Category Archives: Pica
Bog standard: A brief look at toilet tissue eating
In previous blogs I have looked at pica (i.e., the eating of non-nutritive items or substances) and subtypes of pica such as geophagia (eating of soil, mud, clay, etc.), pagophagia (eating of ice), acuphagia (eating of metal), and coprophagia (eating of faeces). It wasn’t until I started to research on specific sub-types of pica, that I discovered how many different types of non-food substances had been identified in the academic and clinical literature. For instance, Dr. V.J. Louw and colleagues provided a long list in a 2007 issue of the South African Medical Journal including cravings for the heads of burnt matches (cautopyreiophagia), cigarettes and cigarette ashes, paper, starch (amylophagia), crayons, cardboard, stones (lithophagia), mothballs, hair (trichophagia), egg shells, foam rubber, aspirin, coins, vinyl gloves, popcorn (arabositophagia), and baking powder. Most of these are generally thought to be harmless but as Louw and colleagues note, a wide range of medical problems have been documented:
“These include abdominal problems (sometimes necessitating surgery), hypokalaemia, hyperkalaemia, dental injury, napthalene poisoning (in pica for toilet air-freshener blocks), phosphorus poisoning (in pica for burnt matches), peritoneal mesothelioma (geophagia of asbestos-rich soil), mercury poisoning (in paper pica), lead poisoning (in dried paint pica and geophagia), and a pre-eclampsia-like syndrome (baking powder pica)”.
In the clinical literature, the eating of paper has been occasionally documented (although anecdotal evidence suggests this is fairly common and I remember doing it myself as a child). A review paper on pica by Dr. Silvestre Frenk and colleagues in the Mexican journal Boletín Médico del Hospital Infantil de México highlighted dozens of pica-subtypes and created many new names for various pica sub-types. They proposed that people who eat paper display ‘papirophagia’ (in fact if you type ‘papirphagia’ into Google, you only get one hit – the paper by Silvestre and colleagues – although this blog may make it two!). Eating paper is not thought to be particularly harmful although I did find a case of mercury poisoning because of ‘paper pica’ (as the authors – Dr. F. Olynk and Dr. D. Sharpe – called it) in a 1982 issue of the New England Journal of Medicine.
One sub-type of papirophagia is the eating of toilet paper. As far as I am aware, there is only one case study in the literature and this was published back in 1981, Dr. J. Chisholm Jr. and Dr. H. Martín in the Journal of the National Medical Association. They described the case of a 37-year old black woman with an “unusually bizarre craving” for toilet tissue paper. The authors reported that:
“[The] woman was referred for evaluation of disturbed smell and loss of taste for over one year. These were associated with chronic fatigue and listlessness. During this same period of time, she rather embarrassedly admitted to an overwhelming desire to eat toilet tissue. Frequently, she would awaken at night and dash to her bathroom to eat toilet tissue. No other type(s) of pica were admitted. In addition, she gave a long history of menorrhagia and frequently passed vaginal blood clots during her menses. Her libido was normal and there was no history of poor wound healing, skin or mucous membrane lesions, or intestinal symptoms. Her dietary history suggested a high carbohydrate diet, and due to a mild exogenous obesity she intermittently resorted to a vegan-like diet that included beans and various seeds”
A variety of medical tests were carried out and she was diagnosed with combined iron and zinc deficiency. She was treated with iron and zinc tablets and within a week, both her taste and smell had returned, and her energy levels greatly improved. Zinc deficiencies can lead to a wide variety of clinical disorders including loss of small and taste, anorexia, dwarfism (i.e., growth retardation), impaired wound healing, and geophagia. The woman’s (sometimes) vegan diet may have been to blame for her zinc deficiency as the authors noted that:
“Although vegetables contain zinc, vegans should be made aware that zinc from plant sources is not readily absorbed because naturally occurring phytates, particularly high in beans and seeds, reduce zinc gastrointestinal absorption. Carbohydrates are very poor sources of zinc. Chronic iron deficiency secondary to chronic menorrhagia accounts well for the anemia, fatigue, and unusual pica for toilet tissue noted in this patient”.
Paper pica has occasionally been mentioned in other academic papers although details have typically been limited. For instance, a 1995 paper in the journal Birth by Dr. N.R. Cooksey on three cases of pica in pregnancy reported that one of the women chewed non-perfumed blue toilet paper during the first trimester of her pregnancy (and was forced by her mother to stop). There was also a 2003 paper published by Dr. Dumaguing in the Journal of Geriatric Psychiatry and Neurology examining pica in mentally ill geriatrics. One of the cases mentioned was a 76-year old patient that not only ingested their medication (an emollient cream for arthritis) but was also recorded eating toilet paper, napkins, Styrofoam cups, crayons, and other patients’ medications.
A more recent 2008 paper by Dr. Sera Young and her colleagues in the journal PLoS ONE, critically reviewed procedures and guidelines for interviews and sample collection in relation to pica substances. In describing the protocols involved, they referred to paper pica in the questions that should be asked:
“What is the local name, brand name, or type of pica substance desired or consumed? This will help others to know if this substance has already been studied and assist interested researchers in obtaining subsequent samples at a later date. Furthermore, different manufactured products may contain different materials, e.g. Crayola chalkboard chalk contains slightly different ingredients from other brands. Similarly, the consequences of toilet tissue paper consumption are different from those of eating pages of a novel; information would be lost if the substance was simply described as paper. For these reasons, the substance consumed should be described in as much detail and as accurately as possible”.
Personally (and based on anecdotal evidence), I think that papirophagia is not overly rare (especially among children – although I admit this may be more out of curiosity that craving) but the clinical literature suggests that it is a fairly rare disorder found amongst distinct sub-groups (pregnant women, the mentally ill). Given the fact that for most people eating paper would not cause any problems, this would provide the main reason why so few cases end up seeking medical, clinical, and/or psychological help.
Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Chisholm Jr, J. C., & Martín, H. I. (1981). Hypozincemia, ageusia, dysosmia, and toilet tissue pica. Journal of the National Medical Association, 73(2), 163-164.
