A woman’s craving for clay got so intense it mimicked signs of addiction

A case report published in Annals of Internal Medicine: Clinical Cases describes the medical complications of a 36-year-old woman with kidney failure whose escalating compulsion to consume clay led to gastrointestinal bleeding, severe electrolyte imbalances, and confusion during radiologic exams. Her habit, rooted in a culturally familiar practice known as geophagia, had intensified to the point of functional impairment—suggesting a shift from traditional behavior to a pattern more aligned with symptoms of a psychological disorder.

This unusual case underscores the complexity of diagnosing and treating behaviors that may begin as culturally accepted but evolve into clinically significant conditions. It also illustrates how psychological drives like craving and reinforcement can transform a once-meaningful practice into a source of harm.

The patient, who had a long history of end-stage kidney disease and iron deficiency anemia, presented to the emergency department with rectal bleeding, severe constipation, muscle aches, and dizziness. Imaging revealed unexplained radiodense material in her colon, which initially obscured attempts to determine the source of her bleeding.

It was only after a thorough review of her behaviors and symptoms that clinicians discovered she had significantly increased her consumption of bentonite clay—up to 85 grams per day over the previous two months. While she had eaten clay for most of her life as part of a shared practice in her community, the dramatic increase reflected more than cultural habit. She described growing fixations and persistent cravings that disrupted her daily life and worsened her physical condition.

The clay she ingested, sourced from Ghana, contained aluminum and silica—compounds known to bind to electrolytes like phosphate and potassium. Her lab results showed elevated aluminum levels, along with low potassium and calcium. After she stopped consuming the clay, her symptoms began to improve, and her electrolyte levels stabilized.

Although the patient declined psychiatric treatment, clinicians noted that her behavior bore resemblance to features commonly associated with substance use disorders: persistent use despite negative consequences, tolerance, and craving. This raises broader questions about where to draw the line between culturally sanctioned behavior and compulsive pathology.

Geophagia—the deliberate consumption of earth or clay—has been observed in human societies for thousands of years and is especially prevalent among pregnant women and individuals with iron deficiency. In some cultural traditions, it is considered normal or even beneficial, believed to soothe nausea, replenish minerals, or promote general well-being.

Yet geophagia also falls under the psychiatric category of pica, which refers to the persistent eating of non-nutritive substances. The Diagnostic and Statistical Manual of Mental Disorders classifies pica as a disorder when the behavior occurs outside of cultural norms and leads to clinical impairment or health risks.

Psychologically, the behavior may be driven by a range of internal factors. In cases like this one, iron deficiency may play a dual role—both biologically and psychologically. Research suggests that some forms of pica, including geophagia, may stem from the body’s attempt to compensate for nutrient shortages. However, this biological urge can interact with learned behaviors, social reinforcement, and psychological craving in complex ways.

In this patient’s case, her desire to consume clay appeared to intensify gradually. What had once been a benign or culturally supported habit escalated into a compulsive behavior that she struggled to control. Her self-reported experience of craving and the disruption to her daily life suggest a pattern of reinforcement similar to addictive behavior.

This is not uncommon in disorders that involve compulsive ingestion. Some studies indicate that pica behaviors, including geophagia, may activate neural reward pathways—similar to the way addictive substances affect the brain. Over time, repeated use may strengthen the association between relief or satisfaction and the act of consumption, creating a feedback loop that is hard to break without intervention.

One complicating factor in diagnosing geophagia and related conditions is the role of cultural stigma and concealment. The behavior is often not volunteered by patients, particularly in Western medical settings where such practices are poorly understood or pathologized.

The authors of the case report emphasize that the patient had not initially disclosed her clay consumption. It only came to light after clinicians conducted a detailed review of her lifestyle and dietary habits. This highlights the importance of culturally sensitive care—approaching such behaviors not with judgment, but with curiosity and respect.

Clinicians must walk a delicate line when treating behaviors that exist on the boundary between culture and pathology. Not all geophagia is disordered, and not every instance warrants psychiatric diagnosis. But when the behavior results in harm, functional impairment, or distress, clinicians have a responsibility to address it—while remaining attuned to the context in which it occurs.

In this case, the patient’s craving-driven clay ingestion had evolved beyond its cultural roots. The progressive nature of her behavior, paired with the resulting physical harm, suggests that the psychological dimension played a significant role.

While case reports cannot confirm causal relationships or establish generalizable findings, they are uniquely suited to spotlight emerging psychological patterns that might be missed in larger studies. In psychiatry and behavioral medicine, they can reveal how individual experiences reflect broader tensions between biology, culture, and mental health.

This case provides evidence that behaviors traditionally viewed as cultural may sometimes mask deeper psychological issues. It suggests that pica-related conditions may involve a combination of physiological drives, environmental reinforcement, and internal psychological compulsions. Recognizing these dimensions can open the door to more effective and empathetic treatment strategies.

The case also points to the need for better integration of psychological screening in patients presenting with unexplained medical symptoms. Behavioral patterns like compulsive ingestion may go unrecognized unless clinicians specifically ask about them, especially when the behavior is culturally normalized or carries social stigma.

The study, “A Patient Presenting With Hematochezia Found to Have Geophagia-Induced Electrolyte Derangements,” was authored by Archit V. Potharazu, Elizabeth Kiernan, Rishi Subrahmanyan, Hector Ibanez, and John Woller.