Pica

Pica

Vergleich: Siehe: Krankheiten + Geburtsgruppe

Generalities – Food and Drinks – Sand – desires – TARENT-h., Sil
Threatening – TARENT, hepar, stram
Restlessness, hyperactivity is a known feature of Tarent-h

[https://abdn.pure.elsevier.com/en/publications/food-aversions-and-cravings-during-pregnancy-on-yasawa-island-fij]

During pregnancy, women often experience new food aversions and cravings (McKerracher, Collard and Henrich 2016). Some of these women also develop

cravings for and consume non-food items, a phenomenon known as pica. Pica refers to the repeated consumption of non-edible items or items with no nutritional

value (Timlin and Burden 2017). Pica frequently observed in children, individuals with development disabilities and pregnant women (Mensah et al. 2010).

In children, pica has been studied extensively, but pica occurring during pregnancy remains under-studied and under-reported (Simpson et al. 2000).

Homoeopathy is an effective and scientific form of healing which helps the natural tendency of the body to heal itself (Castro 1999). It is a very popular alternative

way of managing gynaecological and obstetrics ailments (Hilal and Manzoor 2013). Homoeopathic remedies have become popular among midwives and other

healthcare professionals who are involved in pregnancy and labour due to their speed of action, safety, lack of interaction with other drugs (Hilal and Manzoor 2013). According to Hilal and Manzoor (2013), homoeopathic remedies are ideal for women in their child-bearing years because they are a gentle yet highly effective system

of healing and safe for a growing foetus as only a minute amount of the active ingredient is used in their preparation.

A number of homoeopathic remedies may address pica behavioural tendency and prevent its recurrence (Madan 2019). These are not specific to pica pregnancy, they

are rather generalised to any age and gender. This research focused on pica occurring during pregnancy and the possible homoeopathic remedies that could be used in

treating such patients.

There are remedies already known and in use for the treatment of pica generally occurring at any age and any gender: Alum., Ant-c., Calc., Calc-p., Cic-v., Nit-ac.,

Nux-v. and Sil. (Madan 2019).

The purpose of this study was to provide homoeopathic practitioners with information to enhance the understanding and possible management of pica occurring in

pregnancy and to educate and inform the public about homoeopathy as a safe treatment option for pregnant women experiencing pica.

Pregnancy is the nine-month period in which a mother carries an embryo in her womb which later develops into a foetus (Hommey 2016). It is a specific and

complex period in the life of a woman, in which changes in physiological, psychological planes and social functioning are observed (Bjelica et al. 2018).

According to Shagana et al. (2018), the physiological changes follow the conception and involve every organ system in the body. This is to aid the mother

to adapt to the pregnant state and growth of the foetus. According to Shagana et al. (2018) the physiological changes include the following:

• The uterus increases in size to accommodate the foetus from conception to full-term.

• There is a continuous increase in the body weight during pregnancy which is considered a favourable indication of the foetal growth and maternal adaptation.

• Throughout a normal pregnancy the plasma volume increases progressively resulting in physiological anaemia of pregnancy and later on there is an increase

in iron demands with iron supplementation being needed to avoid iron deficiency.

• The hormone responsible for breast development and production of milk, prolactin, increases significantly together with oestrogen and progesterone levels.

• There is an increase in maternal appetite and nutritional requirement experienced during pregnancy alongside with morning sickness.

As stated above, the amount of nutrients required during pregnancy is increased to meet the demands of the growing foetus and the mother as she also goes

through a period of growth to carry the foetus and prepare for lactation (Brown 2011). According to Williamson (2006), the embryo is most vulnerable to the

effects of poor maternal diet in the first weeks of development even before confirmation of the pregnancy. Because abnormalities in cell division cannot be

corrected at a later stage, improving nutritional status in women should begin before pregnancy whenever possible, as it is beneficial to the pregnancy outcome.

The general dietary recommendation for pregnant women or those intending to get pregnant is to follow a healthy, varied, balanced diet together with

consuming plenty of iron-and folate-rich foods and an adequate intake of energy and nutrients (Williamson 2006).

Pregnancy may be accompanied with food cravings and aversions, as well as non-food item cravings (Kariuki et al. 2016). Though this is thought to be common

in pregnancy, not all pregnant women experience cravings and food aversions (Brown 2011). Many explanations have been given to explain the reason behind

the development of cravings and food aversions during pregnancy and include:

changes in smell and taste (increased sensitivity), and the thought of pregnancy being a time for pregnant women to treat themselves to foods and indulge

themselves. Cravings are thought to be another way of helping the mother meet her nutritional needs (for example, a woman may crave salty food because her

body needs sodium to help her manage her increased fluid volume) (Brown 2011).

