Onset of obsessive compulsive disorder in pregnancy with pica as the sole manifestation.

Pica refers to eating of non-nutritious substances, which is usually seen in childhood or pregnancy. Here we report a case of an illiterate tribal woman who developed pica as the sole manifestation of obsessive compulsive disorder, with onset during pregnancy. The patient had compulsions of eating uncooked rice or wheat, which resulted in toothache and abdominal discomfort. She had this habit in three pregnancies, consecutively. In the first two pregnancies it resolved spontaneously after puerperium, but persisted in the last one. Probably physical stress of limb edema during the third pregnancy was reason for the persistence. She responded to fluoxetine 40 mg / day after three months of treatment, without behavioral therapy. We conclude that pica may either be only a manifestation of obsessive compulsive disorder during pregnancy or it is an obsessive compulsive spectrum disorder.