One study found 20% of people with trichotillomania engaged in these behaviours on a daily basis, including actually swallowing the hair. Another study found of 24 people with trichotillomania, 25% had developed a hair ball in the stomach because of eating the hair.
Pica comes from the Latin word for “magpie”, because of the bird’s unusual eating habits. The disorder involves craving and eating non-nutritious, non-food substances such as clay, dirt, paper, soap, cloth, wool, pebbles and hair.
Pica generally isn’t diagnosed in infants or toddlers because mouthing (and accidentally ingesting) non-food substances is considered pretty normal at this age. It is most common in children, pregnant women, and in people with intellectual disabilities such as autism spectrum disorder.
There have been many theories to explain trichophagia and pica, such as hunger during famine or childhood neglect, as a way of coping with stress, and a part of cultural practices. For instance, in some regions of India, Africa and the United States, eating clay is considered to have positive health or spiritual benefits.
Both trichophagia and pica have been found to occur in people with iron deficiency. In some case reports of Rapunzel syndrome, hair pulling and hair eating stopped after the person was treated for iron deficiency or coeliac disease.
Coeliac disease causes damage to the small intestine, which leads to poor nutrient absorption. Hair does contain trace elements of iron and other minerals, but it’s still unclear if this promotes some kind of biological drive to eat hair. Other case studies have found the blockage caused by the hair ball was actually the root cause of the iron deficiency.
What are the treatments?
In most cases, surgery is required to remove the hair ball in one piece. It’s also possible to dissolve the hair ball with chemicals, break it up into smaller pieces with a laser or remove it via a tube fed through the mouth and into the stomach, called an endoscopy. However, these methods are generally less successful than surgery.
Psychological treatment is recommended to prevent future compulsive hair eating. This is especially important for patients with trichotillomania or stress-related pica because they may be at risk of developing Rapunzel syndrome again.
Involving parents and spouses in psychological treatment is important so they can learn to support their loved one to stop the behaviour, and also because the impact of Rapunzel syndrome can be upsetting for them too.
Information and support for trichotillomania and trichophagia can be found through the TLC Foundation for Body-Focused Repetitive Behaviors.