Waste not, want not: A brief overview of coprophagia

One of the most stomach churning behaviours among humans is coprophagia (i.e., the eating of faeces), and has the capacity to generate intense emotional reactions among those witnessing such behaviour. I don’t know about you, but my first visual exposure to human copraphagia was in the 1972 John Waters film Pink Flamingos when the leading “actress” Divine (a transvestite male) ate the freshly produced (and real) excrement from a dog that had just defecated on the pavement. As the narrator states immediately this as happened, Divine is “not only the filthiest person in the world, but is also the world’s filthiest actress”. The arts world is littered with coprophagic references and acts ranging from the detailed descriptions in the Marquis de Sade’s infamous novel The 120 Days of Sodom through to recent films such as The Human Centipede.

Hundreds of years ago, medical doctors used to taste their patients’ faeces as a way to assess their patients health and condition. Such historical actions, while seemingly gross, at least had a functional goal. In contemporary society, coprophagia often occurs among individuals with severe developmental disabilities although for a very small minority, coprophagic acts may occur as part of the sexual paraphilia coprophilia (i.e., sexual arousal and pleasure from faeces).

Copraphagia is a complex behavioural disorder and is commonly regarded as a variant form of pica (i.e., the eating of non-nutritive items or substances), even though there are many health risks associated with it (e.g., intestinal parasites, diarrhea, blood-borne pathogens). Other problems include poor oral hygiene, chronic gingival infection, and salivary gland infections.

A number of medical disorders have been identified that are associated with coprophagia including seizure disorders, cerebral atrophy, and tumours. There are also many psychological and psychiatric disorders associated with coprophagia including mental retardation, alcoholism, severe depression, autism, obsessive-compulsive disorder, Klüver-Bucy syndrome, schizophrenia, fetishes, delirium, and dementia. The psychopathological roots and etiology of coprophagia still remain little known, and much of what has been published academically involves case studies. Furthermore, the prevalence of copraphagia is also unknown but thought to be very rare.

In a 1989 study of 14 elderly coprophagic patients (average age of 71 years) in psychiatric hospitals published in the British Journal of Psychiatry, Ghaziuddin and McDonald reported that nine had senile dementia, two were severely depressed, and one had cerebral atrophy. Three of the 14 were reported has having no cognitive deficits. Although comprising only 14 patients, this is actually one of the largest studies in the area as most published papers consist of case studies.

As mentioned above, copraphagia can on occasion be seen as part of a sexual fetish where the eating of faeces is associated with sexual arousal. In a 1995 issue of the Journal of Sex and Marital Therapy, Dr. T. Wise and Dr. R. Goldberg reported the case of a non-psychotic 47-year old man of normal intelligence who had a fetish for faecal smearing that escalated into coprophagia when combined with alcohol abuse and depression.

In researching this blog, I came across a form of culture bound syndrome called Arctic Hysteria (also known as Piblokto and Pibloktoq) where one of the common symptoms is coprophagia. Culture bound syndromes comprise a combination of psychiatric and/or somatic symptoms viewed as a recognizable disease within specific cultures or societies. Arctic Hysteria only manifests itself in winter among Inuhuit societies living (unsurprisingly) within the Arctic Circle. The condition is characterized by “an abrupt dissociative episode of intense hysteria, frequently followed by convulsive seizures and coma lasting up to 12 hours. Symptoms can include intense screaming, uncontrolled wild behaviour, depression, coprophagia, and insensitivity to extreme cold”. Some scholars have cast doubt on its existence as a bona fide medical entity, but the association with copraphagia occurs repeatedly.

There is a wide variety of treatments that have been used for coprophagia including behavioural therapy, dietary changes, pharmacotherapy (e.g., tricyclic antidepressants, haloperidol, perospirone), and electro-convulsive therapy. All of these have reported at least partial success.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Beck D.A. & Frohberg, N.R. (2005). Coprophagia in an elderly man: a case report and review of the literature. International Journal of Psychiatry Medicine, 35, 417-427.

Donnellan, C.A. & Playfer, J.R. (1999). A case of coprophagia presenting with sialadenitis. Age and Ageing, 28, 233-234.

Foxx, R. M., & Martin, E. D. (1975). Treatment of scavenging behavior (coprophagy and pica) by overcorrection. Behavior Research and Therapy, 13, 153–162.

Friedin, B.D., & Johnson, H.K. (1979). Treatment of a retarded child’s feces smearing and coprophagic behavior. Journal of Mental Deficiency Research, 23, 55–61.

Ghaziuddin, N. & McDonald, C. (1989). A clinical study of adult coprophagics. British Journal of Psychiatry, 4, 53-54.

Harada, K.I., Yamamoto, K. & Saito, T. (2006). Effective treatment of coprophagia in a patient with schizophrenia with the novel atypical antipsychotic drug perospirone. Pharmacopsychiatry, 39, 113.

Ing, A.D., Roane, H.S. & Veenstra, R.A. (2011). Functional analysis and treatment of coprophagia. Journal of Applied Behavior Analysis. 44, 151–155

Pardini, M., Guida, S. & Gialloreti, L.E. (2010). Aripiprazole Treatment for Coprophagia in Autistic Disorder. Journal Neuropsychiatry and Clinical Neuroscience, 22(4), E33

Wise, T.N. & Goldberg, R.L. (1995). Escalation of a fetish: coprophagia in a nonpsychotic adult of normal intelligence. Journal of Sex and Marital Therapy, 21, 272-275.