Pica

Pica is a feeding and eating disorder defined in DSM-5-TR by the persistent eating of one or more non-nutritive, non-food substances over a period of at least one month. The behavior must be developmentally inappropriate, with a minimum age of approximately two years suggested to exclude normative mouthing in infancy, and must fall outside culturally supported or socially normative practices. When pica occurs alongside another mental disorder or medical condition, it is diagnosed separately only if severe enough to warrant independent clinical attention (American Psychiatric Association, 2022). Presentations are conventionally named for the ingested substance, including geophagia (earth or clay), pagophagia (ice), and amylophagia (raw starch).

In nutritional psychology, pica is notable for its bidirectional relationship with micronutrient status. Pica practices co-occur with anemia, particularly iron deficiency anemia, and resolution of pica following iron repletion is repeatedly documented across the literature. Oral health consequences also vary by substance type, with tooth abrasion associated with geophagia and dental caries associated with amylophagia (Abu et al., 2025). In general population childhood samples, pica behaviors are uncommon, but they are significantly associated with autism and developmental delay across the preschool and school-age years and cluster with broader eating difficulties including undereating, overeating, and food fussiness (Papini et al., 2024).