2.1.3 Prevalence of pica in pregnancy

Pica is a phenomenon that has been documented in almost every culture (Young et al. 2010), and is frequently observed in children, individuals with developmental

disabilities, and pregnant women (Mensah et al. 2010). Globally, 25% to 33% of all pica cases involve small children, 20% are pregnant women, and 10% to 15%

are individuals with learning disabilities (Khan and Tisman 2010). Although this pica phenomenon in pregnancy is known worldwide, Jyothi (2015) explains that

many people are still unfamiliar with this condition and that this phenomenon is still not well understood, mainly due to the fact that no prevalence, social and

biological correlates have been characterised. According to Jyothi (2015), the prevalence of pica in pregnant women is poorly documented as pregnant women

do not recognise the disorder when they have it and, if they do recognise it, they do not report it due to fear of embarrassment, being ridiculed or judged.

The globally available literature shows that the prevalence rate of pica varies from place to place and has been reported to range from 0% to 68% depending on the

characteristics of the population studied (Ngozi 2008). Fawcett, Fawcett and Mazmanian (2016) conducted a meta-analysis of the worldwide prevalence of pica

during pregnancy and post-partum period. Seventy studies estimating pica prevalence during pregnancy +/o. postpartum period using a self-report questionnaire

or interview were included, and these were found on

PSYCARTICLES, PSYCINFO, PubMed and Google Scholar. As a result, the prevalence was estimated to be of 27,8% with it being higher in Africa compared

to other continents (Africa 44,8%, North and South America 23% and Eurasia 17,5%).

In a cross-sectional study conducted by Ezzeddin et al. (2015), the prevalence of pica during pregnancy was studied in the Health Care Centres in West of Tehran,

Iran. Three hundred women were selected from the population by the stratified sampling method. The characteristics of pica during pregnancy such as the kind

of pica, the onset, duration, frequency and reasons were collected via interview and questionnaire. The result showed the prevalence of pica among the studied

samples to be 8,33%, and 64% of the women reported practicing pica regularly on a daily basis.

The prevalence of geophagia (ingestion of earth or clay) and its contributing factors among pregnant women was studied by Macheka et al. (2016) at

Dr. George Mukhari Academic Hospital in Pretoria, South Africa. A quantitative survey was conducted on a convenience sample of 597 pregnant women and

structured interviews were conducted. The prevalence of geophagia in the studied population was 54%. More than half of the studied sample engaged in

geophagia practice.

In a cross-sectional analytical study of geophagia practices and blood metal concentrations in pregnant women conducted by Mathee et al. (2014) in

Johannesburg, South Africa, the prevalence of geophagia in women attending an antenatal clinic was determined. A convenience sample of 307 pregnant women

was selected andstructured interviews conducted. Pica prevalence among the sampled pregnant women was estimated to be 22,8%.

2.1.4 Pica related substances ingested

The substances ingested vary in type and extent in different parts of the world.

These patterns of ingestion are called “phagias” (Ngozi 2008).

2.1.4.1 Geophagia

Geophagia is one of the most common form of pica reported in pregnant women.

The term refers to the consumption of earth in the form of soil/sand, clay, or mud. Metals and metalloids such as arsenic and lead can sometimes be found in

the soil consumed (Mathee et al. 2014). The ingested earth is found from gardens, mountains, river banks, termite mounts, mole hills and earthworm casts

(Macheka et al. 2016).

2.1.4.2 Amylophagia

Amylophagia is another common form of pica characterised by the ingestion of large quantities of starch such as laundry starch and raw starch such as uncooked

rice, cassava, wheat, corn-starch, and rice flour (Young 2010)

Raw rice, one of amylophagic items ingested

2.1.4.3 Pagophagia

This is another form of pica where the patient consumes ice, freezer frost or iced drinks (Bhatia and Kaur 2014). The ice ingested is found in the deep freeze,

from ice trays, scratching the deep freeze, or from bought bags of crushed ice (Osman, Wali and Osman 2005)

2.2.4.4 Other substances

1. Plumbophagia: the ingestion lead paint, chips.

2. Hyalophagia: the ingestion or chewing of glass particles.

3. Lithophagia: the ingestion of stones.

4. Trichophagia: the eating of hair.

5. Cautopyreiophagia: the eating of burnt matches.

6. Coprophagia: the eating of dung (Lavanya and Chandrasekharan (2019)

7. Not labelled substances: ashes, cigarette butts, soap, baking soda, baking powder, coffee ground, charcoal, pieces of papers, etc. (Ezzeddin et al. 2015).

