summary
For the third time a 17-year-old adolescent is presented to a child and adolescent ambulatory mental health clinic, because of eating foam rubber. In this case study pica is being discussed and its possible connection with a somatic disease (sickle cell anaemia). The importance of alertness to unknown symptoms in diagnosing is being underlined, as well as the value of searching for a biological explanation in order to prevent interpreting all strange behaviour as psychosocial of origin.