We all have our unusual food preferences, but it’s unlikely any are quite as weird as the craving experienced by a 36-year-old woman featured in a recent case report. Her doctors described how the woman developed a sudden hunger for bleach—a craving likely triggered by an autoimmune disorder.
Doctors in Michigan detailed the strange tale in a paper published last month in the journal Case Reports in Psychiatry. The woman had developed a severe bout of anemia caused by vitamin B12 deficiency, not long after she began to enjoy smelling and eventually tasting bleach powder. Though she was treated successfully for her anemia and deficiency, it’s unknown whether her bleach craving disappeared for good.
Mouthing bleach
According to the case report, the woman visited a local emergency room with symptoms of severe anemia, including shortness of breath, fatigue, and pain along her lower left side. Initial tests found that she had macrocytic anemia (anemia characterized by overly large red blood cells) caused by a chronic lack of vitamin B12. The woman was soon given a blood transfusion and admitted into the intensive care unit for further treatment and evaluation.
The woman had a history of past psychological disorders, including depression and anxiety, though she had been managing well with medications. But given this history and her severe anemia, the doctors were concerned that she may have also developed pica, or the compulsive urge to eat inedible things. Pica is a complex and poorly understood condition, often linked to psychological issues as well as anemia and nutritional deficiencies.
The woman received a psychological consultation, in which she revealed her bleach habit. She initially only enjoyed the smell and texture of bleach powder but later started to taste it. For more than a month, two to three times a day, she licked her finger, dipped it in the powder, and placed her finger on her tongue. She claimed to have never fully ingested the bleach and instead swished it around her mouth before spitting it out and rinsing her mouth out with water. She also reported that while she had no problem with her craving, her “family had expressed significant concern” and tried to get her to stop.
Later tests showed that the woman carried harmful antibodies to a protein known as intrinsic factor, which is needed for our bodies to absorb vitamin B12 from food. In other words, the woman’s vitamin B12 deficiency and subsequent anemia—and likely her pica as well—were caused by an autoimmune disorder.
This explanation only makes the woman’s ailment all the more unusual, however. For starters, bleach is already a rare, though not unheard of, craving seen with pica (more common cravings are dirt, chalk, or hair). Vitamin B12 deficiency is known to cause several psychological symptoms, but as far as the authors know, this is the first reported case of bleach craving linked to vitamin B12 deficiency. The case is also notable because the woman didn’t have an iron deficiency, a more common trigger for pica.
An uncertain fate
The woman was soon moved from the ICU to the general hospital unit and recovered significantly over the next three days. She was told to take regular vitamin B12 supplements and a medication for her gastritis. But she never followed up with doctors, so whether she continued treatment—or what her current health looks like—remains a mystery.
Still, the doctors say, the saga does provide a timely lesson about the importance of seeking psychiatric consultations for medically complex cases like this one.
“We suggest that nuanced presentations of pica warrant thorough psychiatric evaluation in critically anemic patients, especially since the pica can involve toxic substances like bleach,” they wrote.
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