Trichophagia is a form of disordered eating in which persons with the disorder suck on, chew, swallow, or otherwise eat hair. The term is derived from ancient Greek θρίξ, ("hair") and φαγεῖν, ("to eat"). Tricho- refers only to the chewing of hair, whereas tricho- is ingestion of hair, but many texts refer to both habits as just trichophagia. It is considered a chronic psychiatric disorder of impulse control. Trichophagia belongs to a subset of pica disorders and is often associated with trichotillomania, the compulsive pulling out of ones own hair. Termed a trichobezoar, these masses can be benign, or cause significant health concerns and require emergency surgery to remove them. Rapunzel syndrome is a further complication whereby the hairball extends past the stomach and can cause blockages of gastrointestinal system.

Trichophagia occurs instinctively in many animal species and is not always a sign of a psychological disorder. Cats practice trichophagia as a form of regular grooming.

Signs and symptoms

Signs and symptoms of trichophagia are variable depending on the individual's behavior patterns. Trichophagia's loosest definition is the putting of hair in one's mouth, whether that be to chew it or suck on it, with the strictest definition being that the hair is swallowed and ingested. Trichophagia is most closely associated with trichotillomania, the pulling out of one's own hair, and thus any symptoms of trichotillomania could be predictive of trichophagia and must be ruled out. Rarely, persons with trichophagia do not exclusively have trichotillomania and instead will eat the hair of others.

Trichotillomania can be categorized as either "automatic", where the hair pulling is so habitual it is almost unconscious, or "focused", where the pulling is more deliberate, with the focused behavior thought to be more common among those with trichophagia. Once the hair has been pulled out, persons with trichophagia might rub the hair against their lips, roll the hairs around and inspect them, bite off and swallow the bulb of the hair, or ingest the entire hair shaft as well. Once the trichobezoar grows large enough, it can extend beyond the stomach and lead to bowel obstructions, ulcers, perforations, acute pancreatitis and appendicitis (this is called Rapunzel syndrome). In one study, it was found that a significant percentage of patients with trichotillomania used drugs and alcohol to cope with negative feelings relating to pulling behaviors, with most sufferers reporting symptoms of anxiety and depression. It is important for physicians to recognize and treat these secondary symptoms in order to relieve hair-pulling and eating behaviors.

Epidemiology

Trichophagia is estimated to have a prevalence of 0.6% in the general population with the most restrictive definition of hair ingestion, but looser definitions which are inclusive of sucking and chewing without swallowing, can be as high as 3.2%. Trichophagia can present at any age, with childhood cases typically being more common and of a more habitual nature, while in adulthood it is associated with underlying psychopathologies and more severe symptoms. Highest prevalence is in young adults. The association between trichotillomania, obsessive-compulsive disorder, and related body-focused repetitive behaviors has been of particular interest to researchers, with studies finding that those with both trichotillomania and obsessive-compulsive disorder have higher levels of anxiety and depression as opposed to those who only suffer from trichotillomania. The commonality of comorbid psychopathologies in individuals with trichotillomania and trichophagia could be indirectly caused by the social rejection sufferers face due to their symptoms. Researchers suggest that bringing awareness of the disorders to the general population could help relieve the stigmas faced by patients.

Diagnosis

Diagnosis of trichophagia can be difficult, as the behavior is easy to hide, and because of shame, individuals rarely admit they have trichophagia, even if they have stopped engaging in its related behaviors. In some cases, surgery may be required to remove the mass. In one case, a trichobezoar weighing was removed from the stomach of an 18-year-old woman with trichophagia.

History

Trichophagia and trichobezoars have been documented by physicians for centuries, even long before a medical definition was established for trichotillomania. For example, in the 18th century, French doctor M. Baudamant described the condition in a 16-year-old boy. Trichophagia is most often covered in the medical literature only "as a rare symptom of trichotillomania."

In media

Trichophagia is mentioned in the 1000 Ways to Die episode "Stupid Is As Stupid Dies" featuring a young woman who died from it. It is also mentioned in Grey's Anatomy season 9 episode 11 "The End Is the Beginning Is the End". As well as Season 3 episode 16 of The Resident, "Reverse Cinderella."

References

  • The TLC Foundation for Body-Focused Repetitive Behaviors