Trichophagia

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-phagy refers only to the chewing of hair, whereas tricho-phagia is ingestion of hair, but many texts refer to both habits just as 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. People with trichotillomania often also have trichophagia, with estimates ranging from 48-58% having an oral habit such as biting or chewing (i.e. trichophagy), and 4-20% actually swallowing and ingesting their hair (true trichophagia). In an even smaller subset of people with trichotillomania, their trichophagia can become so severe that they develop a hair ball.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 complicaiton whereby the hair ball extends past the stomach and can cause blockages of gastrointestinal system.
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 ones 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 ones own hair, and thus any symptoms of trichotillomania could be predictive of trichophagia and must be ruled out. Rarely, person's 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 "focussed" where the pulling is more deliberate, with the focussed behavior thought to be more common among those who also have 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. Typically, ingested hair remains asymptomatic and is not harmful. However, if trichophagia is severe or chronic, a large mass of undigested hair can accumulate in the stomach resulting in a trichobezoar. This can be symptomatic, including nausea, vomiting, and abdominal pain. 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).
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 of a more habitual nature, while in adulthood it is associated with underlying psychopathologies. Among childhood cases the distribution between males and females is equal. However, in adolescents and adults trichophagia is increasingly common among females, with a distribution of cases of 15:1, female-to-male. Highest prevalence is in young adults.
Many of the prevalence rates are thought to be underestimates due to stigma, and inconsistent definitions of trichophagia. Moreover, the discrepancy between rates in women and men could be explained by underreporting in men, either do to additional shame for men, or the ease of shaving and hiding their underlying trichotillomania. Trichophagia in men, while more rarely reported, is often more severe.
Diagnosis
Diagnosis of trichophagia can be difficult, as the behavior is easy to hide, and because of shame, individuals rarely admit they have trichophagia. Any patient who has confirmed trichotillomania should be screened for trichophagia.
Prognosis
Rapunzel syndrome, an extreme form of trichobezoar in which the "tail" of the hair ball extends into the intestines, and can be fatal if misdiagnosed. In some cases, surgery may be required to remove the mass; a trichobezoar weighing was removed from the stomach of an 18-year-old woman with trichophagia.
History
Trichophagia is most often covered in the medical literature only "as a rare symptom of trichotillomania." In the 18th century French doctor M. Baudamant described the condition in a 16-year-old boy.
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
External links
The TLC Foundation for Body-Focused Repetitive Behaviors
Body-focused repetitive behavior
Eating behaviors
Habit and impulse disorders
Hair diseases
Hair removal
Human hair
Pica (disorder)