Allotriofagiya – the type of food frustration which is characterized by insuperable desire to feel taste, to eat something inedible or the crude products demanding heat treatment. It is shown by eating of oven coal, chalk, clay, wood, sand, the soil, ice, tooth-powder, small metal objects, the crude test, forcemeat, grain. Frustration develops at hormonal changes, deficiency of minerals and vitamins, some mental pathologies. It is diagnosed by a conversation method. Treatment includes behavioural and family psychotherapy, medicamentous correction.
Allotriofagiya has a set of synonyms: pikatsizm, peak, paroreksiya, taste perversion, appetite perversion. The term came from Ancient Greek language, in translation means "eating alien, inappropriate". For the first time the allotriofagiya was described by Hippocrates, now it is included in the International classification of diseases of the 10th revision, eating inedible at adults" and "Eating inedible at babies and children" is coded by subheadings ". Prevalence among adults makes less than 1%, among children of early and preschool age there are 10-32%. Frustration is more often diagnosed at intellectual violations, for patients with the low social and economic status.
Definition of etiologichesky factors of an allotriofagiya is of great importance by drawing up the forecast and selection of methods of treatment (psychotherapy, application of medicines, change of the living environment). The reasons of frustration can be divided into three big groups: physiological, social and psychological. The main among them are:
- Pathological relationship. Development of an allotriofagiya is promoted by mistakes in education (insistence, the disrespectful relation), neglect of children, authoritarianism of the spouse, violence. At the child symptoms sometimes arise in the absence of toys, hobbies, attention of parents.
- Psychological injuries. The debut of food violation can be provoked by a strong emotional shock. Change of food addictions happens after the death of the loved one, act of violence, participation in the military conflict, accident.
- Unbalanced food. The aspiration to eat inedible arises at specific deficiency of macrocells, amino acids, vitamins, minerals. So, widespread desire to gnaw chalk is provoked by shortage of calcium.
- Sociocultural traditions. The use of inedible substances can be promoted by features of culture. For example, the northern people eat crude meat, suck fresh blood of animals.
- Hormonal imbalance. Manifestations of an allotriofagiya are quite often observed at pregnant women and at teenagers. Change of production of the hormones influencing olfactory and flavoring perception is the cornerstone of depraved appetite.
- Mental disorders. Patients with schizophrenia, intellectual backwardness, autism are incapable to estimate and control the acts critically. Allotriofagiya at this group of patients arises as manifestation of inadequate behavior.
In pathogenesis of an allotriofagiya a key role is played by the combined influence of the contributing factors and reasons of development of frustration. Metabolic violations (gipotalamo-hypophysial), an imbalance of exchange of mediators and biogenous amines (serotonin), the frontal dysfunctions reducing any control of behavior can become a biological basis. The principles of learning act on external level. Allotriofagiya develops as conditioned-reflex reaction: eating, licking, a razgryzaniye of inedible defuses emotional tensions, eliminates physiological discomfort. Affective lability, impulsiveness, decline in the ability belong to the psychological factors promoting formation of pathology to control inclinations and motives, a low threshold of resistance to stress.
Depending on the eaten substance allocate a set of subtypes of frustration: koprofagiya (kcal), emetofagiya (emetic masses), gematofagiya (blood), urofagiya (urine), onikhofagiya (nails), dermafagiya (skin), trikhofagiya (hair), geomelofagiya (crude potatoes), foliofagiya (inedible parts of plants), ksilofagiya (wood) and others. More general classification includes three types of an allotriofagiya:
- Eating of inedible objects. This kind of a disease in MKB-10 is carried to the heading "Eating of an Inedible Inorganic Origin". Patients eat sand, stones, nails, coins, glue.
- Eating of low-edible objects. Frustration is included in the heading "Eating Inedible (Depraved Appetite)". Patients use substances of the organic nature – coal, chalk, food of animals.
- Eating of crude products. Is also appetite perversion option. Mincemeat, crude dough, fish becomes food.
