According to the DSM 5, mineral deficiencies are occasionally associated with pica, but biological abnormalities are rarely found.[21] People practicing forms of pica, such as geophagy, pagophagy, and amylophagy, are more likely anemic or have low hemoglobin concentration in their blood, lower levels of red blood cells (hematocrit), or lower plasma zinc levels.[22] Specifically, practicing geophagy is more likely to be associated with anemia or low hemoglobin.[22] Practicing pagophagy and amylophagy is more highly associated with anemia.[22] Additionally, children and pregnant women may be more likely to have anemia or low hemoglobin relative to the general population.[22] More recently, cases of pica have been tied to the obsessive–compulsive spectrum, and a move has arisen to consider OCD in the cause of pica.[23] However, pica is currently recognized as a mental disorder by the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM 4).