The causes of pica are not clear, and the search for them has been the subject of medical speculation since antiquity. Pica has been seen by most modern doctors and nutritionists chiefly as a means of alleviating nutritional deficiency. Similarly, most ancient and medieval scholars concerned with the subject stressed the importance of good nutrition and recommended fresh fruit and vegetables as a remedy. Despite innumerable recent studies, however, no definite connection has been established between pica and dietary imbalance. Nutrients in which pica practitioners are thought to be deficient include vitamins C and D, phosphorus, calcium, zinc, and especially iron. As early as A.D. 1000, Avicenna was treating pica with iron, and the search for the relationship between iron deficiency and pica continues today.

Psychiatrists and psychologists often feel that both nutritional deficiencies and psychological disorders are linked in pica patients. Some believe it is merely a continuation of infantile hand-mouth behavior patterns. Paulette Robischon (1971) conducted a study of 90 children between the ages of 19 to 24 months, and demonstrated that children who practice pica after infancy generally are slower to develop than those who do not. Other studies have found that black children are more likely than white children to exhibit pica, which has been linked to the overall lower income levels of their parents rather than to any racial cause. Reginald S. Lourie and his associates (1957, 1963), in their numerous studies, discovered that the pattern of pica in youngsters is very close to that of addiction. They termed it "a distorted form of the instinctual seeking of satisfaction." Often pica seems a defense against loss of security, such as that occasioned by separation from one or both parents, or emotional difficulties of the parents. Most young children who practice pica exhibit other oral activities, including thumbsucking, nailbiting, and so on.

There is also a "cultural" etiology for pica. Anthropologists have long been searching the past for practical reasons to explain why certain cultures and religions require the consumption of nonfood items. Symbolic geophagy was practiced in ancient times in Europe (so-called terra sigilata, or "sealed earth"), in the Middle East (consumption of a bit of dust from Mohammed's tomb), and even among early Christians. In parts of Africa it is thought that clay eating promotes fertility in women and lactation during pregnancy. John M. Hunter (1973) has postulated a culture-nutrition hypothesis, which attempts to demonstrate how geophagy, a type of pica, evolved from a nutritional activity and physiological imperative into a cultural institution in some societies. Pregnant women in Nigeria consumed clay in a culturally acceptable way, purchased loaves in the marketplace, and gained needed calcium and magnesium as a result.

A last reason for pica is for pharmacological purposes. It has been suggested that individuals engaged in pica practice may be attempting to medicate themselves for real or imagined illnesses. Physiological problems that have been thought to cause pica include gastrointestinal malaise, stress, hunger, parasitic infestations (such as worms), and toxicosis.

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