Avoidant personality disorder FAQ

[tweetmeme source=”ShatterStigma”]

What is avoidant personaility disorder?

People who are diagnosed with avoidant personality disorder desire to be in relationships with others but lack the skills and confidence that are necessary in social interactions. In order to protect themselves from anticipated criticism or ridicule, they withdraw from other people. This avoidance of interaction tends to isolate them from meaningful relationships, and serves to reinforce their nervousness and awkwardness in social situations.

Avoidant personality disorder is one of several personality disorders listed in the newest edition of  the DSM-IV-TR .

What are the symptoms?

It is characterized by marked avoidance of both social situations and close interpersonal relationships due to an excessive fear of rejection by others. Persons with this disorder exhibit feelings of inadequacy, low self-esteem, and mistrust toward others. These people tend to be very cautious when they speak, and they convey a general impression of awkwardness in their manner. Most are highly self-conscious and self-critical about their problems relating to others.

What are the causes?

The cause of avoidant personality disorder is not clearly defined, and may be influenced by a combination of social, genetic, and biological factors. Avoidant personality traits typically appear in childhood, with signs of excessive shyness and fear when the child confronts new people and situations. These characteristics are also developmentally appropriate emotions for children, however, and do not necessarily mean that a pattern of avoidant personality disorder will continue into adulthood. When shyness, unfounded fear of rejection, hypersensitivity to criticism, and a pattern of social avoidance persist and intensify through adolescence and young adulthood, a diagnosis of avoidant personality disorder is often indicated.

Many persons diagnosed with avoidant personality disorder have had painful early experiences of chronic parental criticism and rejection. The need to bond with the rejecting parents makes the avoidant person hungry for relationships but their longing gradually develops into a defensive shell of self-protection against repeated parental criticisms. Ridicule or rejection by peers further reinforces the young person’s pattern of social withdrawal and contributes to their fear of social contact.

Sleep Terror FAQ

[tweetmeme source=”ShatterStigma”]

What is a sleep terror?

The symptoms of sleep terror are very similar to the physical symptoms of extreme fear. These include rapid heartbeat, sweating, and rapid breathing (hyperventilation). The heart rate can increase up to two to four times the person’s regular rate. Sleep terrors cause people to be jolted into motion, often sitting up suddenly in bed. People sometimes scream or cry. The person’s facial expression may be fearful.

People experiencing sleep terror disorder sometimes get out of bed and act as if they are fighting or fleeing something. During this time injuries can occur. Cases have been reported of people falling out of windows or falling down stairs during episodes of sleep terror.

People experiencing sleep terror are not fully awake. They are nearly impossible to bring to consciousness or comfort, and sometimes respond violently to attempts to console or restrain them. In many cases, once the episode is over the person returns to sleep without ever waking fully. People often do not have any recollection of the episode after later awaking normally, although they may recall a sense of fear.

Episodes of sleep terror usually occur during the first third of a person’s night sleep, although they can occur even during naps taken in the daytime. The average sleep terror episode lasts less than 15 minutes. Usually only one episode occurs per night, but in some cases terror episodes occur in clusters. It is unusual for a person to have many episodes in a single night, although upwards of 40 have been reported. Most persons with the disorder have only one occurrence per week, or just a few per month.

What is sleep terror disorder?

Sleep terror disorder is sometimes referred to as pavor nocturnus when it occurs in children, and incubus when it occurs in adults. Sleep terrors are also sometimes called night terrors, though sleep terror is the preferred term, as episodes can occur during daytime naps as well as at night. Sleep terror is a disorder that primarily affects children, although a small number of adults are affected as well.

What causes sleep terrors?

The causes of sleep terror are for the most part unknown. Some researchers suggest that sleep terrors are caused by a delay in the maturation of the child’s central nervous system. Such factors as sleep deprivation, psychological stress , and fever may also trigger episodes of sleep terror.

Phonological disorder FAQ

[tweetmeme source=”ShatterStigma”]

What is phonological disorder?

Phonological disorder occurs when a child does not develop the ability to produce some or all sounds necessary for speech that are normally used at his or her age.

Phonological disorder is sometimes referred to as articulation disorder, developmental articulation disorder, or speech sound production disorder. If there is no known cause, it is sometimes called “developmental phonological disorder.” If the cause is known to be of neurological origin, the names “dysarthria” or “dyspraxia” are often used. Phonological disorder is characterized by a child’s inability to create speech at a level expected of his or her age group because of an inability to form the necessary sounds.

