Trichotillomania and trichophagia are two related compulsions characterized by the pulling off and eating of hair, respectively. In the past, trichotillomania was believed to be related to obsessive compulsive disorder (OCD), but is now classified as a body-focused repetitive behavior (BFRB). Other BFRBs include skin picking and nail biting. According to the Trichotillomania Learning Center, trichotillomania affects approximately 2 to 4 percent of the population and the average age of onset is 11 years old. Only a fraction of the individuals struggling with trichotillomania ingest the hair they compulsively pull off.
Trichotillomania is pulling hair from the root out of the scalp, eyelashes, eyebrows, pubic region, underarms and other body areas. This typically causes noticeable bald spots. For this reason, warning signs of trichotillomania include wearing hats, wigs and excessive eye makeup, combined with excessive picking at hair, decline in academic or work performance and changes in social behavior. Anxiety and depression often co-occur with trichotillomania, as the compulsion can be used as a coping mechanism to self-soothe. However, the condition is not always indicative of underlying mental health disorders and is typically not considered a form of self-harm.
Trichophagia is different from trichotillomania in that the former is diagnosed when an individual eats his or her own hair. In rare cases, trichophagia includes ingesting other people’s hair. A recent study published in 2008 found that approximately 20.6 percent of individuals struggling with trichotillomania also eat their hair once it has been pulled. The study acknowledged that this number might be larger, since individuals struggling with trichophagia often do not come forward out of shame and the stigma surrounding their behaviors. Out of those who admitted to struggling with trichophagia, only 35.7 percent sought treatment and this treatment was exclusively for their trichotillomania.
As a neurobiological disorder, trichophagia has a genetic component and is often treated with modes of therapy, including cognitive behavioral therapy (CBT). CBT aims to identify what triggers the compulsion in the individual and then condition alternative responses to these triggers. This method of therapy actually changes neural pathways and brain activity, proving to be highly effective in the treatment of trichophagia and other behavioral compulsions and mental health disorders. Prescription medications are sometimes used in concurrence with therapy.
A rare side effect of trichophagia is the development of a trichobezoar, the equivalent of a hairball, in the stomach or intestines. This presence of a trichobezoar is referred to as “Rapunzel syndrome,” and has side effects that include severe abdominal pain, nausea and vomiting. Over time, the specimen often grows into the colon and resembles a tail similar to that of the fairy tale character Rapunzel, whose hair grew long while trapped in a castle for years.
In most cases, doctors induce vomiting to rid an individual’s body of the trichobezoar. However, in the fall of 2014, doctors had to operate on an 18-year-old young woman in Batken, Kyrgyzstan who had a 9-pound trichobezoar blocking her digestive tract. Bahadir Bebezov, one of the surgeons who performed the operation, states, “It was actually the only alternative, nothing else would solve the problem.” She is believed to have struggled with trichophagia for years, eating both her own hair and hair she pulled from the carpet. The teenager reportedly promised to stop acting on the compulsion. While trichophagia varies greatly in each individual — and some can stop the compulsion once they are aware of the problem — most individuals do require some form of therapy or medication to manage symptoms.
If you or your teenager is struggling with trichotillomania or trichophagia, help is available. Sovereign Health Rancho San Diego is a facility that specializes in treating adolescents and teenagers struggling with mental health disorders, substance abuse and dual diagnosis. Call 866-615-7266 to speak with a professional today.
Written by Courtney Howard, Sovereign Health Group writer