Cooksey, N.R. (1995). Pica and olfactory craving of pregnancy: How deep are the secrets? Birth, 22, 129-137.
Dumaguing, N.I., Singh, I., Sethi, M., & Devanand, D.P. (2003). Pica in the geriatric mentally ill: unrelenting and potentially fatal. Journal of Geriatric Psychiatry and Neurology, 16, 189-191.
Frenk, S., Faure, M.A., Nieto, S. & Olivares, Z. (2013). Pica. Boletín Médico del Hospital Infantil de México, 70(1), 55-61
Louw, V.J., Du Preez, P., Malan, A., Van Deventer, L., Van Wyk, D., & Joubert, G. (2007). Pica and food craving in adults with iron deficiency in Bloemfontein, South Africa. South African Medical Journal, 97, 1069-1071.
Olynyk, F., & Sharpe, D. H. (1982). Mercury poisoning in paper pica. The New England Journal of Medicine, 306, 1056 -1057.
Young, S.L., Wilson, M.J., Miller, D., Hillier, S. (2008). Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. PLoS ONE, 3(9), e3147. doi:10.1371/journal.pone.0003147
Bog standard: A brief look at toilet tissue eating
In previous blogs I have looked at pica (i.e., the eating of non-nutritive items or substances) and subtypes of pica such as geophagia (eating of soil, mud, clay, etc.), pagophagia (eating of ice), acuphagia (eating of metal), and coprophagia (eating of faeces). It wasn’t until I started to research on specific sub-types of pica, that I discovered how many different types of non-food substances had been identified in the academic and clinical literature. For instance, Dr. V.J. Louw and colleagues provided a long list in a 2007 issue of the South African Medical Journal including cravings for the heads of burnt matches (cautopyreiophagia), cigarettes and cigarette ashes, paper, starch (amylophagia), crayons, cardboard, stones (lithophagia), mothballs, hair (trichophagia), egg shells, foam rubber, aspirin, coins, vinyl gloves, popcorn (arabositophagia), and baking powder. Most of these are generally thought to be harmless but as Louw and colleagues note, a wide range of medical problems have been documented:
“These include abdominal problems (sometimes necessitating surgery), hypokalaemia, hyperkalaemia, dental injury, napthalene poisoning (in pica for toilet air-freshener blocks), phosphorus poisoning (in pica for burnt matches), peritoneal mesothelioma (geophagia of asbestos-rich soil), mercury poisoning (in paper pica), lead poisoning (in dried paint pica and geophagia), and a pre-eclampsia-like syndrome (baking powder pica)”.
In the clinical literature, the eating of paper has been occasionally documented (although anecdotal evidence suggests this is fairly common and I remember doing it myself as a child). A recent review paper on pica by Dr. Silvestre Frenk and colleagues in the Mexican journal Boletín Médico del Hospital Infantil de México highlighted dozens of pica-subtypes and created many new names for various pica sub-types. They proposed that people who eat paper display ‘papirophagia’ (in fact if you type ‘papirphagia’ into Google, you only get one hit – the paper by Silvestre and colleagues – although this blog may make it two!). Eating paper is not thought to be particularly harmful although I did find a case of mercury poisoning because of ‘paper pica’ (as the authors – Dr. F. Olynk and Dr. D. Sharpe – called it) in a 1982 issue of the New England Journal of Medicine.
One sub-type of papirophagia is the eating of toilet paper. As far as I am aware, there is only one case study in the literature and this was published back in 1981, Dr. J. Chisholm Jr. and Dr. H. Martín in the Journal of the National Medical Association. They described the case of a 37-year old black woman with an “unusually bizarre craving” for toilet tissue paper. The authors reported that:
“[The] woman was referred for evaluation of disturbed smell and loss of taste for over one year. These were associated with chronic fatigue and listlessness. During this same period of time, she rather embarrassedly admitted to an overwhelming desire to eat toilet tissue. Frequently, she would awaken at night and dash to her bathroom to eat toilet tissue. No other type(s) of pica were admitted. In addition, she gave a long history of menorrhagia and frequently passed vaginal blood clots during her menses. Her libido was normal and there was no history of poor wound healing, skin or mucous membrane lesions, or intestinal symptoms. Her dietary history suggested a high carbohydrate diet, and due to a mild exogenous obesity she intermittently resorted to a vegan-like diet that included beans and various seeds”
A variety of medical tests were carried out and she was diagnosed with combined iron and zinc deficiency. She was treated with iron and zinc tablets and within a week, both her taste and smell had returned, and her energy levels greatly improved. Zinc deficiencies can lead to a wide variety of clinical disorders including loss of small and taste, anorexia, dwarfism (i.e., growth retardation), impaired wound healing, and geophagia. The woman’s (sometimes) vegan diet may have been to blame for her zinc deficiency as the authors noted that:
“Although vegetables contain zinc, vegans should be made aware that zinc from plant sources is not readily absorbed because naturally occurring phytates, particularly high in beans and seeds, reduce zinc gastrointestinal absorption. Carbohydrates are very poor sources of zinc. Chronic iron deficiency secondary to chronic menorrhagia accounts well for the anemia, fatigue, and unusual pica for toilet tissue noted in this patient”.
Paper pica has occasionally been mentioned in other academic papers although details have typically been limited. For instance, a 1995 paper in the journal Birth by Dr. N.R. Cooksey on three cases of pica in pregnancy reported that one of the women chewed non-perfumed blue toilet paper during the first trimester of her pregnancy (and was forced by her mother to stop). There was also a 2003 paper published by Dr. Dumaguing in the Journal of Geriatric Psychiatry and Neurology examining pica in mentally ill geriatrics. One of the cases mentioned was a 76-year old patient that not only ingested their medication (an emollient cream for arthritis) but was also recorded eating toilet paper, napkins, Styrofoam cups, crayons, and other patients’ medications.
