Treatment for Coprophagia (Playing with One's Own Feces)
Coprophagia should be treated with a combination of psychiatric evaluation, appropriate pharmacotherapy (particularly antipsychotics like haloperidol or SSRIs), and behavioral interventions based on the underlying cause.
Underlying Causes and Assessment
Coprophagia (ingestion of feces) and playing with feces (scatolia) are abnormal behaviors associated with several conditions:
Neurological disorders:
- Neurodegenerative dementias with medial temporal lobe atrophy 1
- Seizure disorders
- Brain tumors (particularly frontal lobe)
- Cerebral atrophy
Psychiatric conditions:
Other factors:
- Nutritional deficiencies
- Medication side effects
- Substance abuse (particularly alcohol) 2
Treatment Algorithm
Step 1: Psychiatric Evaluation and Medical Workup
- Complete psychiatric assessment to identify underlying conditions
- Brain imaging (MRI/CT) to evaluate for neurological causes, particularly focusing on medial temporal and frontal lobe regions 1
- Laboratory tests to rule out metabolic causes or nutritional deficiencies
Step 2: Pharmacological Interventions
First-line treatment:
- Haloperidol: Most effective documented treatment for stopping coprophagia in neurological disorders 1
- SSRIs (e.g., sertraline): Starting at 25mg daily, particularly effective when depression or anxiety is present 4
Alternative medications based on underlying condition:
- For dementia-related behaviors: Atypical antipsychotics (risperidone, quetiapine)
- For OCD-related behaviors: Higher-dose SSRIs
- For bipolar disorder: Mood stabilizers (valproate, carbamazepine)
Step 3: Behavioral Interventions
- Structured environment with close supervision during high-risk periods
- Behavioral modification techniques:
- Positive reinforcement for appropriate behaviors
- Redirection when attempting coprophagic behaviors
- Consistent toileting schedule
- Immediate cleaning after bowel movements to remove access
Step 4: Environmental Modifications
- Restrict access to feces through:
- Supervised toileting
- Prompt cleaning of bathroom areas
- Protective clothing that limits access when necessary
- Regular checks and cleaning of living spaces
Step 5: Addressing Specific Underlying Conditions
- For neurodegenerative disorders: Optimize dementia management
- For psychiatric disorders: Treat the primary condition (depression, schizophrenia, etc.)
- For developmental disorders: Implement specialized behavioral programs
Special Considerations
- Safety concerns: Coprophagia can lead to serious health consequences including infections and, in rare cases, fatal aspiration 5
- Caregiver education: Essential to ensure proper monitoring and implementation of interventions
- Regular follow-up: Necessary to assess treatment efficacy and adjust as needed
Pitfalls to Avoid
- Focusing solely on the behavior without addressing underlying causes
- Inadequate supervision in high-risk individuals
- Inconsistent implementation of behavioral interventions
- Overlooking medical causes of altered behavior
- Stigmatization of the patient, which can worsen isolation and psychological distress
Treatment Monitoring
- Regular assessment of behavior frequency and intensity
- Monitoring for medication side effects
- Ongoing evaluation of underlying psychiatric or neurological conditions
- Adjustment of interventions based on response
By following this structured approach and addressing both the behavior and its underlying causes, coprophagia can be effectively managed in most cases, improving quality of life and reducing health risks for affected individuals.