Pica responding to SSRI: an OCD spectrum disorder?

Pica is a common disorder in childhood, however, in adults it is associated with mental retardation, psychosis and pregnancy. A few case reports have described it being associated with obsessive compulsive disorder in adults. We describe the case of an adult female patient who developed an impulse to ingest chalk only in stressful situations. These thoughts were ego-dystonic and kept on hammering her mind until she ate it. She was diagnosed as having Major Depressive Disorder with relational problems and pica. We prescribed her escitalopram with clonazepam and asked her to ventilate her feelings during stressful situations. Her depression improved within three weeks, with remarkable improvement in pica symptoms. We concluded that stress may induce the pica in some adults and that such feelings have impulsive/compulsive characters. In addition, appropriate management of stress may help to alleviate the symptoms of pica.