pica

Pica is defined in the DSM-5 as persistent ingestion of nonfood, nonnutritive substances for ≥1 month that is developmentally inappropriate and not part of a culturally supported practice. Common forms include pagophagia (ice), geophagia (soil/clay), amylophagia (starch), and trichophagia (hair, which can lead to trichobezoars). It is most commonly seen in young children, pregnant women, and individuals with intellectual disability or autism spectrum disorder.

Clinically, pica is a key clue to iron deficiency anemia—ice craving (pagophagia) in particular is highly specific and often resolves rapidly with iron repletion, even before hemoglobin normalizes, suggesting a mechanism related to iron-dependent neurotransmitter or dopamine pathways rather than anemia severity alone. It can also be seen with zinc deficiency. Pica raises risk for lead poisoning (especially with paint chip or soil ingestion in children), intestinal obstruction or perforation (from foreign bodies), parasitic infections (from soil), dental injury, and bezoar formation (trichobezoars can cause Rapunzel syndrome).

Workup for a patient presenting with pica should include CBC and iron studies (ferritin, iron, TIBC) to evaluate for iron deficiency, lead level in children, and assessment for developmental or psychiatric comorbidities. Management involves treating the underlying nutritional deficiency and behavioral interventions when needed.