There are many different levels of severity of phonological disorder. These range from speech that is completely incomprehensible, even to a child’s immediate family members, to speech that can be understood by everyone but in which some sounds are slightly mispronounced. Treatment for phonological disorder is important not only for the child’s development to be able to form speech sounds, but for other reasons, as well. Children who have problems creating speech sounds may have academic problems in subject areas such as spelling or reading. Also, children who sound different than their peers may find themselves frustrated and ridiculed, and may become less willing to participate in play or classroom activities.

What causes phonological disorder?

Phonological disorder is often divided into three categories, based on the cause of the disorder. One cause is structural problems, or abnormalities in the areas necessary for speech sound production, such as the tongue or the roof of the mouth. These abnormalities make it difficult for children to produce certain sounds, and in some cases make it impossible for a child to produce the sounds at all. The structural problem causing the phonological disorder generally needs to be treated before the child goes into language therapy. This therapy is especially useful, because, in many of these cases, correction of the structural problem results in correction of the speech sound problem.

The second category of phonological disorder is problems caused by neurological problems or abnormalities. This category includes problems with the muscles of the mouth that do not allow the child sufficient fine motor control over the muscles to produce all speech sounds. The third category of phonological disorder is phonological disorder of an unknown cause. This is sometimes called “developmental phonological disorder.” Although the cause is not known, there is much speculation. Possible causes include slight brain abnormalities, causes rooted in the child’s environment, and immature development of the neurological system. As of 2002, there is research pointing to all of these factors, but no definitive cause has been found.

What are the symptoms?

The symptoms of phonological disorder differ significantly depending on the age of the child. It is often difficult to detect this disorder, as the child with phonological disorder develops speech sounds more slowly than his or her peers; generally, however, he or she develops them in the same sequence. Therefore, speech that may be normal for a four-year-old child may be a sign of phonological disorder in a six-year-old.

Nearly all children develop speech sounds in the same sequence. The consonant sounds are grouped into three main groups of eight sounds each: the early eight, the middle eight, and the late eight. The early eight include consonant sounds such as “m,” “b,”, and “p.” The middle eight include sounds such as “t,” “g”, and “chi,” and the late eight include more complicated sounds such as “sh,” “th,” “z,” and “zh.” Many children do not normally finish mastering the late eight until they are seven or eight years old. As children normally develop speech sound skills, there are some very common mistakes that are made. These include the omission of sounds, (i.e., frequently at the end of words), the distortion of sounds, or the substitution of one sound for another. Often the substitution is of a sound that the child can more easily produce for one that he or she cannot.

Pain Disorder FAQ

[tweetmeme source=”ShatterStigma”]

What is pain disorder?

Pain disorder is one of several somatoform disorders described in the revised, fourth edition of the  DSM-IV-TR. The term “somatoform” means that symptoms are physical but are not entirely understood as a consequence of a general medical condition or as a direct effects of a substance, such as a drug. Pain disorder is classified as a mental disorder because psychological factors play an important role in the onset, severity, worsening, or maintenance of pain.

In 1994, the International Association for the Study of Pain (IASP) defined pain as an unpleasant sensory or emotional experience arising from real or probable tissue damage. In other words, the perception of pain is, in part, a psychological response to noxious stimuli. This definition addresses the complex nature of pain and moves away from the earlier dualistic idea that pain is either psychogenic (of mental origin) or somatogenic (of physical origin). The contemporary view characterizes pain as multidimensional; the central nervous system, emotions, cognitions (thoughts), and beliefs are simultaneously involved.

When a patient’s primary complaint is the experience of pain and when impairment at home, work, or school causes significant distress, a diagnosis of pain disorder may be warranted. The diagnosis is further differentiated by subtype; subtype is assigned depending on whether or not pain primarily is accounted for by psychological factors or in combination with a general medical condition, and whether the pain is acute (less than six months) or chronic (six months or more). The classification of pain states is important since the effectiveness of treatment depends on the aptness of the diagnosis of pain disorder and its type.

What are the symptoms?

Symptoms vary depending on the site of pain and are treated medically. However, there are common symptoms associated with pain disorder regardless of the site:

• negative or distorted cognition, such as feeling helpless or hopeless with respect to pain and its management
• inactivity, passivity, and/or disability
• increased pain requiring clinical intervention
• insomnia and fatigue
• disrupted social relationships at home, work, or school
• depression and/or anxiety

What causes pain disorder?

