The work group has proposed that this diagnosis be reclassified from Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence to Eating Disorders
DSM-5 Proposed Diagnostic Criteria for Pica
A. Persistent eating of non-nutritive, non-food substances over a period of at least 1 month.
B. The eating of non-nutritive, non-food substances is inappropriate to the developmental level of the individual (a minimum age of 2 years is suggested for diagnosis).
C. The eating behavior is not part of a culturally sanctioned practice.
D. If the eating behavior occurs exclusively in the context of another mental disorder (e.g., Mental Retardation, Pervasive Developmental Disorder, Schizophrenia), it is sufficiently severe to warrant independent clinical attention.
Rationale
It is recommended that Pica be moved from ‘Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence’ and into ‘Eating and Feeding Disorders’ as it can occur across the age range.
Level of change: Clarification.
References: Literature review (Bryant-Waugh, Markham, Kreipe, & Walsh, in press).
Criterion A:
The term ‘non-food’ has been added, as ‘non-nutritive substances’ alone could include foodstuffs with no nutritional value, such as diet soda.
Level of change: Clarification.
References: (none – based on Work Group discussion and consensus).
Criterion B:
‘Non-food’ added as above. The statement in parentheses ‘a minimum age of 2 years is suggested for diagnosis’ has been included to clarify that pica is not an appropriate diagnosis in young infants (in whom mouthing of objects including non-nutritive, non-food substances is developmentally normal) and to be consistent with ICD-10.
Level of change: Clarification.
References: Literature review (Bryant-Waugh et al., in press).
Criterion C:
‘During the course of’ has been changed to ‘in the context of’ to retain consistency with parallel criteria for Rumination Disorder and Avoidant/Restrictive Food Intake Disorder and because two of the examples given (Mental Retardation and PDD) do not really run a course.
Level of change: Clarification.
References: (none – based on Work Group discussion and consensus).
Literature Cited:
Bryant-Waugh R, Markham L, Kreipe RD, et al.: Feeding and Eating Disorders in Childhood. Int J Eat Disord, in press.
Severity Criteria:
Severity of medical or psychosocial problems associated or potentially associated with the disorder:
0: None
1: Mild (subthreshold)
2: Meets diagnostic criteria
3: Moderate
4: Severe
Pica
A. Persistent eating of nonnutritive substances for a period of at least 1 month.
B. The eating of nonnutritive substances is inappropriate to the developmental level.
C. The eating behavior is not part of a culturally sanctioned practice.
D. If the eating behavior occurs exclusively during the course of another mental disorder (e.g., Mental Retardation, Pervasive Developmental Disorder, Schizophrenia), it is sufficiently severe to warrant independent clinical attention.