2.1.5 Aetiology of pica

The aetiology of pica has challenged researchers for centuries (Hommey 2016).

According to Hommey (2016), eating disorders (including pica) are not linked to only one factor, but to internal and external factors including social, biological,

psychological and familial influences.

Chung et al. (2019) have suggested some hypotheses regarding the aetiology of pica. These include:

• Hunger hypothesis, where hunger motivates individuals to engage in pica to replace nutrients not found in their diet (this is more specific to geophagic substances

such as clay, dirt);

• Nutritional hypothesis which is a biological response to micronutrient deficiencies like iron, calcium or zinc;

• Protective hypothesis in which they explained that pica relieves short-term illnesses like nausea and/or long-term effects of chemicals, pathogens or toxins; and

• Cultural hypothesis in which cultural and societal norms may contribute to the development of pica.

Cultural pica is recorded in the histories of many countries and remains a common practice in communities all over the world (Stiegler 2005). According to Rose, Porcerelli

and Neale (2000) even in some modern cultures, pica still occurs ritualistically. For example, a study of perceptions of soil eating and anaemia among pregnant women on

the Kenyan coast was conducted by Geissler et al. (1999). In the study, 52 pregnant women from Kilifi District Hospital and 4 traditional healers from the surroundings

of Kilifi were interviewed on soil eating and its perceived causes. 73% of the pregnant women reported eating soil regularly and explained it was culturally believed that

soil-eating has strong connections to fertility, reproduction and blood. In this study, the findings showed that soil-eating is more than just a physiologically induced behaviour; it is a rich cultural practice.

According to Rose, Porcerelli and Neale (2000), pica has also been practiced as part of religious ceremonies, magical beliefs and healing ceremonies. For example,

Simpson et al. (2000) conducted a study on pica during pregnancy in low-income Mexican-born women in Mexico and the United States. A convenience sample of 225 Mexican-born women was selected and interviewed.

75 of the 225 women were interviewed in Ensenada, Mexico and 150 in Southern California, USA. One of the reasons for practicing pica provided by participants was religion. One participant reported to consume, under the influence of her mother, a figure of the Virgin of Guadelope made from holy clay (gathered in San Juan de Los Lagos, Mexico) as it was believed that this would bring her blessings.

Placek and Hagen (2013) have linked pica to psychological factors, where pica is associated with high levels of stress, anxiety, depression, and developmental disorders. Pregnancy is a moment of great changes and may come with emotional state of anguish, fears and insecurities; and to cope with these stressful times, the body might adopt eating disorders such as pica (Cunha et al. 2017). It was therefore hypothesised that pica behaviour is a method of alleviating stress (Rose, Porcerelli and Neale 2000).

In these instances, cravings for pica substances are comparable to the cravings for alcohol and opium with consumption alleviating the psychological discomfort

(Placek and Hagen 2013).

An example of stress induced pica is provided in a study of pica in an urban environment conducted in Washington, DC by Edwards et al. (1994 cited in Rose, Porcerelli and Neale 2000). Many pregnant women reported practicing pica and ingesting ice freezer frost because it helped during stressful times.

According to Rose, Porcerelli and Neale (2000), pica is linked to sensory and psychological factors. They have explained that this is based on the finding that many patients with pica say that they just enjoy the taste, texture, or smell of the item they are eating. They have also linked the pica phenomenon to neuro-psychiatric factors, where it has been postulated that pica might be associated with certain patterns of brain disorders. Ogallo (2008) explained that pica is often seen in those with lower psychological functioning such as developmental disorders, autism, mental retardation, and other brain abnormalities. Although scientific studies have failed to validate this theory, some people with developmental disabilities cannot tell the difference between food and non-food items resulting in them eating non-food items when hungry or when food is not

available.

