Pica

This article provides a detailed overview of pica, including the main symptoms, common forms, how it’s diagnosed, and treatment and management options.

Key Takeaways:

• Individuals with pica experience a strong, compulsive urge to consume items that aren’t actual food. Examples include ice, clay, and laundry starch, although there are many others.
• It is most common in young children and pregnant women. Pica is also higher in certain mental disorders, such as intellectual disability and autism.
• Pica often resolves naturally after a period of time, especially in young children and pregnant women. Behavioral treatments are often effective for more chronic cases.

Understanding Pica

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), pica is an eating disorder characterized by persistent and compulsive consumption of non-nutritive, non-food substances. Individuals with pica may want to stop these behaviors, but have a hard time putting the items down and refraining from eating, due to the compulsive nature of this disorder. ^[1]

Some of the substances that are commonly consumed are chalk, ash, dirt, hair, ice, and paper, although the exact items vary from person to person. Thus, individuals with pica can face physical health issues, particularly if the items consumed are hazardous or harmful when ingested. ^[1]

How Common is Pica?

It is hard to estimate the exact prevalence of pica due to variation in definitions from study to study, under-reporting of symptoms, and social and cultural differences. However, estimates suggest that pica affects 1.1% of adults and 5% of children. ^[2]

Who Does Pica Affect?

Pica most commonly affects young children and pregnant women. Estimates suggest that around 12% of children have experienced pica at some point, and that pica affects up to 27.8% of pregnant women. ^{[1] [2]}

Pica is also more common in individuals with intellectual disability at a rate of 10%. It is also associated with other mental disorders, such as schizophrenia, autism spectrum disorder (ASD), trichotillomania, and excoriation disorder. ^{[1] [2]}

Is it the Same as Polydipsia?

Pica is not the same as polydipsia. Polydipsia is a condition characterized by excessive thirst and an abnormal urge to drink fluids at all times.

Symptoms of Pica

Individuals with pica persistently consume items that are not food and hold no nutritional value. Most often, each person has one preferred item that they eat, although this isn’t always the case.

Common Forms of Pica

Some of the most common forms of pica eating disorder include: ^[1]

• Geophagia (consumption of clay, dirt or soil)
• Pagophagia (consumption of ice)
• Amylophagia (consumption of starch, such as laundry starch).

Other substances that may be consumed in pica disorder are: ^{[1] [2] [3]}

• Paper
• Soap
• Ash
• Cloth
• Baby or talcum powder
• Hair
• Coffee grounds
• Eggshells
• Feces
• Paint
• Pebbles
• Pet food
• Wool
• Charcoal
• Gum
• String

Potential Risks to Physical Health

Pica eating disorder poses a number of potential risks to one’s physical health. Many of these substances may contain contaminants, such as lead or other heavy metals, which can lead to poisoning and subsequent issues, such as neurological damage. If pica occurs during pregnancy, this also increases the risk of fetal complications. ^{[1] [2] [3]}

Certain substances may also contain parasites, which can in turn cause fever, coughing visual problems, and potentially serious consequences like encephalitis (brain inflammation) and myocardium (inflammation of the heart). ^{[1] [2]}

Pica can also cause gastrointestinal issues, such as constipation, intestinal obstruction, ulcers or perforations. Furthermore, individuals with pica have a greater risk of electrolyte imbalances and nutrient deficiencies, such as low potassium and iron deficiency. ^{[1] [3]}

What Causes Pica?

There isn’t one exact cause of pica, and sometimes the causes are unknown. However, there are several risk factors for developing pica disorder, including: ^{[1] [2] [3]}

• Stress
• Learned behavior
• Nutritional deficiencies
• esp. iron
• Cultural factors
• Existing mental health disorders
• e.g. ASD, intellectual disability, trichotillomania, excoriation disorder, anxiety, other eating disorders
• Pregnancy
• Low socioeconomic status
• Child abuse and neglect
• Cultural factors
• Family history

Of these, the most common causes are pregnancy and nutritional deficiencies, particularly iron deficiency. In these cases, pica develops due to the body trying to take in more nutrients to correct a nutrient deficiency. ^[2]

Diagnosing Pica

Diagnosing pica requires a detailed medical history, a comprehensive physical exam, and assessment of the primary behaviors and symptoms.

