Abstract
Pica is the occurrence of at least one experience of non-food substance ingestion and has long been documented in the literature as a “feature of autism” 1 with recent estimates in children ranging in prevalence from 14% to 28% of autistic children without and with co-occurring intellectual disability, respectively. 2 Few studies of adults exist, 3 and pica itself, as an eating disorder, has also been largely overlooked in recent calls for action related to eating disorders in autism. 4
This research gap has been perpetuated by medical coding biases that restricted coding of “pica” as a condition occurring in infancy or childhood (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] F98.3), even though the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 5 was modified in 2013 to include pica as an appropriate diagnosis in adulthood. In the United States, this gap may potentially be reduced with the recent Centers for Medicare and Medicaid update to ICD-10-CM Fiscal Year 2025 (FY25), which added a diagnosis code for pica in the adult population (F50.83) as of October 2024 for FY25. 6 We wish to educate researchers and practitioners of this clinical change in medical coding and encourage research on pica and related eating disorders among autistic adults and other adults with developmental disorders.
Why Pica Is Important to Understand
Pica poses numerous health risks, including lead poisoning, blockage of the gastrointestinal tract, and infections. 7 Individuals who practice geophagy (ingestion of dirt or clay) may unintentionally expose themselves to lead or lead-based paints present in the soil, which can cause severe poisoning and kidney damage. 8 Infections may arise in individuals who consume soil, uncooked foods, or bodily fluids due to microorganisms present in these materials, potentially leading to sepsis or other life-threatening conditions. 8 Individuals who ingest sharp objects may experience internal lacerations and rupture of organs within and surrounding the digestive tract, necessitating prompt care. Pica may also induce dental problems and general gastrointestinal issues, such as constipation and ulcers.3,9 Unfortunately, pica has also been known to cause death in both children and adults with developmental conditions, prompting a need for increased awareness to monitor and prevent such outcomes. However, because most of the literature on adults is outdated or considered low levels of evidence, future work to both understand the prevalence and document effective treatment is required.
Call for More Research on Pica in Adults
We applaud the addition of an ICD-10-CM diagnostic code for adults (F50.83). We call on practitioners and researchers to understand and address this gap in evidence. We suggest that practitioners working with adults on the autism spectrum and with other developmental disabilities use this code when medically indicated. We call on researchers with access to claims or electronic health record data to consider including this code in future studies. Eating disorders are generally believed to be among the most high-mortality diagnoses of all mental health conditions, 10 and pica is no exception. 11 We must address this gap for improved care and quality of life of individuals on the autism spectrum, no matter their age.
Footnotes
Author Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this article.