It prefers clay to coarse loamy upland soils, and is found in hardwood and mixed forest stands.

The plant's most striking feature is its fruit, a 1 cm (1⁄2 in) diameter white berry, whose size, shape, and black stigma scar give the species its other common name, "doll's eyes".

There are pink- and red-berried plants that have been called A. pachypoda forma rubrocarpa, but some of them produce infertile seed, and may actually be hybrids with Actaea rubra.

The berries contain cardiogenic toxins which can have an immediate sedative effect on human cardiac muscle tissue, and are the most poisonous part of the plant.

It requires part or full shade, rich loamy soil, and regular water with good drainage to reproduce its native habitat.