A more recent 2008 paper by Dr. Sera Young and her colleagues in the journal PLoS ONE, critically reviewed procedures and guidelines for interviews and sample collection in relation to pica substances. In describing the protocols involved, they referred to paper pica in the questions that should be asked:
“What is the local name, brand name, or type of pica substance desired or consumed? This will help others to know if this substance has already been studied and assist interested researchers in obtaining subsequent samples at a later date. Furthermore, different manufactured products may contain different materials, e.g. Crayola chalkboard chalk contains slightly different ingredients from other brands. Similarly, the consequences of toilet tissue paper consumption are different from those of eating pages of a novel; information would be lost if the substance was simply described as paper. For these reasons, the substance consumed should be described in as much detail and as accurately as possible”.
Personally (and based on anecdotal evidence), I think that papirophagia is not overly rare (especially among children – although I admit this may be more out of curiosity that craving) but the clinical literature suggests that it is a fairly rare disorder found amongst distinct sub-groups (pregnant women, the mentally ill). Given the fact that for most people eating paper would not cause any problems, this would provide the main reason why so few cases end up seeking medical, clinical, and/or psychological help.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Chisholm Jr, J. C., & Martín, H. I. (1981). Hypozincemia, ageusia, dysosmia, and toilet tissue pica. Journal of the National Medical Association, 73(2), 163-164.
Cooksey, N.R. (1995). Pica and olfactory craving of pregnancy: How deep are the secrets? Birth, 22, 129-137.
Dumaguing, N.I., Singh, I., Sethi, M., & Devanand, D.P. (2003). Pica in the geriatric mentally ill: unrelenting and potentially fatal. Journal of Geriatric Psychiatry and Neurology, 16, 189-191.
Frenk, S., Faure, M.A., Nieto, S. & Olivares, Z. (2013). Pica. Boletín Médico del Hospital Infantil de México, 70(1), 55-61
Louw, V.J., Du Preez, P., Malan, A., Van Deventer, L., Van Wyk, D., & Joubert, G. (2007). Pica and food craving in adults with iron deficiency in Bloemfontein, South Africa. South African Medical Journal, 97, 1069-1071.
Olynyk, F., & Sharpe, D. H. (1982). Mercury poisoning in paper pica. The New England Journal of Medicine, 306, 1056 -1057.
Young, S.L., Wilson, M.J., Miller, D., Hillier, S. (2008). Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. PLoS ONE, 3(9), e3147. doi:10.1371/journal.pone.0003147
That’ll do icily: A brief look at pagophagia
In a previous blog on five ‘weird addictions’ I briefly mentioned pagophagia, a craving and compulsion for chewing ice. Pagophagia is a type of pica (which I also covered in a previous blog). Pica is defined as the persistent eating of non-nutritive substances for a period of at least one month, without an association with an aversion to food. Although the incidence of pagophagia appears to have increased over the last 30 years in westernized cultures, Dr. B. Parry-Jones (in a 1992 issue of Psychological Medicine) carried out some historical research and pointed out that both Hippocrates and Aristotle wrote about the dangers of excessive intake of iced water. Parry-Jones also noted that references to disordered eating of ice and snow were also recorded in medical textbooks from the sixteenth century. However, the first contemporary reference to pagophagia appears to have been a 1969 paper by Dr. Charles Coltman in the Journal of the American Medical Association entitled ‘Pagophagia and iron lack’.
Pagophagia is closely associated with iron deficiency anemia but can also be caused by other factors (biochemical, developmental, psychological, and/or cultural disorders). If pagophagia is due to iron deficiency (such as case studies of those with sickle cell anemia), it may sometimes be accompanied by fatigue (e.g., being tired even when performing normally easy tasks). Dr. Youssef Osman and his colleagues published a number of case reports of pagophagia in a 2005 issue of the journal Pediatric Haematology and Oncology including the case of a child with sickle cell anemia and rectal polyps (that caused a lot of bleeding and made the anemia worse):
“An 8-year-old Omani boy, a known case of sickle cell anemia…presented with history of craving for ice. The child was noticed over the last 4 months to like drinking very cold water and to open the deep freezer and scratch the ice and eat it. The parents tried to stop him from doing so, but they failed…The child was started on oral iron therapy…and his craving for ice was completely stopped. Meanwhile, the rectal polyp was removed surgically”.
Other potential health side effects include constant headaches (a ‘brain freeze’ similar to ‘ice cream headache’) and teeth damage although this is thought to be relatively rare. However, a recent paper by Dr. Yasir Khan and Dr. Glen Tisman in the Journal of Medical Case Reports highlighted the case of a 62-year-old Caucasian man who presented with bleeding from colonic polyps associated with drinking partially frozen bottled water.
Khan and Tisman also suggested that some people who are deficient in iron experience tongue pain and glossal inflammation (glossitis). Others claim that chewing ice may help those with stomatitis (i.e., inflammation of the mucous lining inside the mouth). A recent 2009 case study published by Dr. Tsuyoshi Hata and his colleagues in the Kawasaki Medical Journal, reported the case of a 37-year old Japanese women who ate copious amounts of ice to relieve the pain of temporomandibular joint disorder (i.e., chronic pain in the joint that connects the jaw to the skull). Khan and Tisman also claim that the classical symptoms of pagophagia have changed in the last 40 years since Dr. Coltman’s initial paper in the Journal of the American Medical Association.
“This may probably be the result of advances in technology and changes in culture. When initially described [by Coltman], pagophagia was defined as the excessive ingestion of ice cubes from ice trays and the ingestion of ice scraped from the wall of the freezer. With the advent of ice cube makers and auto defrosters, the presentation of pagophagia has changed in a subtle manner as described in…our patients. Now we observe a subtler ingestion and/or sucking of ice cubes from large super-sized McDonald’s-like cups and from the use of popular bottled water containers that have been frozen”.
There have been few epidemiological studies examining the prevalence of pagophagia. Such estimates vary widely within particular populations but (according to Dr. Youssef Osman and his colleagues) have been shown to be more common in low socioeconomic and underdeveloped areas. Pagophagia is thought to be relatively harmless in itself or to one’s health, although there are some claims in the literature that pagophagia can be addictive. However, empirical reviews suggest that pagophagia (and pica more generally) is part of the obsessive-compulsive disorder spectrum of diseases. As a consequence, some case studies even suggest that ice chewing compromises their ability to maintain jobs or personal relationships.