An initial interview is conducted to provide more details on the specific nature of the behaviors, such as the type and amount of substance consumed, duration of the behaviors, settings where the behaviors usually occur, and the source of the substance. If this is for your child, your doctor will also conduct an interview with you or other prominent caregivers for further information.

To reach an official diagnosis, information is compared to the specific diagnostic criteria found in the DSM-5, which are: ^[2]

• Persistent eating of non-nutritive, non-food substances for at least one month
• The eating behaviors are inappropriate to one’s developmental level
• The eating behaviors are not a part of culturally supported or socially normative practices

Complications and Misdiagnosis

There are a few issues that can complicate the diagnosis of pica, which may also lead to misdiagnosis.

For one, certain cultural practices or social norms may lead to pica-like behaviors. For example, some cultures support the eating of clay as a medicinal practice, which wouldn’t constitute an official pica diagnosis. ^[2]

Pica-like behaviors also commonly occur alongside other mental disorders, such as autism spectrum disorder (ASD), schizophrenia, and other eating disorders. In these cases, a pica diagnosis is made only if the behaviors are persistent and severe enough to require clinical attention. ^[1]

Lastly, the common mouthing behaviors of infants may be confused with pica. As a result, it is highly suggested that pica should only be diagnosed in individuals age 2 and older. ^[1]

Tests and Assessments

A comprehensive physical exam and additional medical exams (if needed) are very important when diagnosing pica, particularly to examine any possible health consequences. To do this, your doctor may perform a variety of tests, including: ^[1]

• Metabolic Panel
• Tests for iron, zinc, and other minerals
• Heavy metal testing, including for lead and mercury
• Imaging studies, such as:
• Abdominal x-ray
• Barium study, which provides imaging of the digestive tract
• Endoscopy, which is another way to examine the digestive system

Certain diagnostic tests may also be used to check for serious health consequences that sometimes result from pica. Examples include: ^{[1] [3]}

• For myocarditis or other heart issues:
• Electrocardiogram, which measures your heart rhythm
• Cardiac enzymes test
• For encephalitis or neurological damage:
• Magnetic resonance imaging (MRI)
• Electroencephalogram (EEG)
• Lumbar puncture
• Complete blood count

Treatment Options

Treatment for pica typically involves specific behavioral interventions. Examples of these strategies are: ^{[1] [3]}

• Differential reinforcement: Teaching the individual to focus on other behaviors and activities, especially when urges are the most prominent.
• Mild aversive therapy: This method involves mild consequences after someone engages in a pica eating behavior, along with positive reinforcement for healthy eating behaviors.
• Behavioral therapy: This therapy can help individuals develop coping skills and strategies to deal with urges.

Treatment may also include supplementation of iron, zinc, or other relevant nutrients to help treat any nutritional deficiencies. ^{[1] [2]}

Currently, there are no medications specifically used to treat pica.

Managing Symptoms

In addition to the above professional treatments, there are things you can do on a regular basis to help manage symptoms, such as: ^{[1] [3]}

• Staying away from triggering settings and environments
• Remove the specific substances from your environment
• Or make them harder to access
• Use a healthier alternative to the substance that is similar in texture, feel, etc.
• e.g. rice/sugar paper instead of regular paper; rope candy instead of string
• Engage in alternative sensory behaviors
• e.g. the use of stress balls, fidget toys, or textured objects

What to Expect When Living with Pica

Very often, symptoms of pica go away on their own in children and pregnant women. In these cases, pica is much less likely to cause problems.

However, pica may persist for a long time in some cases, especially in individuals with intellectual disorders. These cases are more likely to result in bowel obstruction, toxicity, and other health consequences.

If you or someone in your family has pica, it’s important to be honest with your doctor and see them as often as recommended. With the right treatment and interventions, pica has a high likelihood of resolution.

Author

Jack Cincotta

Jack Cincotta holds a M.S. degree in Psychology. He is also a board-certified holistic health practitioner through AADP and an AFPA-certified holistic health coach and nutritionist.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

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Reviewer

Jennifer Brown

Dr. Jennifer Brown is dual board-certified in family medicine and obesity medicine. She currently works for Amwell Medical Group, providing virtual primary care services, including mental health treatment.

Activity History - Medically reviewed on April 4, 2026 and last checked on March 19, 2026