What is Pica and Why do People Self Harm?
Lesser Known Mental Health Conditions in DSM-IV
Oct 27, 2009
Depression, anxiety disorders and substance abuse are among the commonly known psychiatric conditions listed in the book. The following list takes a look at some conditions the DSM-IV discusses which are much less familiar.
What is Pica?
An unusually named condition called pica describes the habit of swallowing or eating non-food items like dirt, coffee grounds, cigarette ashes and even small objects.
Pronounced PIE-kuh, the DSM-IV says this disorder is usually first diagnosed in infancy, childhood or adolescence. It is often associated with developmental delay according to Psychiatric Times columnist, Dr. Ron Pies, clinical professor of psychiatry at Tufts University.
Pica is also often associated with iron deficiency, but it is not clear whether pica causes the deficiency or is caused by it. The condition rarely extends into adulthood, though it is occasionally noticed in pregnant women.
“It’s a difficult condition to treat,” writes Dr. Pies, “though some evidence suggests that behavioral modification may be helpful.”
In 1996, Stein et al, writing in the South African Medical Journal found some patients responded to treatment with a serotonin re-uptake inhibitor (SRI). The authors explored the relationship between pica and obsessive-compulsive disorder (OCD) and concluded that “at least some cases of pica may usefully be conceptualized as lying within a compulsive-impulsive spectrum of symptoms and disorders."
Why Do People Self-Harm?
People who deliberately hurt themselves by cutting their skin with sharp objects, burning or scratching themselves, pulling their own hair or punching themselves may have a borderline personality disorder, according to Dr. Lorne Korman, psychiatrist at the Centre For Addiction and Mental Health in Toronto, Canada. The Canadian organization called Self Abuse Finally Ends (SAFE) describes self-harm as a “pathological attempt to relieve stress.” SAFE says self-injury usually begins in adolescence and is often the result of childhood abuse.
Self-harm is not the same as attempted suicide though, according to The British Mental Health Foundation, which says the practice is on the rise in Europe and in the UK. In fact, the injuries are generally inflicted to help the person cope with difficult feelings, or stressful situations - not to end a life.
How Does a Doctor Treat Patients Who Self-Harm?
Commonly, people report a distressing feeling of inner numbness – which may be the painful after-effect of abuse or neglect. The visceral pain brought on by self-injury is one way of making them feel alive and even in-control. Korman says one treatment replaces the stimulation of cutting with cold ice. The startling coldness redirects the senses and offers the visceral feeling patients seek without the damage.
“We have to teach them to soothe themselves or to do other things like go for a walk,” says Korman. “We teach them meditation. We teach them to regain control over themselves.”