Common sites of pain include the back (especially lower back), the head, abdomen, and chest. Causes of pain vary depending on the site; however, in pain disorder, the severity or duration of pain or the degree of associated disability is unexplained by observed medical or psychological problems.

The prevailing biopsychosocial model of mental disorders suggests that multiple causes of varying kinds may explain pain disorder, especially when the pain is chronic. There are four domains of interest:

• The underlying organic problem or medical condition, if there is one. For example, fibromyalgia (a pain syndrome involving fibromuscular tissue), skeletal damage, pathology of an internal organ, migraine headache, and peptic ulcer all have characteristic patterns of pain and a particular set of causes.
• The experience of pain. The severity, duration, and pattern of pain are important determinants of distress. Uncontrolled or inadequately managed pain is a significant stressor.
• Functional impairment and disability. Pain is exacerbated by loss of meaningful activities or social relationships. Disruption or loss may lead to isolation and resentment or anger, which further increases pain.
• Emotional distress. Depression and anxiety are the most common correlates of pain, especially when the person suffering feels that the pain is unmanageable, or that the future only holds more severe pain and more losses.

In sum, there are multiple causes of pain disorder. A therapist or team of health professionals will weigh the relative causal contributions, assign priorities for therapeutic intervention, and address the several domains in a multimodal fashion. For example, the design of a treatment plan in a pain clinic may involve a physician, psychotherapist, occupational therapist, physical therapist, anesthesiologist, psychologist, and nutritionist.

What is the prognosis?

The prognosis for total remission of symptoms is good for acute pain disorder and not as promising for chronic pain disorder. The typical pattern for chronic pain entails occasional flare-ups alternating with periods of low to moderate pain. The prognosis for remission of symptoms is better when patients are able to continue working; conversely, unemployment and the attendant isolation, resentment, and inactivity are correlates of a continuing pain disorder.

The results of outcome studies comparing pain disorder treatments point to cognitive-behavioral therapy in conjunction with antidepressants as the most continually effective regimen. However, people in chronic pain may respond better to other treatments and it is in keeping with the goal of active self-management for the patient and health professional(s) to find an individualized mix of effective coping strategies.

Pyromania FAQ

[tweetmeme source=”ShatterStigma”]

What is pyromania?

Pyromania is defined as a pattern of deliberate setting of fires for pleasure or satisfaction derived from the relief of tension experienced before the fire-setting. The name of the disorder comes from two Greek words that mean “fire” and “loss of reason” or “madness.” The clinician’s handbook, the Diagnostic and Statistical Manual of Mental Disorders , also known as the DSM, classifies pyromania as a disorder of impulse control, meaning that a person diagnosed with pyromania fails to resist the impulsive desire to set fires—as opposed to the organized planning of an arsonist or terrorist.

What is the cause?

Most studies of causation regarding pyromania have focused on children and adolescents who set fires. Early studies in the field used the categories of Freudian psychonalysis to explain this behavior. Freud had hypothesized that firesetting represented a regression to a primitive desire to demonstrate power over nature. In addition, some researchers have tried to explain the fact that pyromania is predominantly a male disorder with reference to Freud’s notion that fire has a special symbolic relationship to the male sexual urge. A study done in 1940 attributed firesetting to fears of castration in young males, and speculated that adolescents who set fires do so to gain power over adults. The 1940 study is important also because it introduced the notion of an “ego triad” of firesetting, enuresis (bed-wetting), and cruelty to animals as a predictor of violent behavior in adult life. Subsequent studies have found that a combination of firesetting and cruelty to animals is a significant predictor of violent behavior in adult life, but that the third member of the triad (bed-wetting) is not.

INDIVIDUAL. The causes of firesetting among children and teenagers are complex and not well understood as of 2002. They can, however, be described in outline as either individual or environmental. Individual factors that contribute to firesetting include:

• Antisocial behaviors and attitudes. Adolescent firesetters have often committed other crimes, including forcible rape (11%), nonviolent sexual offenses (18%), and vandalism of property (19%).
• Sensation seeking. Some youths are attracted to firesetting out of boredom and a lack of other forms of recreation.
• Attention seeking. Firesetting becomes a way of provoking reactions from parents and other authorities.
• Lack of social skills. Many youths arrested for firesetting are described by others as “loners” and rarely have significant friendships.
• Lack of fire-safety skills and ignorance of the dangers associated with firesetting.