Treatment for pagophagia can often be overcome with iron therapy and Vitamin C supplements (to supplement iron deficiency if that is the cause). For instance, Dr. Mark Marinella in a 2008 issue of the Mayo Clinic Proceedings successfully treated a 33-year old woman with pagophagia following complications with gastric bypass surgery:
“The patient received red blood cells, iron sucrose, and levofloxacin. On further questioning, the patient denied taking vitamin, mineral, or iron supplements since surgery and reported prolonged, heavy menstrual cycles. She consumed large amounts of ice daily for several months. The patient’s husband frequently observed her in the middle of the night with her head in the freezer eating the frost off the icemaker. The patient admitted to awakening several times nightly for months with an uncontrollable compulsion to eat the frost on the icemaker. This craving resolved after transfusion and iron administration”
However, if the condition is psychologically or culturally based, iron and vitamin supplements are unlikely to work, and other psychological treatments (such as cognitive-behavioural therapy) are likely to be employed.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Coltman, C.A. (1969). Pagophagia and iron lack. Journal of the American Medical Association, 207, 513-516.
de Los Angeles, L., de Tournemire, R. & Alvin, P. (2005). Pagophagia: pica caused by iron deficiency in an adolescent. Archives of Pediatrics, 12, 215-217.
Edwards, C.H., Johnson, A.A., Knight, E.M., Oyemadej, U.J., Cole, O.J., Westney, O.E., Jones, S. Laryea, H. & Westney, L.S. (1994). Pica in an urban environment. Journal of Nutrition (Supplement), 124, 954-962.
Hata, T., Mandai, T., Ishida, K., Ito, S., Deguchi, H. & Hosoda, M. (2009). A rapid recovery from pagophagia following treatment for iron deficiency anemia and TMJ disorder accompanied by masked depression. Kawasaki Medical Journal, 35, 329-332.
Khan, Y. & Tisman, G. (2010). Pica in iron deficiency: A case series. Journal of Medical Case Reports, 4, 86. Located: http://www.jmedicalcasereports.com/content/4/1/86
Kirchner, J.T (2001). Management of pica: A medical enigma. American Family Physician, 63, 1177-1178.
Marinella, M. (2008). Nocturnal pagophagia complicating gastric bypass. Mayo Clinic Proceedings, 83, 961
Osman, Y.M., Wali, Y.A. & Osman, O.M. (2005). craving for ice and iron-deficiency anemia: a case series. Pediatric Hematology and Oncology, 22, 127-131.
Parry-Jones, B. (1992). Pagophagia, or compulsive ice consumption: A historical perspective. Psychological Medicine, 22, 561-571.
Stats entertainment (Part 2): A 2013 review of my personal blog
My last blog of 2013 was not written by me but was prepared by the WordPress.com stats helper. I thought a few of you might be interested in the kind of person that reads my blogs. I also wanted to wish all my readers a happy new year and thank you for taking the time to read my posts.
Here’s an excerpt:
The Louvre Museum has 8.5 million visitors per year. This blog was viewed about 860,000 times in 2013. If it were an exhibit at the Louvre Museum, it would take about 37 days for that many people to see it.
Sheathing troubles: The strange case of accidental condom inhalation
While researching a previous blog on condom snorting, I came across an interesting case study of ‘accidental condom inhalation’ (and no, I promise I am not making this up). The case dates back to 2004 and was published by Dr. C.L. Arya and colleagues in the Indian Journal of Chest Diseases and Allied Sciences (IJCDAS).
Anyone who has kids will know that (just out of curiosity) they commonly put things in their mouths. The IJCDAS paper made reference to a number of medical studies that have shown inhaled items include things that can be from the edible (nuts, seeds, beans, etc) to the non-edible (plastic objects, screws, needles, pins, etc). They also note that when inhaling such objects, it doesn’t always lead to immediate medical symptoms or complications (such as choking, wheezing, coughing, etc.). However, the case that Dr. Arya and colleagues reported on was a little out of the ordinary.
The case involved a 27-year-old woman who was a schoolteacher. For a six-month period she had been suffering from a persistent cough where she was coughing up mucus along with some pneumonia symptoms. Initial examination showed nothing of consequence. Further tests took place and the paper reported that:
“The chest radiographs carried out subsequently showed development of a non-homogeneous right upper lobe lesion, not resolving either with antibiotics or a four-month trial of an empirical anti-tuberculosis treatment instituted by various practitioners. No symptomatic relief was obtained with either therapy. [A later] chest radiograph demonstrated a right upper lobe collapse-consolidation of lung. The opacity led us to promptly carry out a video-bronchoscopy, which gave impression of a white membranous object protruding from the collapsed right upper lobe bronchus. On probing further, it was noticed to be an inverted bag-like structure ‘sitting’ in the bronchus and having a flap-like action. A rigid bronchoscopy was then performed and the object was easily removed with biopsy forceps, though, it tore into pieces during procedure”.
As you will have noted from the title of this blog, the pieces were identified as being from a condom. The woman and her husband eventually recalled to the medics (after much probing by the medics) that there was an incident that occurred where a condom had become loosened while the wife was performing oral sex on her husband. During this particular sexual act, the woman had experienced a bout of coughing and sneezing and without her knowing she had accidentally inhaled her husband’s condom.
One of the reasons that the accidental inhalation went unnoticed for so long was because the inhaled object was of “soft, elastic and rubbery consistency that [was] unlikely to cause a direct lung injury”. The authors noted that:
“The airway obstruction of the right upper lobe segments produced by [the condom], could have resulted in the retention of secretions and the infection of corresponding lung segments, which may have become radiologically visible as a non-homogeneous right upper lobe collapse-consolidation. Despite mechanical obstruction, the flap-like action of condom (as noticeable on video-bronchoscopy) probably continued to clear secretions from right upper lobe, contributing to the delay in radiologic presentation of case”.
