Allotriophagy is a type of eating disorder characterized by an irresistible desire to taste, eat something inedible or raw foods that require heat treatment. It is manifested by eating charcoal, chalk, clay, wood, sand, soil, ice, tooth powder, small metal objects, raw dough, minced meat, cereals. The disorder develops with hormonal changes, deficiency of trace elements and vitamins, some mental pathologies. It is diagnosed by the conversation method. Treatment includes behavioral and family psychotherapy, drug correction.
F50.8 Other eating disorders
Allotriophagy has many synonyms: picacism, pica, parorexia, perversion of taste, perversion of appetite. The term originated from the ancient Greek language, translated as “eating alien, inappropriate.” For the first time, allotriophagy was described by Hippocrates, currently it is included in the International Classification of Diseases of the 10th revision, encoded by the subheadings “Eating inedible in adults” and “Eating inedible in infants and children”. The prevalence among adults is less than 1%, among children of early and preschool age – 10-32%. The disorder is more often diagnosed with intellectual disabilities, in patients with low socio-economic status.
Causes of allotriophagy
The determination of etiological factors of allotriophagy is of great importance when making a prognosis and selecting treatment methods (psychotherapy, the use of medications, changes in the living environment). The causes of the disorder can be divided into three large groups: physiological, social and psychological. The main ones among them are:
- Pathological relationships. The development of allotriophagy is promoted by mistakes in upbringing (demanding, disrespectful attitude), neglect of children, authoritarianism of the spouse, violence. The child’s symptoms sometimes occur in the absence of toys, hobbies, parents’ attention.
- Psychological trauma. The debut of an eating disorder can be triggered by a strong emotional shock. A change in food preferences occurs after the death of a loved one, an act of violence, participation in a military conflict, or a catastrophe.
- Unbalanced nutrition. The desire to eat inedible occurs with a specific deficiency of macronutrients, amino acids, vitamins, trace elements. So, the widespread desire to gnaw chalk is provoked by a lack of calcium.
- Socio-cultural traditions. The use of inedible substances can contribute to the peculiarities of culture. For example, the northern peoples eat raw meat, drink fresh animal blood.
- Hormonal imbalance. Manifestations of allotriophagy are often observed in pregnant women and adolescents. Perverted appetite is based on a change in the production of hormones that affect olfactory and taste perception.
- Mental disorders. Patients with schizophrenia, mental retardation, autism are unable to critically evaluate and control their actions. Allotriophagy in this group of patients occurs as a manifestation of inappropriate behavior.
The combined influence of predisposing factors and causes of the disorder plays a key role in the pathogenesis of allotriophagy. The biological basis may be metabolic disorders (hypothalamic-pituitary), an imbalance in the metabolism of mediators and biogenic amines (serotonin), frontal dysfunctions that reduce arbitrary control of behavior. At the external level, the principles of learning operate. Allotriophagy develops according to the type of conditioned reflex reaction: eating, licking, gnawing of inedible relieves emotional tension, eliminates physiological discomfort. The psychological factors contributing to the formation of pathology include affective lability, impulsivity, a decrease in the ability to control drives and impulses, a low threshold of stress resistance.
Depending on the substance eaten, there are many subtypes of the disorder: coprophagia (feces), emetophagia (vomit), hematophagia (blood), urophagia (urine), onychophagia (nails), dermaphagia (skin), trichophagia (hair), geomelophagia (raw potatoes), foliophagia (inedible parts of plants), xylophagia (wood) and others. A more general classification includes three types of allotriophagy:
- Eating inedible items. This type of disease in ICD 10 is classified under the heading “Eating inedible inorganic origin”. Patients eat sand, stones, nails, coins, glue.
- Eating inedible items. The disorder is included in the heading “Eating inedible (perverted appetite)”. Patients consume organic substances – coal, chalk, animal food.
- Eating raw foods. It is also a variant of perversion of appetite. Minced meat, raw dough, and fish become food.
