Pica and Rumination Disorder
What pica and rumination disorder are, how these feeding disorders differ, their causes and risks, and how they are diagnosed and treated.
Clinically reviewed by Dr. Ponlawat Pitsuwan, Physician and Addiction Medicine Specialist, Phuket Island Rehab.
Pica and rumination disorder are two feeding and eating disorders that involve unusual eating behaviors. Pica is the persistent eating of non-food items with no nutritional value, such as dirt, chalk, paper, or ice, over at least a month. Rumination disorder (rumination syndrome) is the repeated regurgitation of food, which is then re-chewed, re-swallowed, or spat out, without a medical cause such as reflux. Both can occur in children and adults, are sometimes linked to developmental conditions, stress, or other mental health issues, and can cause real medical problems, from poisoning or blockages in pica to weight loss and nutritional problems in rumination. Both are diagnosed by a professional and treated mainly with behavioral treatment, alongside addressing any underlying cause.
Two feeding and eating disorders
Pica and rumination disorder are both classified as feeding and eating disorders, and both involve behaviors around eating that are outside the norm. They are quite different from each other, but they are often discussed together because both can occur in children and in people with developmental or mental health conditions, and both need proper assessment. Understanding each helps families and individuals know when to seek help.
What pica is
Pica is the persistent eating of non-food, non-nutritive items for at least a month, in a way that is not developmentally normal. People with pica may eat things such as dirt, clay, chalk, paper, hair, paint, or ice. It is more common in young children, in pregnancy, and in people with intellectual or developmental disabilities. Pica can sometimes signal a nutritional deficiency, such as iron, and it carries real risks: poisoning, dental damage, infections, and intestinal blockages.
What rumination disorder is
Rumination disorder, or rumination syndrome, is the repeated, effortless regurgitation of recently eaten food, which the person then re-chews and re-swallows or spits out. Crucially, this is not caused by a medical condition such as acid reflux. It often becomes an automatic, learned behavior. It can occur in infants, children, and adults, and over time it can lead to weight loss, malnutrition, dental problems, and social difficulties.
| Feature | Pica | Rumination disorder |
|---|---|---|
| Behavior | Eating non-food items | Regurgitating and re-chewing food |
| Duration for diagnosis | At least 1 month | At least 1 month |
| Common in | Children, pregnancy, developmental conditions | Infants, children, and adults |
| Main risks | Poisoning, blockages, infection | Weight loss, malnutrition, dental harm |
| Not explained by | Cultural practice alone | Reflux or a medical condition |
Causes and links
Both disorders can be linked to developmental and intellectual conditions, and to stress, anxiety, or other mental health issues. Pica may also relate to nutritional deficiencies. Rumination is often a self-soothing or learned behavior. Because the causes vary, assessment looks at the whole picture, medical, nutritional, developmental, and psychological, to guide treatment.
Diagnosis and treatment
Diagnosis is made by a professional based on the pattern of behavior over time, after ruling out medical explanations. Treatment is mainly behavioral: for pica, this includes behavioral strategies, safety measures, and correcting any nutritional deficiency; for rumination, techniques such as diaphragmatic breathing to interrupt the regurgitation reflex, alongside behavioral treatment. Addressing any underlying developmental, emotional, or mental health condition is part of care in both.
The bottom line
Pica is the eating of non-food items, and rumination disorder is the repeated regurgitation and re-chewing of food, two feeding and eating disorders that can occur in children and adults and cause real medical harm. Both are diagnosed by a professional and treated mainly with behavioral treatment, alongside addressing any underlying medical, nutritional, or mental health cause.
Reviewed by Dr. Ponlawat Pitsuwan, Physician and Addiction Medicine Specialist.
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