The medics were unsure whether the woman had genuinely accidentally swallowed the condom or whether she was just too embarrassed to report the incident and/or didn’t relate the incident to her subsequent symptoms. The authors also claimed that the original physicians who examined the woman were responsible for the condition being prolonged as they had failed to suspect that a foreign object (i.e., a condom) was the cause of the non-resolved pneumonia. They then noted that:
“Perhaps, views of physicians were guided by the age of patient (that was less suited for a suspicion of an inhaled foreign body), and also the fact, that a disease like tuberculosis was so highly prevalent in this part of world that a preference for the institution of [anti-tuberculosis treatment] was quite natural”.
Together, all of these reasons are likely to have resulted in a delayed diagnosis. The authors also noted that:
“Even following the condom retrieval [both husband and wife] were understandably hesitant in disclosing it owing to the nature of affair concerned (involving one’s privacy), the unusual nature of coitus performed (via an oral route) and the inhalation of a discrete object (like condom). The possibility of seminal aspiration also taking place simultaneously may not be ruled out…The case has certain atypical features, of which, the foremost relates to the type of inhaled object, i.e., a condom, which has not been reported in the literature to the best of our knowledge…[Another] atypical feature was adult-age of patient, that by any means, would be least expected to be associated with any foreign body inhalation”.
The authors speculated as to whether this incident was a one-off or whether such incidents were more widespread and were being under-reported because the Indian sub-continent has “a traditional conservative culture” where “people tend to have religious attitudes and sex is largely considered to be a subject limited to a person’s private life”. The authors concluded that:
“Perhaps, the young lady in our case was also quite apprehensive about fellatio, a fact that could have played a part in the condom inhalation. It is much desirable that sex taboos prevalent on the sub-continent are curbed and greater sexual awareness created in the people’s minds”.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Agarwal, R.K., Banerjee, G., Shembish, N., & Jamal, B.A., Kareemullah, C. & Swaleh, A. (1988). Foreign bodies in the tracheobronchial tree: A review of 102 cases in Benghazi, Libya. Annals of Tropical Paediatrics, 8, 213-16.
Arya, C.L., Gupta, R. & Arora, V.K. (2004). Accidental condom inhalation. Indian Journal of Chest Diseases and Allied Sciences, 46, 55-58.
Ben-Dov, I. & Aelony, Y. (1989). Foreign body aspiration in the adult: An occult cause of chronic pulmonary symptoms. Postgraduate Medical Journal, 65, 299-301.
Causey, A.L., Talton, D.S., Miller, R.C., Warren, E.T. (1997). Aspirated safety pin requiring thoracotomy: Report of a case and review. Pediatric Emergency Care, 13, 397-400.
Lyons, D.J., McClod, D., Prichard, J., Dowd, D., & Clancy L. (1993). Very long retention of bronchial foreign bodies: Two new cases and a review of the literature. Irish Medical Journal, 86, 74-75.
Murthy, P.S., Ingle, V.S., George, E., Ramakrishna S. & Shah, F.A. (2001). Sharp foreign bodies in the tracheobronchial tree. American Journal of Otolaryngology, 22, 154-56.
Muddy daughters: A beginner’s guide to geophagia
In previous blogs I have looked at pica and some of the pica sub-variants including pagophagia (the eating of ice) and coprophagia (the eating of faeces). Pica is defined as the persistent eating of non-nutritive substances for a period of at least one month, without an association with an aversion to food. Today’s blog takes a look at geophagia (the eating of earth, soil and/or clay). In a literature review published in the Journal of the Royal Society of Medicine by Dr Alexander Woywodt and Dr. Akos Kiss that geophagia has been regarded as a psychiatric disease, a culturally sanctioned practice and/or a sequel to poverty and famine. Geophagia is also a culturally sanctioned practice in some parts of the world. Woywodt and Kiss also stated that:
“[Geophagia] is not uncommon in southern parts of the United States5 as well as urban Africa. Fine red clay is often preferred. In particular, geophagia is observed during pregnancy or as a feature of iron-deficiency anaemia. Where poverty and famine are implicated, earth may serve as an appetite suppressant and filler; similarly, geophagia has been observed in anorexia nervosa. However, geophagia is often observed in the absence of hunger, and environmental and cultural contexts of the habit have been emphasized. Finally, geophagia is encountered in people with learning disability, particularly in the context of long-term institutionalization”.
The relationship between anaemia and pica (including geophagia) has been well documented. However, Woywodt and Kiss assert that it is still unclear whether anaemia prompts geophagia to compensate for iron deficiency or whether geophagia is the cause of anaemia. Prevalence rates of pica have range anywhere between 0.02% and 74% depending on the study and population studied although there are few reliable prevalence estimates of geophagia. One study of pregnant Tanzanian women found a prevalence rate of 26.5% (but this is – of course – a totally unrepresentative sample).
A recent review on pica led by Dr Sera Young (University of California, USA) noted that geophagia is the most common type of pica described in the psychological and medical literature although it did also report that geophagics frequently eat other non-food stuffs (particularly if the desired soil is unavailable or socially unacceptable). For many people, pica is not dangerous but for geophagia there may be complications including parasitic infections (from eating soil). Although eating soil and clay may be regarded as unappetizing (and perhaps bizarre) by most people, some authors have argued that eating soil can be nutritionally beneficial (which if that was the case, it wouldn’t technically be a form of pica).
While not being considered a social norm in Western society, eating soil or clay is said to be quite common among primitive or economically depressed peoples a way of augmenting a scanty and/or mineral-deficient diet. Having said that, the geophagia is most often confined to people suffering from chronic mental illness. Clay (as opposed to soil) consumption has been reported in India, Haiti, various parts of Africa (Cameroon, Gabon, Guinea), and even rural areas of the USA. Like soil consumption, clay consumption has also been associated with pregnant women and some women claim they eat it to eliminate nausea. The Wikipedia entry on geophagia noted:
“In Haiti, the poorest economy in the Western Hemisphere, geophagy is widespread. The clay mud is worked into what looks like pancakes or cookies, called ‘bon bons de terres’…The cookies have little or no nutritional value and are associated with various health problems”.