There are discrepancies between adult researchers’ understanding of individual factors in firesetting and reports from adolescents themselves. One study of 17 teenaged firesetters, 14 males and three females, found six different self-reported reasons for firesetting: revenge, crime concealment, peer group pressure, accidental firesetting, denial of intention, and fascination with fire. The motivations of revenge and crime concealment would exclude these teenagers from being diagnosed with pyromania according to DSM-IV-TR criteria.

ENVIRONMENTAL. Environmental factors in adolescent firesetting include:

• Poor supervision on the part of parents and other significant adults.
• Early learning experiences of watching adults use fire carelessly or inapproriately.
• Parental neglect or emotional uninvolvement.
• Parental psychopathology. Firesetters are significantly more likely to have been physically or sexually abused than children of similar economic or geographic backgrounds. They are also more likely to have witnessed their parents abusing drugs or acting violently.
• Peer pressure. Having peers who smoke or play with fire is a risk factor for a child’s setting fires himself.
• Stressful life events. Some children and adolescents resort to firesetting as a way of coping with crises in their lives and/or limited family support for dealing with crises.

Selective Mutism FAQ

[tweetmeme source=”ShatterStigma”]

What is selective mutism?

Selective mutism was first described in the 1870s, at which time it was called “aphasia voluntaria”.  This name shows that the absence of speech was considered to be under the control of the child’s will. In 1934 the disorder began to be called selective mutism, a name that still implied purposefulness on the part of the silent child. In the 1994 edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV ) the disorder was renamed selective mutism. This name is considered preferable because it suggests that the child is mute only in certain situations, without the implication that the child remains silent on purpose.

Selective mutism is characterized by a child’s inability to speak in one or more types of social situation, although the child is developmentally advanced to the point that speech is possible. The child speaks proficiently in at least one setting, most often at home with one or both parents, and sometimes with siblings or extended family members. Some children also speak to certain friends or to adults that are not related to them, but this variant of selective mutism is somewhat less common.

The most common place for children to exhibit mute behavior is in the classroom, so that the disorder is often first noticed by teachers. Because of this characteristic, selective mutism is most frequently diagnosed in children of preschool age through second grade. As the expectation of speech becomes more evident, selective mutism can have more pronounced negative effects on academic performance. Children who do not talk in classroom settings or other social situations because the language of instruction is not their first tongue are not considered to have the disorder of selective mutism.

What are the symptoms?

The symptoms of selective mutism are fairly obvious. The child does not talk in one or more social situations in which speech is commonly expected and would facilitate understanding. Some children with selective mutism do not communicate in any way in certain settings, and act generally shy and withdrawn. The disorder is also often associated with crying, clinging to the parent, and other signs of social anxiety. Other children with the disorder, however, may smile, gesture, nod, and even giggle, although they do not talk.

What causes it?

Consensus regarding the most common causes of selective mutism has changed significantly over time. When the disorder was first studied, and for many years thereafter, it was thought to be caused by severe trauma in early childhood. Some of these causative traumas were thought to include rape, molestation, incest, severe physical or emotional abuse , and similar experiences. In addition, many researchers attributed selective mutism to family dynamics that included an overprotective mother and an abnormally strict or very distant father. As of 2002, these factors have not been completely eliminated as causes of selective mutism in most cases, but it is generally agreed that they are not the most common causes.

Instead, selective mutism is frequently attributed at present to high levels of social anxiety in children and not to traumatic events in their early years. Children with selective mutism have been found to be more timid and shy than most children in social situations, and to exhibit signs of depression, OCD , and anxiety disorders. Some children have been reported to dislike speaking because they are uncomfortable with the sound of their own voice or because they think their voice sounds abnormal.

Many links have also been found between selective mutism and speech development problems. Language reception problems have also been documented in selectively mute children. Although there is no evidence indicating that selective mutism is the direct result of any of these difficulties in language development, possible connections are being explored.

Cyclothymic disorder FAQ

[tweetmeme source=”ShatterStigma”]

What is Cyclothymic disorder?

Cyclothymic disorder, also known as cyclothymia, is a relatively mild form of bipolar disorder characterized by mood swings that may appear to be almost within the normal range of emotions. These mood swings range from mild depression, or dysthymia, to mania of low intensity, or hypomania.

What are the sysmptoms?

The symptoms of cyclothymic disorder are identical to those of bipolar I disorder except that they are usually less severe. It is possible, however, for the symptoms of cyclothymia to be as intense as those of bipolar I, but of shorter duration. About one-half of all patients with cyclothymic disorder have depression as their major symptom. These persons are most likely to seek help for their symptoms, especially during their depressed episodes. Other patients with cyclothymic disorder experience primarily hypomanic symptoms. They are less likely to seek help than those who suffer primarily from depression. Almost all patients with cyclothymic disorder have periods of mixed symptoms (both depression and hypomania together) during which time they are highly irritable.

