Is pagophagia a mental disorder? Exploring the link between compulsive ice eating and mental health

October 8, 2025 •

4 min read

According to the DSM-5, the compulsive eating of non-nutritive, non-food substances—known as pica—can be classified as an eating disorder. Pagophagia, the specific craving for and consumption of ice, is a form of pica, and while it is often associated with physical conditions like iron deficiency anemia, it can also manifest as a symptom of a mental disorder.

Quick Summary

Pagophagia is the compulsive eating of ice and a subtype of the eating disorder pica. It can be caused by underlying issues like iron deficiency, psychological stress, and mental health conditions. While treating the root cause, whether nutritional or psychological, is key, the behavior itself warrants independent attention in some cases.

Key Points

Subtype of Pica: Pagophagia, or compulsive ice chewing, is a specific form of the eating disorder known as pica.
Iron Deficiency Link: A very common cause of pagophagia is iron deficiency anemia, and treating the anemia often resolves the craving.
Mental Health Connections: Pagophagia can also be a coping mechanism for stress or anxiety and is associated with conditions like OCD, depression, and autism.
Significant Health Risks: The behavior can lead to serious dental damage and, if related to untreated anemia, heart problems and other complications.
Requires Professional Assessment: Anyone with a persistent ice-chewing habit should see a doctor for a full medical and psychological evaluation to determine the root cause.
Treatment Addresses Underlying Cause: Treatment depends on the diagnosis and may involve iron supplementation, behavioral therapy, or medication for a mental health disorder.

Understanding Pagophagia: More Than Just a Habit

Many people occasionally enjoy chewing on ice cubes, especially on a hot day. However, for those with pagophagia, the craving is an intense, persistent, and compulsive urge that they feel unable to resist. This behavior is considered a form of pica, an eating disorder that involves consuming non-food items. A diagnosis of pica is made when the behavior persists for at least one month and is not appropriate for the individual's developmental stage. While not all instances of pagophagia signal a mental disorder, its compulsive nature and potential links to other mental health issues mean it should be taken seriously.

The Link Between Pagophagia and Nutritional Deficiencies

One of the most well-documented associations with pagophagia is iron deficiency anemia. Studies have shown that a significant percentage of individuals with iron deficiency also experience pagophagia. The link is so strong that treating the iron deficiency with supplementation often resolves the ice-chewing behavior. While the exact reason for this connection is not fully understood, some theories suggest that chewing ice may provide a temporary boost in alertness for those with iron deficiency anemia, perhaps by increasing blood flow to the brain.

Other nutritional deficiencies, such as low calcium, have also been reported in association with pagophagia, though the link is less clear than with iron deficiency.

Pagophagia as a Manifestation of a Mental Disorder

While a nutritional deficiency is a common driver, in some cases, is pagophagia a mental disorder? The answer is yes, it can be a symptom of an underlying mental health condition. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), classifies pica as a feeding and eating disorder. Pagophagia may be a symptom that requires clinical attention alongside conditions such as:

Obsessive-Compulsive Disorder (OCD): Chewing ice can function as a compulsion, a repetitive behavior used to relieve anxiety or distress.
Depressive Disorders: Case studies have documented pagophagia in patients with depression, where the behavior served as a coping mechanism for low mood and stress.
Autism Spectrum Disorder: Repetitive behaviors, including forms of pica, can occur in individuals with autism.
Other Eating Disorders: In some instances, a person with an eating disorder might use ice to feel full without consuming calories, which can develop into a persistent pagophagia habit.

Pagophagia and Mental Health: A Comparison

To understand the different contexts of pagophagia, it is helpful to compare its presentation when linked to a nutritional deficiency versus a mental disorder.