A study led by Dr. L.T. Glickman and colleagues, and published in a 1999 issue of the International Journal of Epidemiology, provided some data on geophagia by carrying out a study examining intestinal parasitism among children from three rural villages in Guinea (Africa). More specifically they examined the faecal stools of 266 randomly selected children (aged 1-18 years). The researchers found that 53% of children were infected by at least one type of soil-transmitted parasite. They also surveyed parents and reported that geophagia was reported by parents to occur in 57% of children aged 1-5 years, 53% of children aged 6-10 years, and 43%, of children aged 11-18 years. It was concluded that geophagia is an important risk factor for orally acquired parasitic infections in African children.
A small study carried out by Turkish researchers and published in a 1978 issue of Acta Haematologica carried out oral iron and zinc tolerance tests on 12 patients from Turkey and Iran aged between 8 and 21 years with iron deficiency anemia and geophagia. The research team reported decreased iron and zinc absorption in patients compared to control patients. They concluded that iron and zinc malabsorption may be an additional feature of the syndrome characterized by geophagia among those from Turkey and Iran. Finally, in their literature review on geophagia, Dr Woywodt and Dr Kiss concluded that:
“The causation is certainly multifactorial; and clearly the practice of earth-eating has existed since the first medical texts were written. The descriptions do not allow simple categorization as a psychiatric disease. Finally, geophagia is not confined to a particular cultural environment and is observed in the absence of hunger”
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Arcasoy, A., Cavdar, A.O. & Babacan, E. (1978). Decreased iron and zinc absorption in Turkish children with iron deficiency and geophagia. Acta Haematologica, 60, 76-84.
Ashworth, M., Hirdes, J.P. & Martin, L. (2008). The social and recreational characteristics of adults with intellectual disability and pica living in institutions. Research in Developmental Disabilities, 30, 512-520.
Danford, D.E. & Huber, A.M. (1982). Pica among mentally retarded adults. American Journal of Mental Deficiency, 87, 141-146.
Glickman, L.T., Camara, A.O., Glickman, N.W. & McCabe, G.P. (1999). Nematode intestinal parasites of children in rural Guinea, Africa: Prevalence and relationship to geophagia. International Journal of Epidemiology, 28, 169-174.
Kettaneh, A., Eclache, V., Fain, O., Sontag, C., Uzan, M. Carbillon, Stirnemann, J. & Thomas, M. (2005). Pica and food craving in patients with iron-deficiency anemia: A case-control study in France. American Journal of Medicine, 118, 185-188
Lacey, E. (1990). Broadening the perspective of pica: Literature review. Public Health Reports, 105, 29-35.
López, L.B., Ortega Soler, C.R. & de Portela, M.L. (2004). Pica during pregnancy: A frequently underestimated problem. Archivos latinoamericanos de nutricion, 54, 17-24.
Nyaruhucha, C.N. (2009). Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania. Tanzania Journal of Health Research, 11(1), 29–34.
Rose, E.A., Porcerelli, J.H, & Anne Neale, A.V. (2000). Pica: Common but commonly missed. Journal of the American Board of Family Practice, 13, 353-358.
Stein, D.J., Bouwer, C. & van Heerden, B. (1996). Pica and the obsessive- compulsive spectrum disorders. South African Medical Journal, 86, 1586-1592.
Woywodt, A. & Kiss, A. (2002). Geophagia: the history of earth-eating. Journal of the Royal Society of Medicine, 95:143-146.
Young, S.L., Wilson, M.J., Miller, D., & Hillier, S. (2008). Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. PLoS One, 3(9), e3147.
Wikipedia (2012). Geophagy. Located at: http://en.wikipedia.org/wiki/Geophagy
This farming man: An unusual case of zoocoprophilia?
One of the most bizarre sex-related stories I have come across in the last few years concerns an Englishman called David Truscott from Pengegon Parc, Camborne (in Cornwall). Truscott, was 41-years-old when he was put in prison for two years after he had harassed and terrorized one particular family for a six-year period near Redruth (Cornwall). He repeatedly covered his naked (or scantily-clad) body in cow manure and would roll around on the floor masturbating on the family’s farm (if he wasn’t completely naked he either wore just underpants although on one occasion he was apprehended by police wearing shiny red sorts and latex gloves). He had already received a court order preventing him from going anywhere near the family but breached his restraining order on February 26 [2011] when he was caught by the farmer Clive Roth’s 16-year old son pleasuring himself while covered in cow manure.
Jill Wilson, the crown prosecutor in the case at Truro Court told the court that there was “a history of [Truscott] visiting this particular farm seeking sexual gratification while immersed in cow dung and mud”. Mark Charnley, the lawyer defending Truscott told the court that his client was a “sad, vulnerable, socially inadequate man…He does show remorse for what he did and a realization of the harm he was doing to the family” and pleased for leniency because his client had no close family and had learning difficulties. Charnley also suggested that Truscott was suffering from a form of autism that led him to engage in his sexual behaviour while under stress. However, Judge Christopher Elwen said Truscott had to be jailed for his “perverted activities [and because he’d] made the home life of the Roth family absolute hell through your bizarre fetish and disgusting behaviour”. The Judge concluded: “The family members live in fear of what you might get up to from time to time. They have constantly to look over their shoulders. Any untoward activity on the farm brings your disgusting behaviour to mind”.
It was back in 2004 that Truscott was first spotted by the family when he was found masturbating in the faeces of the farm’s muck spreader. As the behaviour was not an isolated incident, the family tried to keep their manure spreading equipment clean but Truscott still found ways to make himself a nuisance to the family. When the manure became harder to come by, Truscott took his revenge on the family by setting fire to an animal pen containing the family’s cows and calves in which one of the cows died. The family’s three-year old son was traumatized by the incident and lived in fear that the house where he lived was going to be burned to the ground. Mr Roth’s mother also lived in fear that the farmhouse was going to be the subject of an arson attack. As a consequence, Truscott pleaded guilty and received a three-year prison sentence.
When he was released from prison in 2009, Truscott returned to the family’s farmhouse and was found naked in a pile of manure. He received yet another prison sentence (of 20 weeks) and a restraining order preventing him from stepping foot on the family’s farm. However, this proved ineffective and was broken on a number of subsequent occasions (including one where he immersed himself almost naked inside a large vat of manure inside the farm’s milking parlour. It was also revealed in court that Trsucott owned 360 pairs of women’s knickers and usually slept in ladies’ pyjamas.