Cyclothymic disorder may cause disruption in all areas of the person’s life. Many individuals with this disorder are unable to succeed in their professional or personal lives as a result of their symptoms. A few who suffer primarily from hypomanic episodes are high achievers who work long hours and require little sleep. A person’s ability to manage the symptoms of the disorder depends upon a number of personal, social, and cultural factors.

The lives of most people suffering from cyclothymic disorder are difficult. The cycles of the disorder tend to be much shorter than in bipolar I. In cyclothymic disorder, mood changes are irregular and abrupt, and can occur within hours. While there are occasional periods of normal mood, the unpredictability of the patient’s feelings and behavior creates great stress for him or her and for those who must live or work with the patient. Patients often feel that their moods are out of control. During mixed periods, when they are highly irritable, they may become involved in unprovoked arguments with family, friends, and co-workers, causing stress to all around them.

Who gets cyclothymic disorder?

Patients with cyclothymic disorder are estimated to constitute from 3–10% of all psychiatric outpatients. They may be particularly well represented among those with complaints about marital and interpersonal difficulties. In the general population, the lifetime chance of developing cyclothymic disorder is about 1%. The actual percentage of the general population with cyclothymia is probably somewhat higher, however, as many patients may not be aware that they have a treatable disease.

Cyclothymic disorder often co-exists with BPD, in fact an estimated 10% of outpatients and 20% of inpatients with borderline personality disorder also have cyclothymic disorder.

Gender identity disorder FAQ

[tweetmeme source=”ShatterStigma”]

What is gender identity disorder?

Gender identity disorder is a condition characterized by a persistent feeling of discomfort or inappropriateness concerning one’s anatomic sex. The disorder typically begins in childhood with gender identity problems and is manifested in adolescence or adulthood by a person dressing in clothing appropriate for the desired gender, as opposed to one’s birth gender. In extreme cases, persons with gender identity disorder may seek gender reassignment surgery, also known as a sex-change operation.

Gender identity disorder is distressing to those who have it. It is especially difficult to cope with because it remains unresolved until gender reassignment surgery has been performed. Most people with this disorder grow up feeling rejected and out of place. Suicide attempts and substance abuse are common. Most adolescents and adults with the disorder eventually attempt to pass or live as members of the opposite sex.

Gender identity disorder may be as old as humanity. Cultural anthropologists and other scientists have observed a number of cross-gender behaviors in classical and Hindu mythology, Western and Asian classical history, and in many late nineteenth- and early twentieth-century pre-literate cultures. This consistent record across cultures and time lends support to the notion that the disorder may be, at least in part, biological in origin.

What causes gender identity disorder?

There is no clearly understood or universally agreed-upon cause for gender identity disorder. However, most experts agree that there may be a strong biological basis for the disorder.

The sex of a human baby is determined by chromosomes. Males have a Y chromosome, in addition to a X chromosome, while females have two X chromosomes. The Y chromosome contains a gene known as the testes determining factor. This gene causes cells in an embryo to differentiate and develop male genitals. Embryos without the testes determining factor continue to develop undifferentiated as females.

The newly formed male testes release significant quantities of male hormones during the third month of pregnancy, further enhancing male differentiation. This sudden surge of hormones occurs again in males sometime between the second and twelfth week after birth. It is important to note that there is no corresponding feminizing hormonal surge sequence observed in females at this age.

These facts provide the biological basis for gender identity disorder. Male hormonal surges must occur not only in sufficient amounts, but also during a short window of time to cause masculinization of the developing infant. If there is insufficient androgen, the hormone primarily responsible for masculinization, or the surge comes too early or too late, the developing infant may be incompletely masculinised.

In addition to biological factors, environmental conditions, such as socialization, seem to contribute to gender identity disorder. Social learning theory, for example, proposes that a combination of observational learning and different levels and forms of reinforcement by parents, family, and friends determine a child’s sense of gender, which, in turn, leads to what society considers sex-appropriate or inappropriate behavior.

What are the symptoms?

The onset of puberty increases the difficulties for people with gender identity disorder. The subsequent development of unwanted secondary sex characteristics increases a person’s anxiety and frustrations. In an effort to cope with their feelings, some men with gender identity disorder may engage in stereo-typical, or even super-masculine, activities. For example, a man struggling with the disorder may engage in such “macho” sports as wrestling and football in order to feel more “male.” Unfortunately, the result is usually an increase in anxiety.

