Eating of nonnutritive, nonfood substances may occur during the course of other mental disorders (e.g., autism spectrum disorder, schizophrenia) and in Kleine-Levin syndrome.
In any such instance, an additional diagnosis of pica should be given only if the eating be- havior is sufficiently persistent and severe to warrant additional clinical attention.
Anorexia nervosa. Pica can usually be distinguished from the other feeding and eating disorders by the consumption of nonnutritive, nonfood substances. It is important to note, however, that some presentations of anorexia nervosa include ingestion of nonnutritive, nonfood substances, such as paper tissues, as a means of attempting to control appetite. In such cases, when the eating of nonnutritive, nonfood substances is primarily used as a means of weight control, anorexia nervosa should be the primary diagnosis.
Factitious disorder. Some individuals with factitious disorder may intentionally ingest foreign objects as part of the pattern of falsification of physical symptoms. In such in— stances, there is an element of deception that is consistent with deliberate induction of in- jury or disease.
Nonsuicidal seIf-injury and nonsuicidal seIf-injury behaviors in personality disorders.
Some individuals may swallow potentially harmful items (e.g., pins, needles, knives) in the context of maladaptive behavior patterns associated with personality disorders or nonsuicidal self-injury.
Disorders most commonly comorbid with pica are autism spectrum disorder and intellec- tual disability (intellectual developmental disorder), and, to a lesser degree, schizophrenia and obsessive-compulsive disorder. Pica can be associated with trichotillomania (hair— pulling disorder) and excoriation (skin-picking) disorder. In comorbid presentations, the hair or skin is typically ingested. Pica can also be associated with avoidant/ restrictive food intake disorder, particularly in individuals with a strong sensory component to their pre- sentation. When an individual is known to have pica, assessment should include con- sideration of the possibility of gastrointestinal complications, poisoning, infection, and nutritional deficiency.
Diagnostic Criteria 307.53 (F9821)
A. Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
B. The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g.. gastroesophageal reflux, pyloric stenosis).
C. The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.
D. It the symptoms occur in the context of another mental disorder (e.g., intellectual dis- ability [intellectual developmental disorder] or another neurodevelopmental disorder), they are sufficiently severe to warrant additional clinical attention.
Specify it:
In remission: After full criteria for rumination disorder were previously met, the criteria have not been met for a sustained period of time.