Allotriophagy: diagnosis, treatment, prognosis, and prevention

A type of eating disorder expressed by an irresistible urge to taste something inedible or raw is called allotriophagy. Everything is eaten: chalk, charcoal, clay, sand, earth, ice, metal objects, raw minced meat or dough. The disorder is formed against a background of hormonal changes, with a lack of micro- and macronutrients, vitamins, with some mental deviations.

How the diagnosis is made and the pathology is corrected, whether there is a connection of eating disorder with the fat tissue hormone – leptin, you will learn from the article.

Contents:

1. General issues
2. Etiopathogenesis
3. Classification and symptoms
4. Complications
5. Diagnosis
6. Treatment
7. Prognosis and prevention

General Questions

Allotriophagy is essentially a perversion of taste and appetite. The term in Greek means “eating that which is foreign, inappropriate. Hippocrates first wrote about allotriophagy; today it is included in ICD 10 under the heading “Eating inedible things in adults” and “Eating inedible things in infants and children”. The prevalence of the pathology is less than percent in adult patients and more than 30 percent in children. More often such symptomatology accompanies intellectual disorders or diseases in patients of low socioeconomic status.

Etiopathogenesis

The triggers of allotriophagy can be divided into three groups: physiological, psychological and social. Among them, it is worth highlighting:

1. Mistakes of upbringing: excessive demanding, lack of respect for others, authoritarianism of one of the spouses, lack of attention to children. Sometimes the cause of pathology in children is the absence of toys and hobbies.
2. Psychotraumas, emotional distress: the death of loved ones, violence, war, and disasters.
3. An unbalanced diet provokes a desire to eat indigestible things due to a lack of minerals, amino acids, vitamins, trace elements. For example, the desire to chew chalk is provoked by a lack of calcium.
4. Cultural traditions and the social environment contribute to perverted food cravings. For example, in the North it is common to eat raw meat and fish, and people drink fresh animal blood.
5. Fluctuations in hormonal background: allotriophagy occurs during gestation and during puberty. The essence is a change in the production of hormones that affect the taste and smell centers of the hypothalamus, the sense of satiety. Here one of the leading roles belongs to leptin – a hormone of adipose tissue.
6. Mental deviations from the norm, which accompany schizophrenia, oligophrenia, retardation, autism, provoke allotriophagy, as patients are not able to critically reflect on their actions.

The mechanism of pathological condition development is a combination of several disease triggers. Metabolic, pituitary-hypothalamic disorders become the biological basis, with leptin acting as a mediator and connecting link. In addition, an imbalance of metabolic mediators and biogenic amines such as serotonin is important. Add in the frontal dysfunctions that minimize arbitrary control of the situation, and the picture becomes almost complete.

Externally, provocation of conditioned reflexes is important: gluttony, licking, gnawing of inedible objects relieves negative emotions, discomfort. Psychologically, affective lability, impulsivity, minimal ability to control cravings and urges, minimal threshold of stress resistance help to form the disease.

Classification and symptoms

Depending on the inedible substance consumed, there are gradations into many subtypes of an eating disorder:

• coprophagia (feces);
• emetophagy (vomit);
• hematophagy (blood);
• urophagia (urine);
• onychophagy (nails);
• dermaphagia (skin);
• trichophagy (hair);
• geomelophagy (raw potatoes);
• foliophagy (inedible plant parts);
• xylophagy (wood).

A more general classification includes three types of pathological condition:

• eating inedible objects: sand, stones, nails, coins, glue;
• eating inedible objects: charcoal, chalk, animal feed;
• eating raw foods: minced meat, raw dough, fish.

The main symptom of food perversion is ingestion of objects that are not intended for that purpose at all. There is an acute desire to taste objects or substances and patients start licking, chewing, gnawing, then chewing and spitting them out. Small objects may be swallowed in the heat of emotion. This can occur in schizophrenia, psychopathy, and affective states.

In children, allotriophagy is formed at the age of 1.5 to 6 years. Babies replace food with inedible substances or consume along with normal food. Pathological overeating often occurs, requiring immediate medical intervention.

Complications

The most dangerous complication of allotriophagy is intestinal obstruction, perforation of the intestinal wall with the risk of death if medical attention is not given in time. This applies especially to swallowing traumatic objects, sharp, cutting, stabbing. Less serious but more common are parasitic infestations, secondary infections and deficiency states. A high risk of infection is predicted by eating feces, sand, and soil. Eating salts of heavy metals carries the risk of poisoning and intoxication, which is fraught with CNS damage.

Diagnosis

The diagnosis is made, as a rule, by a psychiatrist on the basis of anamnesis, which pays special attention to the patient’s upbringing methods, cultural and religious affiliation of the family, presence of psychological traumas, neurological and endocrine pathologies. The examination is comprehensive; along with allotriophagy, concomitant pathologies and a number of diagnostic criteria are identified:

1. Duration of the existence of the pathology: we can talk about perversion only when the course of the disease is at least one month.
2. Frequency of symptoms: assess the danger of the eaten object, its proportion in the patient’s diet. In children, it may completely replace normal food intake.
3. Adequacy of manifestations refers to cases of eating raw food, which normally must be treated thermally.

Treatment

Patients receive psychotherapeutic care, above all. Plus, an individual course of medication is chosen. The goal is to eliminate the cause of the pathological eating disorder and replace it with normal eating habits. The complex of measures involves the work of a team of narrow specialists: from a psychiatrist to a nutritionist. They use:

1. Behavioral correction with the use of delimitation techniques: the space and regime of the day are organized so that there is no contact with an indigestible object. To level the negative habit, aversive treatment tactics are used – punishment for undesirable behavior. Positive reinforcement helps develop correct eating habits.
2. Family psychotherapy involves identifying and discussing allotriophagy habits, correcting destructive relationships that become a trigger for stress and maintain the disorder. The therapist individually organizes the patient’s eating routine and rules. Often, it is enough to reduce the time to watch TV, and for children to play computer games, add toys and materials for creativity.
3. Drug therapy does not involve special drugs to correct allotriophagy. Endocrine disorders are corrected with hormones, unbalanced nutrition with nutrient deficiencies with vitamin and mineral complexes, specific medications that relieve deficit states. Emotional lability, tension, anxiety are relieved by anxiolytics, sedatives, antidepressants.

Prognosis and prevention

If pathological changes in eating habits are detected in time and adequate correction of the condition is appointed – the prognosis is positive: the patient returns to normal eating habits, gets rid of the urge to eat indigestible objects. With severe mental pathology, the prognosis worsens, up to and including death. The main preventive measures are a healthy diet and goodwill in the family. It is important from childhood to cultivate a culture of nutrition, to demonstrate a positive attitude toward food, to admire its flavor, aroma, to thank the cook. Food should not be manipulated, encouraged or punished. The meal should be enjoyable.