To our knowledge, only one population-based study has assessed PB, indicating at least one-time PB in 12.31% and recurrent PB in 4.98% of youth aged from 7 to 14 years (Hartmann et al., 2018).Įpidemiological studies assessing rumination disorder or RB in the general adult population are lacking. Notably, both reviews only included studies conducted prior to the introduction of the DSM-5 (APA, 2013), and assessment methods and diagnostic/definition criteria varied vastly. Pica prevalence in this meta-analysis was also greater in individuals with lower education and higher anaemia (Fawcett et al., 2016). Pregnant women have also been proposed as a high-prevalence population: A meta-analysis integrating 70 studies yielded an aggregate PB prevalence estimate of 27.8% (95% confidence interval (CI) 22.8–33.3 Fawcett et al., 2016), although with strong geographical differences, for example, pregnant European women hardly exhibited PB. Moreover, a literature review of six studies suggested a high PB prevalence in individuals with intellectual disabilities both in community settings (from 0.3 to 14.4%) and in institutionalised populations (from 9 to 25% Ali, 2001). A study in N = 100 adult females and males with overweight or obesity at a weight-loss clinic indicated frequent PB (Delaney et al., 2015). According to the DSM-5, the prevalence of pica is unclear (APA, 2013), and epidemiological studies in the general adult population are lacking. As with PB, rumination behaviour (RB) needs to be severe enough to warrant clinical attention as rumination disorder beyond comorbid diagnoses (APA, 2013).ĭespite the definition of diagnostic criteria for both disorders across the lifespan, epidemiological data on the full-syndrome disorders or PB and RB in the general population are scarce. Diagnosis can only be given if the behaviour is not due to a physical condition and does not only occur in the course of another eating disorder. Symptoms must be present over at least one month and occur repeatedly over one year (APA, 2013). Moreover, the food is only minimally digested and thus still has a pleasant taste. Regurgitation usually seems effortless and is not accompanied by nausea (Stanghellini et al., 2016). The brought-up food is subsequently re-chewed, re-swallowed or spit out. Rumination disorder is characterised by recurrent regurgitation of previously ingested food. Pica behaviour (PB) must not be socially or culturally accepted, and should be severe enough to warrant clinical attention as pica disorder beyond the treatment of comorbid diagnoses (APA, 2013). It is only diagnosed if symptoms have been present for longer than one month and patients show a developmental age of at least 2 years. Potential substances vary greatly, for instance sand, paper or faeces (Leung and Hon, 2019), and craving for the substance can be strong (Young, 2011 Sturmey and Williams, 2016). Pica is defined as the consumption of substances that are neither edible nor nutritious (APA, 2013). Against this background, it is surprising that their prevalence in the general population, comorbid symptom presentation and relations to other eating disorder symptoms in adults have barely been studied. obstructions or perforations of the gastrointestinal tract in pica, and malnourishment in rumination disorder Decker, 1993 Chial et al., 2003 Luoba et al., 2005 Stiegler, 2005). Both disorders can be physically detrimental (e.g. Compared to the former classification in the category Mental Disorders with Onset in Childhood or Adolescence in the DSM-IV (APA, 1996) and the ICD-10 (WHO, 1993), this new prominent placement in the category Feeding and Eating Disorders (DSM-5) and in the category Feeding or Eating Disorders (ICD-11) highlights their potential lifelong relevance. Pica and rumination disorder are two new diagnostic entities in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 American Psychiatric Association, APA, 2013) and the 11th version of the International Classification of Diseases (ICD-11 World Health Organization, WHO, 2021).
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