Latest developments in causes and treatments



Understanding Xylophagia — The Addiction to Eating Paper

Addictions come in all shapes and sizes. At AddictionNews, we have covered alcohol and drug addiction, eating addiction and sex addiction, gambling addiction and gaming addiction, smartphone addiction and work addiction. You can even get addicted to exercise in an unhealthy way.

One thing all addictions have in common is the inappropriate displacement of stress. When this build-up of stress is released through repetitive action, such as eating or consuming mind-altering drugs, it can become habit-forming, resulting in more anxiety and stress when the desired item or action is not available.

The item or action of compulsion can be anything available: candy, alcohol, tobacco, television, puzzles, pacing, hair-pulling. An addiction we have not previously covered on AddictionNews is xylophagia, an addiction to eating paper.

A meta-synthesis of the scientific literature on xylophagia was published in the Mental Health Review Journal in 2019. The authors found a total of 18 studies involving a total of 25 persons, 16 female and 9 male, averaging 30 years of age.

Xylophagia is a form of pica, “a developmentally inappropriate compulsive yearning for and eating of non-nutritive substances,” including stones, dirt, ice, paint chips, and hair. Xylophagia involves the uncontrollable urge to eat paper and other wood-based products such as toothpicks, pencils, matches, and tree bark. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies xylophagia as an eating disorder.

Pica is most commonly observed in children and developmentally disabled persons. According to the meta-synthesis, the behavior is considered “normal” in children and not pathological, though quite harmful depending on the non-food substance being eaten. Among institutionalized patients, the incidence rate of pica is as low as 4%, however, hospitalizations due to pica nearly doubled in the decade from 1999 to 2009.

Estimates on the rarity of incidents of xylophagia are clouded by the fact that few sufferers want to admit their compulsion, even when it results in emergency medical treatment. One major factor predictive of xylophagia is cultural acceptance and learned behavior. For example,

A study conducted on pregnant women in Mexico found that between approximately 30-50% of the women consumed dirt, ashes, and clay; believing that failure to do so would lead to miscarriage.

Why do people start compulsively eating paper or wood? The main reason cited in the meta-synthesis brings us back to the inappropriate displacement of stress:

Some patients started eating paper or cardboard in order to escape from painful experiences and avoid reality.

For other people, eating paper or cardboard started as a way to attempt to control overeating or weight gain and became habitual. For others, the act of eating paper or cardboard was in itself soothing. TLC recently publicized a woman who unapologetically eats up to four rolls of one-ply toilet paper every day, in part due to a desire to control her weight, but also because she finds it soothing.

The authors of the meta-synthesis state that “understanding xylophagia is problematic because its symptomatology is complicated by the presence of various comorbid psychological and medical disorders,” including substance use disorders, obsessive-compulsive disorders, eating disorders, depression, and intellectual disability.

For both children and adults, xylophagia is associated with impulse control dysfunction. A number of researchers believe it should be classified as a behavioral addiction similar to obsessive-compulsive disorder, and not an eating disorder, although it is comorbid with both eating disorders and behavioral disorders.

Written by Steve O’Keefe. First published May 20, 2024.


“Xylophagia: a meta-synthesis of the literature,” Mental Health Review Journal, October 2019.

“An unusual case of xylophagia (paper-eating),” Industrial Psychiatry Journal, June 2014.

“This Woman Eats Toilet Paper!?,” TLC, June 22, 2023.

Image Copyright: 125892716@N05, used under Creative Commons license.


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