The main sign of frustration – eating of the objects and substances which are not intended or not ready to the use inside. At keen desire to feel taste or a consistence patients lick, long chew, gnaw a subject, then swallow or spit out. Swallowing of small objects can be connected with emotional pressure and uncontrollable compulsive actions. Such option is observed at schizophrenia, heavy psikhopatiya at the okhvachennost moments by affect. At children the allotriofagiya most often develops aged from 1,5 up to 6 years. Little patients use inedible substances besides food or instead of it. Often reception of substances happens in unsafe volumes, demands immediate intervention of doctors.
Allotriofagiya can result in intestinal impassability, perforation of walls of a GIT – to the complications demanding immediate surgical intervention and interfaced to risk of a lethal outcome. In particular it concerns cases of a proglatyvaniye of firm and sharp objects (chipped glass, paper clips, needles). To less serious, but more widespread consequences parasitic diseases, infections of digestive tract and food deficiency belong. The high risk of infection exists when eating excrements of animals, soils, sand. The use of the connections containing lead, mercury, zinc is accompanied by danger of poisoning, toxic damage of the central nervous system (especially at early age).
The diagnosis is established by the psychiatrist on the basis of data of a clinical conversation with the patient and relatives. At poll the attention is paid to methods of education, cultural and religious affiliation of a family of the patient, existence of the psychoinjuring situations, hormonal and neurologic diseases. Examination is conducted in a complex, along with an allotriofagiya the accompanying frustration are defined (schizophrenia, mental retardation, autism). In the course of diagnostics the doctor reveals existence of a number of criteria:
- Duration of symptoms. The perverted eating is observed within 1 month and more. This criterion is offered by authors of classification of DSM-V.
- Frequency of emergence of symptoms. Danger of the used substance, its share in a daily diet is estimated. At children's age pathological food can replace normal meals completely.
- Adequacy of symptoms. The criterion belongs to cases of eating of a crude product which in habitual understanding demands thermal treatment. It is important to consider compliance of a diet of the patient to the accepted rules of food in a microenvironment (a family, the tribe).
Treatment of an allotriofagiya
The help to patients is carried out by psychotherapy methods, and also selection of drug treatment. The main objective – to remove the frustration cause, to replace a pathological eating habit with normal behavior. Integrated therapeutic approach is implemented by forces of the psychiatrist, psychotherapist, endocrinologist, neurologist, nutritionist. The following methods are used:
- Behavioural psychotherapy. Use of the equipment of an otgranicheniye – the organization of space and a day regimen is widespread so that to avoid contact with inedible substance. Aversivny therapy – punishment for undesirable behavior is applied to elimination of an undesirable habit. The positive reinforcement promotes development of a habit to eat properly.
- Family psychotherapy. To family members, especially parents, tell about mechanisms and the reasons of an allotriofagiya. Carry out correction of the destructive relations which are a source of a stress and supporting frustration. The psychotherapist makes individual recommendations about the organization of the day mode, Regulations of Admission of food. Quite often for children it is sufficient to reduce time of viewing of the TV, computer games, to add to the room of toys, materials for creativity.
- Medicamentous correction. Special medicines for treatment of an allotriofagiya it is not developed. At endocrine violations hormonal means are applied, at unbalanced food and shortage of nutrients – the vitamin and mineral complexes, specific medicines eliminating deficiency. To patients with emotional instability, tension, alarm anksiolitik, sedatives, antidepressants are appointed.
Forecast and prevention
At complex timely treatment an allotriofagiya outcome positive – to patients is possible to return to normal food, to get rid of thirst for eating of substances unsuitable for this purpose. At a serious mental illness the forecast can be adverse. The main preventive measures – healthy food and the benevolent, open relations in a family. Important since the childhood to impart culture of the use of food (the mode, table layout, a set of dishes and products). Demonstration of the positive relation to food – admiration of taste and a smell, gratitude prepared is necessary. During a meal it is necessary to avoid quarrels and the conflicts, it is forbidden to use food as means of manipulation, punishment for undesirable acts.