pica is defined as persistent eating of non - nutritive substances for at least one month . the behavior must be developmentally inappropriate , not culturally sanctioned , sufficiently severe to merit clinical attention , and not occurring during the course of another mental disorder . such non - nutritive substances include soil / clay ( geophagia ) , starch ( amylophagia ) , ice ( pagophagia ) , burnt matches , charcoal , cigarette ash , and baking soda . the etiology of pica remains unknown ; however , nutritional deficiencies of minerals , iron or zinc , and association of family stress have more literature support . pica during pregnancy has been associated with relief in nausea and vomiting , and with replacement of deficient micronutrients like calcium and iron . in literature there are many studies of pica in pregnancy , or obsessive compulsive disorder ( ocd ) in pregnancy ; there are few studies regarding pica presenting as ocd , but no case has yet been reported depicting ocd in pregnancy presenting as pica . a 26-year - old female presented to the dental outpatient department ( opd ) with complaints of toothache . she had the habit of eating uncooked rice and wheat for the last one - and - a - half years , hence , she was referred to the psychiatry opd . she had an intense and irresistible urge to eat these substances despite being aware of their non - edible nature . every attempt of resistance was leading to a feeling of restlessness and anxiety , which resolved only after eating . initially she was expecting it to subside within few months after delivery like earlier pregnancies , but it persisted with similar intensity . her choice between rice and wheat was determined by their availability and there was no preference for either . she always had abdominal discomfort because of her eating patterns . during the last six months she was subjected to multiple religious practices by faith healers , for treatment of the said supernatural illness , but without any result . there was no history of any other abnormal behavior or irrelevant talks , although wasting of time due to her eating habit resulted in inadequate care of the children . she had revealed a similar habit during her previous pregnancies four and six years prior . every time it started during the third or fourth month and resolved spontaneously two - to - three months after delivery . both the earlier pregnancies were uneventful and she delivered healthy male and female babies , respectively . there was no past history of psychiatric illness , medical illness , or substance abuse . all communications were mediated by her husband who understood hindi with some difficulty . on mental status examination she had a depressed mood , in addition to preoccupation with ideas of eating raw rice or wheat . she acknowledged that these repetitive , irresistible thoughts were her own , but she could not describe any reason for her habit , except intense urges for it . the serum micronutrient assay was not done , as it was not available at our center , it being a new medical institute . behavior therapy was not considered because of the patient 's language problem and reluctance of her husband . she was started on fluoxetine 20 mg once a day along with alprazolam 0.25 mg per day . after one month she reported mild mood lifting , although the craving and subsequent eating was unchanged . significant improvement was noted in her eating habits and depression after taking 40 mg / day for two months . she was maintained on the same dose for six months , after which she was lost to follow - up . despite many reports , pica and ocd are still not considered as similar spectrum disorders . if we go by the convention of two different entities , this case appears to be of ocd rather than pica , despite of some contrary observations . although these factors are more linked with pica , the association of ocd with lower socioeconomic status is also reported . a family history of a similar disorder can be observed in both pica and ocd , but it has more strong evidences of ocd . onset during pregnancy is more in favor of pica , but ocd may have onset during pregnancy . neziroglu f et al . found that 39% of the women with ocd who had children , developed the disorder during pregnancy . one important aspect is the onset of symptoms during pregnancies and resolution of symptoms a few months after delivery in the earlier pregnancies , but persistence in the last one . pregnancy is a physical and mental stress , and stress - induced precipitation of psychiatric illness is a fact . probably ocd in this patient was a response to physical stress , rather than the mental stress of pregnancy , so it resolved spontaneously after puerperium in the previous pregnancies , but the presence of edema in the last pregnancy increased the magnitude of physical stress , resulting in persistence of the symptoms . neziroglu f has observed that the most common life event associated with the onset of ocd in women without children is physical illness , in women having children it is pregnancy . among various perinatal risk factors , our patient improved after pharmacological treatment at doses required for ocd , and no pica management was used . although ocd patients usually have some other symptoms , it is not uncommon for ocd to present with single compulsion , without other symptoms . we conclude that either of these two hypotheses will be established in future . first , pica is one of the obsessive compulsive spectrum disorders ; second , pica may be the presenting symptom of pregnancy onset ocd , like washing or checking .
pica refers to eating of non - nutritious substances , which is usually seen in childhood or pregnancy . here 
 we report a case of an illiterate tribal woman who developed pica as the sole manifestation of obsessive compulsive disorder , with onset during pregnancy . 
 the patient had compulsions of eating uncooked rice or wheat , which resulted in toothache and abdominal discomfort . 
 she had this habit in three pregnancies , consecutively . 
 in the first two pregnancies it resolved spontaneously after puerperium , but persisted in the last one . 
 probably physical stress of limb edema during the third pregnancy was reason for the persistence . 
 she responded to fluoxetine 40 mg / day after three months of treatment , without behavioral therapy . we conclude that pica may either be only a manifestation of obsessive compulsive disorder during pregnancy or it is an obsessive compulsive spectrum disorder .