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Cultural, socioeconomic, organic, and psychodynamic factors have been implicated.
• Nutritional deficiencies:
o Although firm empirical data supporting any of the nutritional deficiency etiologic hypotheses are absent, deficiencies in iron, calcium, zinc, and other nutrients (eg, thiamine, niacin, vitamins C and D) have been associated with pica.
o In some patients with malnutrition who eat clay, iron deficiencies have been diagnosed, but the direction of this causal association is unclear. Whether the iron deficiency prompted the eating of clay or the inhibition of iron absorption caused by the ingestion of clay produced the iron deficiency is not known...
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