This anxious state is characterized by feelings of confusion, shame, guilt, and fear. These individuals are confused over their inability to handle their problem. They feel shame over their inability to control what society considers “perverse” activities. Even though cross-dressing and cross-gender fantasies provide relief, the respite is temporary. These activities often leave individuals with a profound shame over their thoughts and activities.

Closely associated with shame is guilt, particularly about being dishonest with family and friends. Sometimes people with gender identity disorder get married and have children without telling their spouse about their disorder. Typically, it is kept secret because they have the mistaken conviction that participation in marriage and parenting will eliminate or cure their gender identity problems. The fear of being discovered further raises their anxiety. With some justification, people with gender identity disorder fear being labeled “sick,” and being rejected and abandoned by people they love.

Trichotillomania FAQ

[tweetmeme source=”ShatterStigma”]

What is trichotillomania?

Individuals with trichotillomania repetitively pull out their own hair. Trichotillomania as an impulse-control disorder. Nail-biting, skin-picking, and thumb-sucking are considered to be related conditions.

What are the causes?

Scientific research regarding trichotillomania has been conducted primarily in the past 10 years and causes are only theoretical. Psychoanalytic theories suggest that the behavior is a way of dealing with unconscious conflicts or childhood trauma. Biological theories look for a genetic basis. For instance, people with trichotillomania often have a first-degree relative with an obsessive-compulsive spectrum disorder. Researchers are also evaluating similarities between trichotillomania and Tourette’s disorder. Behavioral theories assume that symptoms are learned, that a child may imitate a parent who engages in hair-pulling. The behavior may also be learned independently if it serves a purpose. For example, hair-pulling may begin as a response to stress and then develop into a habit.

What are the symptoms?

• noticeable hair loss (alopecia) due to recurrent hair-pulling
• tension immediately before hair-pulling, or when attempting to resist hair-pulling
• reduction of tension, or a feeling of pleasure or gratification, immediately following hair-pulling
• significant distress or impairment in social, occupational, or other important areas of functioning

Pica FAQ

[tweetmeme source=”ShatterStigma”]

What is pica?

Pica is a term that refers to cravings for substances that are not foods. Materials consumed by patients with pica include dirt, ice, clay, glue, sand, chalk, beeswax, chewing gum, laundry starch, and hair.

What are the causes?

The cause of pica is not known. Many hypotheses have been developed to explain the behavior. These have included a variety of such factors as cultural influences; low socioeconomic status; deficiency diseases; and psychological disorders.

Malnutrition is often diagnosed at the same time as pica. A causal link has not been established. Eating clay has been associated with iron deficiency; however, whether decreased iron absorption is caused by eating clay or whether iron deficiency prompts people to eat clay is not known. Some cultural groups are said to teach youngsters to eat clay. Persons with iron deficiency anemia have also been reported to chew on ice cubes. Again, the mechanism or causal link is not known.

Eating paint is most common among children from families of low socioeconomic status. It is often associated with lack of parental supervision. Hunger also may result in pica.

Among persons with mental retardation, pica has been explained as the result of an inability to tell the difference between food and nonfood items. This explanation, however, is not supported by examples of nonfood items that were deliberately selected and eaten by persons with limited mental faculties.

Pica, iron deficiency, and a number of other physiological disturbances in humans have been associated with decreased activity of the dopamine system in the brain. Dopamine is a neurotransmitter, or chemical that helps to relay the transmission of nerve impulses from one nerve cell to another. This association has led some researchers to think that there may be a connection between abnormally low levels of dopamine in the brain and the development of pica. No specific underlying biochemical disorders have been identified, however.

What are the symptoms?

Infants and children diagnosed with pica commonly eat paint, plaster, string, hair, and cloth. Older children may eat animal droppings, sand, insects, leaves, pebbles and cigarette butts. Adolescents and adults most often ingest clay or soil.

The symptoms of pica vary with the item ingested.

• Sand or soil is associated with gastric pain and occasional bleeding.
• Chewing ice may cause abnormal wear on teeth.
• Eating clay may cause constipation.
• Swallowing metal objects may lead to bowel perforation.
• Eating fecal material often leads to such infectious diseases as toxocariasis, toxoplasmosis, and trichuriasis.
• Consuming lead can lead to kidney damage and mental retardation.