What Is Pica? Symptoms, Causes, and Treatment

Pica is an eating disorder that involves eating items that aren’t typically thought of as food and that don’t contain meaningful nutritional value, such as dirt, hair, or paint chips.¹ A diagnosis requires this pattern to persist for at least one month and to fall outside what’s developmentally expected for the person's age or accepted within their culture.²

Pica can affect children, teens, and adults of any gender, though it often occurs in young children and during pregnancy.^1,2

Like other eating disorders, pica can have serious health consequences. The good news is that with medical and behavioral support, pica is treatable.¹

What Is Pica?

Pica is an eating disorder in which a person repeatedly eats things that aren’t food and have no nutritional value.^1,2 This can include things like:^1,2

• Dirt.
• Clay.
• Pebbles.
• Chalk.
• Sand.
• Paper.
• Soap.
• Ice.
• Hair.
• Gum.
• Plastic.
• Metal.
• Paint chips.

For the behavior to be considered pica, it must continue for at least one month and be outside what’s considered appropriate for a person's age and developmental stage. For example, babies and toddlers naturally explore the world by putting things in their mouths, so doctors usually don’t diagnose pica before age two.^1,2

The behavior also isn’t considered pica if it’s part of a culturally accepted practice, like the traditional consumption of clay in some communities, unless it becomes excessive or poses a health risk.^1,2

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) recognizes pica as its own diagnosis.² It belongs to the DSM-5 category of Feeding and Eating Disorders, alongside conditions such as avoidant/restrictive food intake disorder (ARFID) and rumination disorder.

Signs and Symptoms of Pica

The defining feature of pica is the persistent eating of substances with no nutritional value, continuing for a month or more.¹ The specific items eaten vary widely and often depend on a person's age and what’s available to them.

Physical Signs

• Persistent eating of substances such as dirt, clay, chalk, paper, soap, cloth, hair, string, wool, soil, talcum powder, paint, gum, metal, pebbles, charcoal, ash, starch, or ice.¹
• Gastrointestinal complaints, including abdominal pain or constipation.²
• Signs consistent with a possible intestinal blockage, such as severe abdominal pain, distention, vomiting, or an inability to pass gas or stool.¹
• Dental damage or abrasions to the gums from chewing hard or abrasive substances.¹

Emotional and Behavioral Signs

• A strong, sometimes hard-to-resist urge to eat the item, rather than occasional curiosity.²
• Continued interest in eating regular food, since pica doesn’t typically involve an aversion to food itself.¹

What Causes Pica?

There isn’t a single known cause of pica, and researchers still don’t fully understand why it develops.¹ Instead, pica is thought to result from a combination of factors that vary from person to person.¹

One of the most common factors is a nutritional deficiency. Iron-deficiency anemia and malnutrition are strongly linked to pica, and pregnancy can also increase the likelihood of developing the condition.¹

A meta-analysis of 43 studies involving 6,407 people with pica found that they were more than twice as likely to have anemia and also had lower average zinc levels than people without pica.³ For people whose pica is linked to a nutritional deficiency, treating the deficiency with iron or other supplements may help stop the behavior.¹

Pica is also associated with several neurodevelopmental and mental health conditions, including intellectual disability, autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD), schizophrenia, trichotillomania (hair-pulling disorder), and excoriation disorder (skin-picking disorder).¹

Researchers have also linked pica to psychological and environmental factors, including chronic stress, child neglect, and lower socioeconomic status.²

Who Is at Risk of Pica?

Pica is most commonly diagnosed in young children, though doctors don't diagnose it before around two years of age because putting objects in the mouth is a normal part of early development.²

Pregnant people are another group at increased risk. A meta-analysis found that nearly 28% of pregnant people worldwide reported pica behaviors, with higher rates in low- and middle-income countries.¹

Although pica is most often associated with childhood and pregnancy, it can occur at any age. An estimated 1.1% of adults experience recurrent pica behaviors, often alongside another mental health condition or an intellectual disability rather than as a standalone disorder.¹

People with ASD and intellectual disability are also at higher risk. Studies estimate that up to 30% of children with autism and up to 26% of children with intellectual disability have pica, with the highest rates reported among those living in institutional care.⁴

A large case-control study likewise found that children with autism and other developmental disabilities were significantly more likely to have pica than children without these conditions.⁵

How Is Pica Diagnosed?

