Unusual case of Pica with generalized anxiety disorder and obsessive–compulsive disorder

Dear Editor, Pica is commonly observed in children and is often associated with obsessive–compulsive disorder or major depressive disorder. However, cases of Pica in adults are relatively rare, and its onset in adults is even less common.[1] We share an unusual case of Pica accompanied by generalized anxiety disorder and obsessive–compulsive disorder in a young adult female that developed in adulthood. A 24-year-old female reported to our outpatient department with a 6-month history of consuming non-nutritive substances, including paper, chalk, and soil. Her family brought her in, who reported observing these behaviors and noting a decline in her social interactions and academic performance. The patient also complained of recurrent abdominal pain, nausea, and fatigue. She was diagnosed with generalized anxiety disorder (GAD) 2 years before, for which she was taking prescribed medications irregularly. There was no history of substance abuse, significant medical conditions, or pregnancy. Physical examination revealed pallor and mild tenderness in the epigastric region. Psychiatric evaluation revealed exacerbation of her GAD symptoms, including persistent worry, restlessness, and difficulty concentrating. The patient also exhibited signs of Pica, such as repetitive thoughts about eating nonfood items and compulsive ingestion behaviors. Laboratory investigations, including complete blood count, serum electrolytes, and iron studies, revealed microcytic anemia and low serum ferritin levels, indicating iron deficiency. Abdominal X-ray and endoscopy confirmed the presence of ingested foreign materials in the gastrointestinal tract. Management involved a multidisciplinary approach, integrating medical, nutritional, and psychiatric interventions. The patient was started on iron supplements to address the anemia and was advised to have a balanced iron-rich diet. Her medication regimen was reviewed and optimized to include selective serotonin reuptake inhibitors (SSRIs) to manage her anxiety and Pica symptoms. In addition, cognitive–behavioral therapy (CBT) was initiated to address her GAD, OCD, and pica symptoms. Over a 6-month follow-up period, the patient showed significant improvement. Her pica behaviors ceased, and her gastrointestinal symptoms resolved. Her anxiety and OCD symptoms also diminished with continued therapy and medication adherence. The family was educated about the importance of ongoing psychiatric support and regular monitoring to prevent relapse. The literature suggests that pica can be associated with various psychiatric disorders, including anxiety, OCD, and depression. The importance of detailed psychiatric evaluation in patients with pica is to identify and manage comorbid psychiatric disorders. In addition, integrated psychiatric and nutritional interventions are crucial for effectively treating pica.[2-4] This case underscores the importance of considering psychiatric symptoms in patients with pica and adopting a comprehensive, multidisciplinary approach to management. Early recognition and treatment of underlying psychiatric conditions are essential to prevent complications and improve patient outcomes. Further research is needed to explore the complex interplay between pica and psychiatric disorders to develop targeted therapeutic strategies. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the forms, the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Authors’ contributions Concept and design of paper: SM, AS, SC, AJ. Drafting and revising the article critically for important intellectual content: SM, AS, SC. Final editing and approval of the version to be published: SC, AJ. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.