Although I only have the various news reports to go on (all the ones I read are listed in the ‘Further reading’ section at the end of this blog), I would make a number of observations. Firstly, the primary sexual attraction appears to be towards animal faeces, therefore he could possibly be classed as a coprophile. Although I have never come across a case of anyone in the academic and clinical literature deriving sexual pleasure from anything other than human faeces, definitions of coprophilia never specify that the faecal matter has to be human. Maybe Truscott’s behaviour could therefore be classed as “zoocoprophilia” (my own word to describe those individuals who derive sexual pleasure and arousal from animal faeces).
Secondly, (and I admit this is highly speculative), it could perhaps be argued that Truscott would classify as a ‘Class V zoosexual’ in Dr. Anil Aggrawal’s recently published new classification of zoophiles. The Class V zoosexual type comprises what Aggrawal calls fetishistic zoophiles. These individuals keep various animal parts (especially fur) that they then use as an erotic stimulus as a crucial part of their sexual activity. Such individuals have been reported in the clinical literature including the case of a woman (reported in a 1990 issue of the American Journal of Forensic Medical Pathology) who used the tongue of a deer as her primary masturbatory aid. Given that the animal manure appeared to be a critical component in Truscott’s masturbatory activity, maybe he could arguably be classed as a Class V zoosexual.
Thirdly, there is some empirical evidence of an overlap in coprophilia and zoophilia. An earlier study on a sample of paraphiliacs reported that zoophiles appear to engage in many paraphilic behaviours including coprophilia. In a survey of 561 non-incarcerated paraphiliacs seeking treatment, Dr Gene Abel and colleagues reported in an issue of the Bulletin of the American Academy of Psychiatry and the Law, that all of the 14 zoophiles in their sample reported more than one paraphilia and seven of them reported at least five other paraphilas including coprophilia, urophilia, pedophilia, exhibitionism, voyeurism, frotteurism, telephone scatophilia, transvestic fetishism, fetishism, sexual sadism, and/or sexual masochism. This also supports the observation that if a person has one paraphilia, they often have others. In the case of Truscott, there was some evidence that he engaged in transvestite sexual behaviour in the fact that he often wore women’s knickers and slept in female nightwear.
Finally, fact that Truscott’s lawyer suggested his client had a form of autism may be an important factor in the behaviour displayed. In a previous blog I wrote on coprophagia (i.e., people that eat faeces, and a behaviour that sometimes overlaps with coprophilia), I noted that various medical and psychological disorders have been identified that are associated with coprophagia including mental retardation and autism.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Abel, G. G., Becker, J. V., Cunningham-Rathner, J., Mittelman, M. S., & Rouleau, J. L. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16, 153–168.
Aggrawal, A. (2011). A new classification of zoophilia. Journal of Forensic and Legal Medicine, 18, 73-78.
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.
Crazy News (2011). The pervert who got sexual thrills in cow manure. March 24. Located at: http://weirdcrazynews.blogspot.co.uk/2011/03/pervert-who-got-sexual-thrills-in-cow.html
Daily Mirror (2011). Pervert who got sexual thrills in cow manure sent to prison. Daily Mirror, March 24. Located at: http://www.mirror.co.uk/news/weird-news/pervert-who-got-sexual-thrills-in-cow-117998
Evening Standard (2011). Pervert with fetish for cow manure is locked up, March 23. Located at: http://www.standard.co.uk/news/pervert-with-fetish-for-cow-manure-is-locked-up-6384125.html
Ghaziuddin, N. & McDonald, C. (1989). A clinical study of adult coprophagics. British Journal of Psychiatry, 4, 53-54.
Omasiali (2011). Sick white devil repeatedly has sex with cow manure back in jail, May 15. http://omasiali.wordpress.com/2011/05/15/sick-white-devil-repeatedly-has-sex-with-cow-manure-back-in-jail/
Randall, M.B., Vance, R.P., McCalmont, T.H. (1990). Xenolingual autoeroticism. American Journal of Forensic and Medical Pathology, 11, 89-92.
Skruff, J. (2012). Britain’s filthiest sex fiend strikes again, July 18. Located at: http://skrufff.com/2012/07/britains-filthiest-sex-fiend-strikes-again/
White Watch (2011). White man who repeatedly has sex with cow manure back in jail. March 27. Located at: http://whitewatch.info/2011/03/27/white-man-who-repeatedly-has-sex-with-cow-manure-back-in-jail.aspx
Stats entertainment: A review of my 2012 blogs
My last blog of 2012 was not written by me but was prepared by the WordPress.com stats helper. I thought a few of you might be interested in the kind of person that reads my blogs. I also wanted to wish all my readers a happy new year and thank you for taking the time to read my posts.
Here’s an excerpt:
About 55,000 tourists visit Liechtenstein every year. This blog was viewed about 180,000 times in 2012. If it were Liechtenstein, it would take about 3 years for that many people to see it. Your blog had more visits than a small country in Europe!
Ashes to ashes: Does “cremainlining” really exist?
I’m starting today’s blog with a news story from May 13th 1993 that occurred in Boynton Beach (Florida, US) and can be found on the Snopes.com website:
“When Nathan Radlich’s house was burgled, thieves left his TV, his VCR, and even left his watch. What they did take was ‘generic white cardboard box filled with greyish-white powder’. (That at least is the way the police described it.) A spokesman for the Fort Lauderdale police said ‘that it looked similar to cocaine and they’d probably thought they’d hit the big time.’ Then Nathan stood in front of the TV cameras and pleaded with the burglars: ‘Please return the cremated remains of my sister, Gertrude. She died three years ago. Well, the next morning, the bullet-riddled corpse of a drug dealer known as Hoochie Pevens was found on Nathan’s doorstep. The cardboard box was there too; about half of Gertrude’s ashes remained. And there was this note. It said: ‘Hoochie sold us the bogus blow, so we wasted Hoochie. Sorry we snorted your sister. No hard feelings. Have a nice day’”
This story is arguably the first instance of “cremainlining” (the snorting of someone’s cremated ashes). However, the myth-busting website Snopes says that the part about ‘cremainlining’ is simply not true. In fact, Barbara Mikkelson, author of the online article for Snopes said that no dead body turned up on Radlich’s doorstep, and no note was left by the people who bought the “drugs”. Mikkelson also says that even the reference to Radlich appealing on television for the return of his sister’s ashes was made up just to tell a better story. Fast forward to London (UK) seven years later when this gem of a story did the rounds in British newspapers such as The Sun.