There isn't a single test that can diagnose pica. Instead, a healthcare provider makes the diagnosis by asking about a person's symptoms, medical history, and eating behaviors.^1,6

The DSM-5 outlines the criteria used to diagnose pica.⁶ Providers may also order tests to look for complications or possible underlying causes, such as anemia, nutritional deficiencies, intestinal blockages, or poisoning from the substances being eaten.

According to the DSM-5, a diagnosis of pica generally requires all of the following:⁶

• The person repeatedly eats nonfood items for at least one month.
• The behavior isn't typical for their age or stage of development, such as the normal mouthing of objects in children under age two.
• The behavior isn't part of a culturally accepted practice.
• If another mental health or medical condition is present, the pica is severe enough to require its own clinical attention.

Because pica is often linked to nutritional deficiencies, doctors commonly order blood tests to check iron levels and other nutrients, along with a basic metabolic panel.² If someone has abdominal pain, vomiting, or other signs of a blockage, imaging tests such as an abdominal X-ray may also be needed.²

Health Risks of Pica

The health risks of pica depend on what a person eats and how long the behavior continues. Some complications are mild, while others can be serious or even life-threatening. Getting diagnosed and treated early can help prevent many of these complications before they become serious.¹

Lead Poisoning

Eating paint chips or other lead-containing materials can cause lead poisoning. Symptoms of lead poisoning include headaches, irritability, fatigue, and seizures.^1,7

Even low levels of lead exposure can affect brain development, leading to learning difficulties, behavior problems, attention issues, and lower IQ. In severe cases, lead poisoning can cause coma or death.^1,7

Infections

Eating dirt, clay, or other contaminated substances can expose a person to harmful bacteria and parasites. While many infections are treatable, some can become severe and affect the heart or brain.¹

Digestive Problems

Pica can damage the digestive tract, leading to constipation, stomach ulcers, intestinal blockages, or perforations.^1,6 Sometimes swallowed material forms a hard mass called a bezoar, which may need to be removed with an endoscopy or surgery.^1,6

Damage to the Teeth and Mouth

Chewing hard or rough materials can wear down or break teeth and injure the gums.1

More Gastrointestinal Symptoms in Some Children

Children with autism or other developmental disabilities who have pica are more likely to experience vomiting, diarrhea, constipation, and other digestive problems than children with these conditions who do not have pica.⁵

Treatment Options for Pica

Treatment for pica usually begins with a medical evaluation to identify any underlying health problems. If blood tests show an iron, zinc, or other nutrient deficiency, treating that deficiency is often the first step. For many people, pica behaviors improve or stop once the deficiency is corrected.¹ In people with iron-deficiency anemia, symptoms have been shown to resolve within about three weeks of starting iron treatment.³

If pica continues after a nutritional deficiency has been treated, behavioral therapy is typically the next step. One of the most effective approaches is differential reinforcement, which teaches a person to choose a safer, more appropriate behavior instead of eating nonfood items. Positive reinforcement is used to encourage these healthier choices, and this approach has been especially effective for children and people with developmental disabilities.²

There are no medications approved specifically to treat pica. However, if pica occurs alongside another mental health condition, treating that condition with therapy, medication, or both may help reduce pica behaviors and improve overall well-being.²

Because pica can affect the entire family, education and support are also important parts of treatment. Learning more about eating disorder treatment options can help families understand what to expect, from the initial evaluation through ongoing care.

How to Help Someone with Pica

If you think a child, family member, or partner has pica, try to respond with patience instead of judgment. Encourage them to see a healthcare provider, who can check for nutritional deficiencies and other medical conditions that may be contributing to the behavior.

At home, focus on keeping potentially dangerous items out of reach rather than punishing or criticizing the behavior.² This can help reduce the risk of injury while the person receives professional care.

Seek medical attention right away if the person has severe abdominal pain, a swollen abdomen, or cannot pass stool or gas, as these may be signs of an intestinal blockage. You should also seek immediate care if you think they have eaten something toxic, such as paint chips.

Supporting a loved one with pica can feel overwhelming. Learning how to help someone with an eating disorder can provide practical guidance on starting difficult conversations, encouraging treatment, and offering support throughout recovery.

Find Treatment for Pica

Pica can be confusing and overwhelming, but it's a treatable condition. The sooner it's recognized, the sooner a healthcare provider can identify any underlying nutritional deficiencies or other contributing factors and recommend the right treatment.

If you or someone you love is showing signs of pica, a primary care doctor or pediatrician is a good first stop for evaluation.

If you’re looking to take the next step and find care, you can find eating disorder treatment centers near you using Recovery.com. Easily find and compare options and connect with providers who understand this condition and can guide you toward the right level of care.