Barker (2005) has explained that apart from psychological and cultural hypotheses as the cause of pica, there are numerous links to nutritional deficiencies such as iron, zinc, calcium, nicotinic acid, vitamins B, C and D, with iron being the most common associated deficiency to pica. According to Hommey (2016), red clay, stone and soil may

be ingested because they contain high levels of natural iron. At the same time, researchers have shown that clay displaces iron in the body and this can worsen the problem if

a deficiency is the cause of pica practice (Hommey 2016). For that reason, the relationship of pica and iron deficiency has never been fully understood, and it has been proposed that pica may be either a cause or an effect of iron deficiency anaemia (Barker 2005).

2.1.6 Pica effects on the mother and her unborn child

According to Young (2010), pica has been regularly associated with both negative and positive effects on health. Among the positive effects, Young lists the provision of micronutrients, soothing of gastro-intestinal distress such as nausea and vomiting, and prevention of harmful chemicals or pathogens from entering the bloodstream.

According to Chung et al. (2019), studies have identified certain pica substances such as clay that can bind directly to pathogens, toxins or chemicals; or that can reduce the intestinal wall’s permeability by forming a barrier, preventing absorption of harmful pathogens. However, although some substances ingested may be harmless, there are some items which, when ingested, can cause serious health problems, as stated by Mortazavi and Mohammadi (2010). Such problems include toxicity like lead poisoning; bowel

obstruction; intestinal pain; parasitic infections; dental injury; iron deficiency

anaemia; and in rare cases even death.

Possible effects on the foetus, as described by Lavanya and Chandrasekharan (2019), include prematurity, perinatal mortality, low birth weight, irritability, decreased head circumference, and exposure to chemicals such as lead, herbicides, and pesticides.

The medical consequences of pica on mother and foetus vary and depend on the nature of the substances ingested (Simpson et al. 2010). For example, lead mainly has effects on the peripheral nervous system in adults and the central nervous system in children and infants (Chandramouli et al. 2009). Chronic exposure to lead has irreversible effects on cognition, behaviour and neuro- psychological function. Lead poisoning also affects the gut, kidneys,

haematological and reproductive system.

Geophagia can be a cause of parasitic infections from ingestion of soil, clay, mud leading to fever, hepatomegaly, malaise, cough, myocarditis,encephalitis, retinal lesions and loss of vision (Ogallo 2008). According to Ogallo, pregnant women practicing geophagia are particularly at risk of infection from Ascaris, Lumbricodes and Trichuris trichuria, which may contribute to severe morbidity.

Mortazavi and Mohammadi (2010) state that eating clay can cause too much or too little potassium and excessive phosphorus. The authors explain that clay can bind potassium in the intestines leading to severe hypokalemic myopathy.

According to Mensah et al. (2010), not only pica substances can have serious implication on health, but also when ingested in large quantities, can interfere with the gut’s capacity and absorption of nutrients during pregnancy. They compete for space with nutrients in the gut, therefore resulting in malnutrition, anaemia, and micronutrient imbalances. The micronutrient deficiencies as described by Kelkitli et al. (2016) are associated with health risks such as abnormal mental and motor development in infants, impaired work capacity, risk of premature birth, increased maternal and infant mortality, and more.

2.1.7 Diagnosis and tests of pica

According to Rose, Porcerelli and Neale (2000), the discovery of pica behaviour in a particular patient can be difficult in the absence of complications that might signal such eating patterns. They explained that the diagnosis depends on self-reporting, which becomes hard as patients are likely to not report the pica behaviour as they fear embarrassment, or they are not aware that such behaviour might be worth reporting. Therefore, the diagnosis is usually made when the patient has complications like anaemia, lead poisoning, intestinal obstruction, etc.

When they do report it, many individuals practicing pica display a compulsion to eat particular substances and may describe a craving or strong urge or desire to ingest the substance due to its taste, texture or consistency, as stated by Hartmann et al. (2012).

There is no specific screening test for pica (Jyothi 2015). When evaluating pregnant women, health practitioners should interview them about dietary habits and favourite food, followed by specific questions about ingestion of non-food substances and pica behaviour (Ogallo 2008). A thorough physical examination should be conducted on patients suspected to practice pica, looking for pica complications, and order blood tests including full blood count (FBC), iron levels, lead levels, ferritin level, electrolytes and liver function test (Ogallo 2008).

Abdominal radiographies such as abdominal ultrasound and barium studies as required, should also be ordered as they will help visualise foreign objects, intestinal obstruction from parasites, radiopaque particles of clay or soil, intestinal perforation, etc. (Blinder, Goodman and Henderson 1988).

psychological function. Lead poisoning also affects the gut, kidneys,

haematological and reproductive system.