“Cocaine-crazy thieves tried to snort powder they found in an English housewife’s living room, not realizing it was the ashes of her dead dog, according to a British press report…The burglars thought they had hit the jackpot when they saw the powder marked “Charlie” – slang for cocaine – in a dainty ceramic pot on pet-lover Dee Blyth’s mantelpiece, said the report in The Sun. But they were unaware the pot was an urn and the “drugs” really the remains of her beloved Newfoundland Charlie, who died in 1997. A policeman called to investigate the break-in at Chadwell Heath fell about laughing when he saw the burglars had arranged the ashes in cocaine-style lines. “I’d love to see their faces when these thieves realize,” said Blyth. “It was horrible knowing they were in my house, but the idea of them trying to get high on a dead dog certainly made me feel a bit better. ‘I didn’t realize the significance until the policeman started laughing’”
While the burglary did indeed take place, there is actually no evidence that the thieves engaged in any unintentional cremainlining. More recently, in April 2007, Keith Richards, the guitarist in The Rolling Stones, was interviewed by the New Musical Express (NME) about his lifelong drug exploits. In that interview he was asked what the strangest thing he had ever tried to snort. He replied by saying he had snorted his father Bert’s cremated ashes mixed with cocaine. He told the NME: “My dad wouldn’t have cared” and then added that the snorted mixture “went down pretty well, and I’m still alive”. However, in his 2010 autobiography (“Life”), Richards reveals the truth behind the whole story (pp.611-612) which was a lot less ‘rock ‘n’ roll’:
“After having Dad’s ashes in a big black box for six years, because I really couldn’t bring myself to scatter him around, I finally planted a sturdy English oak to spread him around. And as I took the lid of the box, a fine spray of his ashes blew out onto the table. I couldn’t just brush him off, so I wiped my finger over it and snorted the residue”.
On the 15th December 2010, five teenage burglars in the US broke into a woman’s house in Silver Springs (Florida, US) and all snorted what they thought was cocaine or heroin but were in fact the ashes of a dead man and two Great Dane dogs. They stole jewelry, electronic equipment, and two urns (one containg the dead man’s ashes, and the other the cremated remains of the two dogs). Waldo Soroa (aged 19 years), Matrix Andaluz (18), Jose David Diaz Marrero (19), and two juveniles who could not be named were eventually arrested on charges of burglary and grand theft.
Earlier this year, it was alleged that a 51-year old man in Florida (why does Florida seem to be the epicentre of many of these cremainlining stories?) – Joseph Pointer – stole a dead woman’s ashes and told the dead woman’s mother that he was going to snort the remains. Pointer was living with a woman called Angela Speakman who shared the cremated remains of her sister (who in 2008 had been killed in a car accident) with her parents. On moving out of the house he shared with Speakman, Pointer stole the ashes. He then drove past Angela’s mother’s house allegedly shouting “I’ve got your dead daughter’s ashes and I’m going to snort them”. Pointer was arrested before he could snort the ashes but was charged with grand theft and jailed.
Just to finish with, I did mention in a previous blog I wrote on people’s fascination with death, the story of the woman who was “addicted to eating the ashes of her late husband” from the US television documentary series My Strange Addiction. The woman in question lost her husband following a fatal asthma attack and allegedly developed “a strong compulsion” to keep his ashes by her side at all times that then developed into eating the ashes. She says the ashes eating began when she was first transferring her husband’s cremated remains from a box into an ornamental urn. She accidentally got some of the ashes on her finger and “not wanting to just brush them off, licked them off, starting a habit that has become compulsive”. At the time of the television programme being recorded (and despite the ashes tasting horrible) she had been eating the ashes for two months and had consumed approximately six pounds of the ashes. In this particular case, the behaviour appears to be an unusual type of pica (i.e., the behaviour in which individuals eat non-nutritive items or substances) and which in some cases has been shown to be compulsive. Other online commentators have speculated that the eating of her husband’s ashes is a way of symbolically holding onto her husband in the easiest way possible.
So what are we to conclude? Certainly ashes have been ingested by a few loved ones, and there appears to be some evidence that a few thieves may have snorted cremated human remains mistakenly thinking it was cocaine during a burglary (a case of ‘crim0-cremainlining’ perhaps?). However, there doesn’t seem to be a single case of anyone doing it because they got any pleasure or enjoyment out of it.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Daily Mail (2011). Dumb, dumber and dumbest: Burglars snort ashes of a man and two dogs after they mistook them for cocaine, January 20. Located at: http://www.dailymail.co.uk/news/article-1348820/Burglars-snort-ashes-man-2-dogs-mistaking-cocaine.html
Geekosystem (2011). Woman is addicted to eating the ashes of her late husband. August 9. Located at: http://www.geekosystem.com/woman-eats-husbands-ashes/
Herzberg, R. (2012). Man steals dead woman’s ashes and threatens to snort them. The Dream Demon, April 17. Located at: http://www.dreamindemon.com/2012/04/17/joseph-pointer-steals-dead-womans-ashes-threatens-snort/
Mikkelson, B. (2012). Cremainlining. Snopes, July 2011, Located at: http://www.snopes.com/horrors/cannibal/cocaine.asp
MSNBC News (2007). Keith Richards says he snorted father’s ashes, April 4. Located at: http://today.msnbc.msn.com/id/17933669/ns/today-entertainment/t/keith-richards-says-he-snorted-fathers-ashes/
Richards, K. (2010). Life. London: Orion Books.
Zipadeeday (2000). Thieves snort the line of a dog, November 6. Located at: http://www.zipadeeday.com/story/17/thieves-snort-a-line-of-dog/
drmarkgriffiths 