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CASE REPORT article

Front. Psychiatry

Sec. Psychopathology

Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1646188

Situational xylophagia from chronic anemia: case report

Provisionally accepted
  • 1Department of Internal Medicine, Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, United States
  • 2Department of Chemistry and Biochemistry, Northern Arizona University, Flagstaff, United States
  • 3School of Medicine, University of California Davis, Davis, United States
  • 4Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, United States

The final, formatted version of the article will be published soon.

Background: Xylophagia is a rare subtype of pica involving consumption of paper or wood products. It is unknown why an individual may choose non-food items for consumption; however, pica has higher co-occurrence in those with schizophrenia, intellectual disability, or mineral deficiency. Case Presentation: We present a case of a patient with severe abdominal pain and a small bowel obstruction due to a paper bezoar (xylobezoar). Evaluation led to a diagnosis of xylophagia in the context of chronic symptomatic microcytic anemia and not due to an underlying primary psychiatric etiology. Anemia manifested in variable sensory experiences for the patient, including changes in the perception of smell, touch, and taste. The patient's specific preference for books of a particular era could be influenced by changes in printing practices. Additionally, familial practices delayed recognition of xylophagia as an odd, learned behavior. Once recognized as untreated anemia and confirmed to have iron and zinc deficiency, oral supplementation was initiated throughout hospitalization with surgical surveillance following discharge. Conclusion: The presented patient developed a xylobezoar in the setting of severe symptomatic anemia precipitated by a combination of regular menses and a history of Roux-en-Y gastric bypass, leading to both monthly blood loss and chronic iron and zinc malabsorption, respectively. Although pica and xylophagia are frequently linked to primary psychiatric disorder or intellectual disability, and sometimes familial predisposition, the underlying trigger for these behaviors may, in some cases, stem from an unrecognized or untreated medical condition rather than a primary psychiatric disorder.

Keywords: case report, xylophagia, Roux-en Y bypass, Microcytic anemia, iron deficiency

Received: 16 Jun 2025; Accepted: 01 Sep 2025.

Copyright: © 2025 CREDO, Mubarik and Scher. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: JONATHAN CREDO, Department of Internal Medicine, Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, United States

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