Aspect	Pagophagia due to Iron Deficiency	Pagophagia as a Symptom of a Mental Disorder
Underlying Cause	Lack of iron in the body, leading to anemia.	Underlying mental health issue such as OCD, depression, or autism.
Associated Symptoms	Fatigue, pallor, swollen tongue, headaches, restlessness.	Symptoms of the mental health condition, e.g., low mood, repetitive thoughts, social difficulties.
Treatment Focus	Iron supplementation and dietary changes.	Psychotherapy (like CBT), sometimes medication for the mental disorder, and behavioral strategies.
Response to Treatment	Cravings often resolve as iron levels return to normal.	Requires addressing the root mental health issue to manage the compulsive behavior.
Behavioral Context	May be a physiological response that increases alertness.	Often a coping mechanism for stress, anxiety, or internal distress.

The Health Risks of Pagophagia

Regardless of the root cause, compulsive ice chewing carries its own set of health risks. The most common complication is dental damage, as the habit can wear down tooth enamel, increase tooth sensitivity, and lead to chipped or cracked teeth. It can also damage existing dental work and cause jaw pain. Furthermore, when pagophagia is due to an untreated iron deficiency, it can lead to more serious issues, such as heart problems due to the strain on the cardiovascular system.

The Importance of Diagnosis and Treatment

If you or someone you know is compulsively chewing ice, it is crucial to consult a healthcare provider. A proper diagnosis is the first step toward effective treatment. The process typically involves:

Medical Evaluation: A doctor will likely perform blood tests, including a complete blood count (CBC), to check for iron deficiency anemia or other nutritional issues.
Psychiatric Assessment: If nutritional deficiencies are ruled out or if there are co-occurring mental health symptoms, a referral to a psychiatrist or psychologist may be necessary.
Treatment Plan: The treatment will be tailored to the underlying cause. For iron deficiency, supplementation is often sufficient to resolve the cravings. For psychological causes, therapy such as cognitive-behavioral therapy (CBT) can help individuals develop healthier coping strategies.

Conclusion

While a persistent craving for ice, or pagophagia, may seem benign, it is a behavior that warrants attention. It is a specific form of the eating disorder pica, and its causes can be either physiological, such as iron deficiency anemia, or psychological, stemming from underlying mental health conditions. By understanding whether is pagophagia a mental disorder, or a symptom of another condition, individuals can pursue the right diagnosis and treatment plan to protect both their physical and mental health. Early intervention is key to preventing long-term complications and developing effective management strategies.

Resources

Healthdirect: Pica - causes, treatment: https://www.healthdirect.gov.au/pica
Cleveland Clinic: Pica: What It Is, Causes, Symptoms & Treatment: https://my.clevelandclinic.org/health/diseases/22944-pica
Verywell Mind: Pagophagia: Causes, Symptoms, and Treatments: https://www.verywellmind.com/pagophagia-causes-symptoms-and-treatments-5094104

Frequently Asked Questions

A casual habit of chewing ice is not a cause for concern. Pagophagia, however, is a compulsive and persistent craving for ice that lasts for more than a month and can indicate an underlying medical or psychological issue.

Yes, pagophagia can be a symptom of a mental disorder, particularly pica, which is an eating disorder listed in the DSM-5. It can also occur in individuals with depression, anxiety, OCD, or autism.

The exact reason is unclear, but studies show a strong link between iron deficiency anemia and pagophagia. One theory suggests chewing ice increases blood flow to the brain, providing a temporary boost in alertness for anemic individuals suffering from fatigue.

Chronic ice chewing can be very damaging to teeth, leading to worn enamel, increased sensitivity, chipped teeth, and cracked fillings. It can also irritate and harm the gums.

Treatment depends on the underlying cause. If it is due to iron deficiency, supplements and dietary changes are often prescribed. If the cause is psychological, therapies like cognitive-behavioral therapy (CBT) may be used.

A doctor will begin with a medical history and blood tests to check for conditions like iron deficiency anemia. If a nutritional cause is not found, a mental health evaluation may be necessary to assess for other disorders.

Yes, children can develop pagophagia, and it can sometimes be associated with developmental delays. However, a pica diagnosis is typically not made in children under two years old, as eating non-food items is considered part of normal exploration.