PICA DISORDER IN AN INSTITUTIONALISED CHILD: A TWO-PHASE CASE STUDY OF SEQUENTIAL BEHAVIOURAL AND PSYCHOSOCIAL INTERVENTION

This case study describes the sequential, two-phase psychological management of an institutionalised 13-year-old boy, referred to by the pseudonym Bilal, following his separation from his family of origin after physical abuse at home. Bilal was seen independently by two trainee clinical psychologists under faculty supervision, approximately a year apart. In Phase 1 (14 sessions) he presented with school avoidance, poor social skills, and low self-esteem, and non-nutritive eating was identified incidentally near the end of treatment. In Phase 2 (22 sessions) he was re-referred for escalating pica and disruptive classroom conduct and met criteria for Pica Disorder (F98.3; DSM-5-TR). Assessment combined interviews, behavioural observation, a functional (antecedent–behaviour–consequence) analysis, a reinforcement survey, the Coloured Progressive Matrices, the Slosson Intelligence Test, the House-Tree-Person technique, and informant severity ratings. Management combined rapport building, contingency management, a token economy, academic assistance, awareness training, craving-management techniques adapted from the substance-use literature, motivational interviewing, teacher-mediated co-therapy, and social-skills and self-esteem work. Across the 36 sessions, informant-rated eating of non-edible items fell from 10 to 0 on a 10-point scale, disruptive behaviour decreased, and modest, partial gains emerged in attendance, self-esteem, and social confidence; the treating clinicians estimated overall improvement of approximately 40% in Phase 1 and 70% in Phase 2. The case highlights cultural and systemic factors shaping the care of institutionalised children in Pakistan and underscores the value of routine behavioural monitoring even when treatment begins with an unrelated presenting complaint. Keywords: Pica Disorder, Institutionalised Children, Runaway Children, Behaviour Modification, Craving Management, Cultural Context, Case Study, Pakistan