Geophagia can be a cause of parasitic infections from ingestion of soil,clay, mud leading to fever, hepatomegaly, malaise, cough, myocarditis,encephalitis, retinal lesions and loss of vision (Ogallo 2008). According to Ogallo, pregnant women practicing geophagia are particularly at risk of infection from Ascaris, Lumbricodes and Trichuris trichuria, which may contribute to severe morbidity.

2.1.7 Diagnosis and tests of pica

There is no specific screening test for pica (Jyothi 2015). When evaluating pregnant women, health practitioners should interview about dietary habits and favourite food, followed by specific questions about ingestion of non-food substances and pica behaviour (Ogallo 2008). A thorough physical examination should be conducted on patients suspected to practice pica, looking for pica complications, and order blood tests including full blood count (FBC), iron levels, lead levels, ferritin level, electrolytes and liver function test (Ogallo 2008).

2.1.8 Treatment of pica

As described previously, there are no specific screening tests to facilitate the diagnosis of pica (Jyothi 2015). When the diagnosis is made, there is poor documentation of treatments for pica that are clinically proven (Rose, Porcerelli and Neale 2000). In a pica clinical review of different database sources from MEDLINE and PSYCH-Lit,

the authors Rose, Porcerelli and Neale (2000) concluded that the treatment of pica must be individualised and must first involve screening for comorbid conditions and complications. When these are found, they need to be addressed. In the case of lead poisoning from ingestion of paint chips, chelation therapy may be prescribed (Holm 2019). In this procedure, patients are given medication (orally or intravenously) that binds with lead allowing the excretion of the lead in the urine (Holm 2019). Surgical procedures may be necessary to remove metal objects from a patient’s digestive tract or to repair other injuries such as gastric perforation, intestinal obstruction and blockage, etc.

(Newport Academy 2018).

According to Jyothi (2015), the only mainstream treatments for pica are behavioural modification and counselling. In addition to those two lines of treatment, listed by Jyothi, Munir and Qadir (2010) have cited the use of medication in managing pica. Munir and Qadir (2010) listed psychological therapy and medicines as common strategies used in pica management.

2.1.8.1 Psychological management

2.1.8.1.1 Counselling or psychotherapy

This is the initial and most effective way of treating pica patients. Family care, group counselling or marital counselling, guidance, overcorrection and teaching can help in controlling pica in all kinds of patients experiencing pica (Munir and Qadir 2010). According to Carter, Mayton and Wheeler (2004), pica is related to anxiety +/o: frustrations, so self-monitoring together with progressive relaxation have long term effectiveness due to skills taught to reduce anxiety.

2.1.8.1.2 Cognitive behaviour therapy

This treatment is behaviour-based. For instance, creating a negative image of the harmful substances in the mind of the pica sufferer, and discrimination training between edible and non-edible items, can reduce consumption of pica substances (Munir and Qadir 2010). In the same behavioural approach, associating a pica patient’s behaviour with consequences such as reward or punishment, depending on whether the patient abstains from pica substances or not, can be helpful in pica treatment (Hommey 2016).

Other psychological interventions have been used to address pica, namely, responsive blocking and redirection. According to Carter et al. (2004), redirecting the pica patient

to their preferred food (when the craving surges) in conjunction with response blocking is effective in producing reduction in pica rates. Response blocking can be achieved, for example, placing a hand between the hand of the patient and their lips to prevent them from eating the pica substance when they are about to do so (Hagopian and Adelinis 2001).

Vincent van Gogh: schluckte Terpentin und aß Farbe

[Antonia Fuchs]

Das Rapunzel-Syndrom ist eine seltene, aber schwerwiegende psychiatrische Erkrankung, bei der sich die Betroffenen Haare ausreißen (Trichotillomanie) und anschließend schlucken (Trichophagie). Da Haare im Magen nicht verdaut werden können, bildet sich mit der Zeit ein Haarknäuel, das sich wie ein Zopf vom Magen vorbei am Zwölffingerdarm bis in den Dünndarm erstrecken kann. Das gab dem Rapunzel-Syndrom, angelehnt an Grimms Märchenfigur, seinen Namen.

Laut Expertenschätzungen neigen etwa ein bis 4% der Bevölkerung dazu, sich die eigenen Haare als Ventil gegen innere Anspannung auszurupfen. 20% unter ihnen schlucken die Haare, wovon wiederum bei einem Drittel das Rapunzel-Syndrom auftritt und sich ein sogenannter Trichobezoar im Magen-Darm-Trakt bildet.