Symptoms of allotriophagy
The main sign of the disorder is eating objects and substances that are not intended or not ready for ingestion. With an acute desire to feel the taste or consistency, patients lick, chew for a long time, gnaw the object, then swallow or spit out. Swallowing small objects can be associated with emotional stress and uncontrolled compulsive actions. This option is observed in schizophrenia, severe psychopathies in moments of affect. In children, allotriophagia most often develops at the age of 1.5 to 6 years. Small patients consume inedible substances in addition to food or instead of it. Often, the intake of substances occurs in unsafe volumes, requires immediate intervention by doctors.
Allotriophagy can lead to intestinal obstruction, perforation of the walls of the gastrointestinal tract – complications requiring immediate surgical intervention and associated with the risk of death. This is especially true in cases of swallowing hard and sharp objects (crushed glass, paper clips, needles). Less serious but more common consequences include parasitic diseases, gastrointestinal infections and food deficiency. There is a high risk of infection when eating animal feces, soil, sand. The use of compounds containing lead, mercury, zinc is associated with the risk of poisoning, toxic damage to the central nervous system (especially at an early age).
The diagnosis is established by a psychiatrist based on the data of a clinical conversation with the patient and relatives. The survey pays attention to the methods of education, cultural and religious affiliation of the patient’s family, the presence of traumatic situations, hormonal and neurological diseases. The examination is carried out comprehensively, along with allotriophagy, concomitant disorders (schizophrenia, oligophrenia, autism) are determined. In the process of diagnosis , the doctor identifies the presence of a number of criteria:
- Duration of symptoms. Perverted eating is observed for 1 month or more. This criterion is proposed by the authors of the DSM-V classification.
- The frequency of symptoms. The danger of the substance used is assessed, its share in the daily diet. In childhood, abnormal nutrition can completely replace normal meals.
- Adequacy of symptoms. The criterion refers to cases of eating a raw product, which in the usual sense requires heat treatment. It is important to take into account the compliance of the patient’s diet with the accepted rules of nutrition in the microenvironment (family, tribe).
Treatment of allotriophagy
Assistance to patients is carried out by methods of psychotherapy, as well as the selection of medical treatment. The main goal is to eliminate the cause of the disorder, replace the pathological eating habit with normal behavior. A comprehensive therapeutic approach is implemented by a psychiatrist, psychotherapist, endocrinologist, neurologist, nutritionist. The following methods are used:
- Behavioral psychotherapy. It is common to use the technique of delineation – the organization of space and the mode of the day in such a way as to avoid contact with inedible matter. Aversive therapy is used to eliminate an undesirable habit – punishment for undesirable behavior. Positive reinforcement contributes to the development of the habit of eating right.
- Family psychotherapy. Family members, especially parents, are told about the mechanisms and causes of allotriophagy. The correction of destructive relationships that are a source of stress and support the disorder is carried out. The psychotherapist gives individual recommendations on the organization of the daily regime, the rules of eating. It is often enough for children to reduce the time of watching TV, computer games, add toys and creative materials to the room.
- Medical correction. No special drugs have been developed for the treatment of allotriophagy. Hormonal agents are used for endocrine disorders, vitamin and mineral complexes, specific drugs that eliminate deficiency are used for unbalanced nutrition and lack of nutrients. Patients with emotional instability, tension, anxiety are prescribed anxiolytics, sedatives, antidepressants.
Prognosis and prevention
With complex timely treatment, the outcome of allotriophagy is positive – patients manage to return to normal nutrition, get rid of cravings for eating unsuitable substances. In severe mental illnesses, the prognosis may be unfavorable. The main preventive measures are a healthy diet and friendly, open relationships in the family. It is important to instill a culture of eating from childhood (regime, table setting, set of dishes and products). It is necessary to demonstrate a positive attitude to food – admiration for the taste and smell, gratitude to the cook. During the meal, quarrels and conflicts should be avoided, it is forbidden to use food as a means of manipulation, punishment for undesirable actions.