title: Pica and rumination behavior among individuals seeking treatment for eating disorders or obesity.
abstract: OBJECTIVE
  Pica and rumination disorder (RD)-formerly classified within DSM-IV Feeding and Eating Disorders of Infancy or Early Childhood-are now classified within DSM-5 Feeding and Eating Disorders. Though pica and RD have been studied in select populations (e.g., pregnant women, intellectually disabled persons), their typical features and overall prevalence remain unknown. This study examined the clinical characteristics and frequency of DSM-5 pica and RD among individuals seeking treatment for eating disorders and obesity.
  
  
  METHODS
  We conducted structured interviews with adolescent and young adult females from a residential eating disorder center (N = 149), and adult males and females with overweight or obesity from an outpatient weight-loss clinic (N = 100).
  
  
  RESULTS
  Several participants reported ingesting non-nutritive substances (e.g., ice) for weight-control purposes. However, only 1.3% (n = 2; 95% CI: .06% to 5.1%) at the residential eating disorder center and 0% at the weight-loss clinic met DSM-5 criteria for pica, consuming gum and plastic. Although no eating disorder participants were eligible for an RD diagnosis due to DSM-5 trumping rules, 7.4% (n = 11; 95% CI: 4.0% to 12.9%) endorsed rumination behavior under varying degrees of volitional control. At the weight-loss clinic, 2.0% (n = 2; 95% CI: 0.1% to 7.4%) had RD.
  
  
  CONCLUSIONS
  DSM-5 pica and RD were rare in our sample of individuals seeking treatment for eating disorders and obesity, but related behaviors were more common. The wide range of pica and rumination presentations highlights the challenges of differential diagnosis with other forms of disordered eating.
authors.affiliation: Albert Einstein College of Medicine, Yeshiva University, Bronx, New York; Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Charlotte B
authors.initials: CB
authors.lastname: Delaney
authors.forename: Kamryn T
authors.initials: KT
authors.lastname: Eddy
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Hartmann
authors.forename: Anne E
authors.initials: AE
authors.lastname: Becker
authors.forename: Helen B
authors.initials: HB
authors.lastname: Murray
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D005247:Feeding Behavior / Q000523:psychology; D019959:Feeding and Eating Disorders of Childhood / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000523:psychology / Q000628:therapy; D010842:Pica / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D015431:Weight Loss; D055815:Young Adult
keywords: DSM-5; eating disorder; feeding disorder; pica; rumination