Was sind die Ursachen für das Rapunzel-Syndrom?

Ob ein Trichobezoar entsteht, hängt auch mit der Menge und Länge der verschluckten Haare zusammen. Die genauen Hintergründe sind jedoch weitgehend unbekannt, ebenso wie die Ursachen für die Verhaltensstörung. Die Erkrankung tritt häufig in Zusammenhang mit Depressionen, Schizophrenie, Angststörungen oder Essstörungen wie Bulimie und dem Pica-Syndrom auf, bei dem die Betroffenen Dinge essen, die keine Nahrungsmittel sind.

Der erste Fall des Rapunzel-Syndroms wurde 1968 bei einem damals 16-jährigen Mädchen beschrieben. Seitdem sind in der medizinischen Fachliteratur nur etwa 100 Fälle bekannt geworden. Fast ausschließlich waren Mädchen betroffen, die meisten jünger als 20 Jahre. Warum vor allem Mädchen betroffen sind, ist nicht abschließend geklärt. Möglich ist, dass dies auch mit der durchschnittlich längeren Haarlänge bei Mädchen zu tun hat, was die Entstehung eines Trichobezoars begünstigt.

Welche Symptome treten beim Rapunzel-Syndrom auf?

Oft bleibt das Rapunzel-Syndrom jahrelang unerkannt, denn die Mädchen verschweigen ihr Verhalten oder sind sich dessen gar nicht bewusst, bis erste Beschwerden auftreten. Typische Symptome des Rapunzel-Syndroms sind Schmerzen im Oberbauch, Appetitlosigkeit, Verstopfung, ein aufgeblähter Bauch, Gewichtsverlust und kahle Stellen am Kopf, die durch das Ausreißen der Haare entstehen.

Neben Bauchschmerzen kann das Haarknäuel einen Darmverschluss verursachen, wodurch der betroffene Darmabschnitt absterben kann und im schlimmsten Fall zum Tode führt. Eine 38-jährige Patientin in Tucson, Arizona, konnte laut einer Fallstudie kein Essen ohne Erbrechen bei sich behalten. Ihr Magen schwoll an wie ein Ballon, die typischen gluckernden Darmgeräusche fehlten indes komplett. Ein Haarball in Tennisballgröße im Magen mit einem Fortsatz bis in den Zwölffingerdarm und ein zweites Knäuel im Dünndarm hatten bei ihr zu einem Darmverschluss geführt. Eine Operation rettete ihr das Leben.

In manchen Fällen wurden auch Risse in der Magen- oder Darmwand und lebensbedrohliche Entzündungen festgestellt, bei der Frau aus Tucson auch ein Proteinmangel

im Blut. Mediziner vermuten, dass die Haare die Darmschleimhaut angreifen und damit die Aufnahme von Nahrungsbestandteilen wie Proteine ins Blut gestört ist.

Wie wird das Rapunzel-Syndrom therapiert?

Haben Mediziner die Ursache für die Beschwerden erst einmal erkannt, wird zunächst versucht, den Haarballen mit Abführmitteln oder Enzymen zu entfernen. In vielen Fällen ist jedoch ein chirurgischer Eingriff nötig, denn alternative Methoden scheitern häufig an der schieren Größe der Filzgebilde.

So wie im Fall eines Mädchens aus Wiesbaden: Laut "Ärztezeitung" zog sich ein steinharter Trichobezoar wie eine Fliese quer durch den Magen der Vierjährigen und ragte noch rund 30 Zentimeter in den Dünndarm hinein. Auch der Versuch, den steinernen Haarknäuel in kleinere Stücke zu zerteilen, blieb ohne Erfolg – das Mädchen musste operiert werden.

Wurde kein Gewebe beschädigt, erholen sich die Patientinnen meist ohne Folgen, sobald das Haarknäuel entfernt wurde. Für Betroffene ist es jedoch wichtig, psychologische Hilfe in Anspruch zu nehmen, um das schädigende Verhalten in Zukunft zu verhindern und die zugrunde liegenden Ursachen der Störung aufzuklären. Bei der Behandlung von Pica-Syndrom und Trichotillomanie sind verhaltenstherapeutische Strategien etabliert und die Wirksamkeit gut belegt. Um Rückfälle zu verhindern, kann auch der Einsatz von Antidepressiva und Antipsychotika sinnvoll sein.

Vorwort/Suchen Zeichen/Abkürzungen Impressum