The term "crazy quilting" is often used to refer to the textile art of crazy patchwork and is sometimes used interchangeably with that term. Crazy quilting does not actually refer to a specific kind of quilting (the needlework which binds two or more layers of fabric together), but a specific kind of patchwork. Crazy quilts rarely have the internal layer of batting that is part of what defines quilting as a textile technique.

Crazy Quilting created a stir in the 1880’s when it became quite a fad in the United States. The Japanese Exhibit in the 1876 Philadelphia Centennial Exposition inspired the crazy quilt with its asymmetrical art. Articles encouraging crazy quilting, or condemning it could be found in women’s publications. Women could purchase packages of random fabrics, as well as already embellished pieces to use in their own crazy quilts.

During the first several years of the crazy quilting fad fine fabrics and heavy embellishment was the norm. As time passed quilters began to make simpler quilts in the crazy quilt style. These used everyday fabrics like wool or cotton and little or no embellishment. Crazy quilting is also used on clothing like vests and jackets. Some art quilters use crazy quilting as a part of their art quilts. Today, crazy quilting is enjoyed by quilters with an organic approach to their art. They often use cast off clothing and photographs to infuse the crazy quilt with meaning and memory.

Crazy quilts differ from "regular" quilts in other ways as well. Because the careful geometric design of a quilt block is much less important in crazy quilts, the quilters are able to employ much smaller and more irregularly-shaped pieces of fabric. In comparison to standard quilts, crazy quilts are far more likely to use exotic pieces of fabric, such as velvet, satin, tulle, or silk, and embellishments such as buttons, lace, ribbons, beads, or embroidery. Crazy quilting as a textile art is extremely creative and free-flowing by nature, and crazy quilters will often learn as much about specific embellishments as they will about crazy quilting itself.

Regular patchwork combines the pieces of fabric into a predetermined and regular design, but crazy patchwork uses irregular pieces of fabric on a foundation fabric or paper. This may create haphazard-looking and asymmetrical designs, or the designer may use some control in placement. Patches can be hand appliquéd onto a base fabric. This method gives the most variety as every patch is unique. There are also block patterns designed for crazy quilt that can be sewn by machine.

Sometimes part of a crazy quilt is haphazard while other parts are placed in a planned pattern. A common example of this the placement of patches in a fan pattern. The patches and seams are then usually heavily embellished.