Many of us think about food all the time. And in Charleston, there's plenty of reasons to do just that. From high-end restaurants to dives, Holy City chefs and cooks serve up some of the tastiest cuisine in all of America. But imagine that instead of craving Raul's carne en su jugo or the doughnuts Red Drum serves for brunch, you crave dryer sheets. Or corn starch, plastic, foam, clay, or even metal. Sadly, some people do.
The urge to eat nonfood items in large quantities for extended periods of time is the defining symptom of pica, a rare eating disorder. Although it is difficult to determine exactly how many people suffer from it and why numbers may be increasing, pica appears to be on the rise.
Between 1999 and 2009, the rate of pica-related hospitalizations increased 93 percent, according to data from the Healthcare Cost and Utilization Project. In 2008, 1,862 patients were hospitalized for the disease. The number is still a small fraction —only 6 percent — of total hospitalizations for eating disorders, but pica has experienced significantly more growth than any other.
As the number of documented cases increases, so too does the disorder's notoriety. Severe cases have been popularized by shows like TLC's My Strange Addiction. The docu-drama features women like Kailyn, who has consumed 12 remotes and over 5,000 plastic beads by her account, and Adele, who said in one year she had eaten the foam padding from the equivalent of seven sofas.
Then there is the infamous artwork in the Glore Psychiatric Museum, an arrangement of 1,446 items swallowed by a pica patient who died from internal bleeding during surgery. The items include nails, screws, safety pins, and salt and peppershaker tops.
Addictions such as these can be very dangerous, says Charlotte Caperton-Kilburn, a registered dietitian who practices in West Ashley. Ingesting nonfood objects can cause major intestinal blockage and may require intensive surgery. Dental problems can also arise, as well as problems with insulin, particularly in those eating corn starch.
But extreme obsessions, like noshing on plastic or sofa padding, are a small percentage of the already rare disease. Most o ften, cravings for seemingly bizarre substances are a result of nutrition or vitamin deficiencies, Caperton-Kilburn says.
"We used to think about it being in underprivileged and undernourished communities. People would eat the paint on the walls and they would get lead poisoning or if it was a child they would develop mental problems," Caperton-Kilburn says.
Even these cases are rare, says Ashleigh Ricevuto, a registered dietitian at the Medical University of South Carolina. Ricevuto works in the prenatal wellness clinic, an area of the hospital that sees the most pica patients.
Pregnant women account for many cases of pica, since they are more likely to become iron deficient. "Most of the time they just start craving soil or laundry starch, and they don't know they have [pica]," Ricevuto says.
The first thing Ricevuto recommends when a person reports signs of pica is a blood test. Often, vitamin supplements will eliminate all of the symptoms, but she also tells patients to substitute food like frozen grapes or frozen drinks for the unhealthy substances if a patient has developed a habit or oral fixation.
For some, however, the answer is not so easy. The behavior can be an associated with psychological disorders, such as obsessive-compulsive disorder or attention deficit hyperactivity disorder.
"It also ends up being something that relieves anxiety or tension for those people. That is why it becomes so compulsive and they continue to do it," Caperton-Kilburn says. "Sometimes it is just because people enjoy the taste, the texture, or the smell of the things they are eating and that is where they start."
Depending upon the addiction, Caperton-Kilburn says psychotherapy can be a good option "to retrain people to realize that yes, it is a behavior that is ingrained." In some cases, Caperton-Kilburn has seen research that indicates commonly used anti-depressants like SRIs and SSRIs have been proven effective.
However, one of the most difficult parts of treating pica is secrecy. Because the symptoms of the disease can be taboo or embarrassing, it often goes unreported, and sufferers can go to great lengths to hide it from family and friends.
"If no one is asking them about their behavior," Caperton-Kilburn says, "they are certainly not going to report it, even if they feel like it's not normal what they are doing."