) that she had swallowed.

Pica in children is quite common and generally not seen as a disorder. It becomes a problem when the habit is developmentally inappropriate. The small amount of research that has been conducted on pica suggests that it results from a biochemical deficiency, often iron deficiency. Only when a mineral deficiency cannot be identified is pica diagnosed as a mental disorder.

I’m off to seek a second opinion. In the meantime, if you have any strange medicine stories, or would like to comment on pica (I could use the advice), please email me at ben.spencer@mater.org.au.