Trichotelomania and Trichobezoar

Volume 7 Issue 2 February, 2017

Consultation Liaison Psychiatry Focus: Paediatric Surgery

Colloquially termed as a hairball, it’s a collection of impacted hairs along with ingested food formed in the stomach and sometimes intestine. A commonly described term by veterinary physicians formed in the stomach of animals that is occasionally vomited up when it becomes too big. Felids and rabbits are especially prone to hairball formation since they groom themselves by licking their fur, and thereby ingest it.

Found in people with Trichotillomania – a form of impulse control disorder characterized by a long term urge to pull and ingest hair. Though many people with trichophagia may not clinically develop the bezoar, it’s typically seen in young ladies with long hair. An extension of gastric trichobezoar all along the small bowel is termed Rapunzel Syndrome. There is an intense sense of tension before pulling hair typically gratifying with pulling. It’s associated with obsessive compulsive disorder, nail biting, skin picking, tics and eating disorders. Presentation may be with loss of hair on scalp, eyebrows, eyelashes etc. to dermatologists. Some patients with a conscious irresistible urge seek help for impulse control while quite a few may land up as surgical patients with features of vomiting, intestinal obstruction, poor weight gain in children etc.

Its characterized by three distinct age groups- preschool children, adolescents and adults. Preschool children pull their
hair unknowingly, usually from the scalp, usually at bed times, along with nail biting and thumb sucking and occasionally sibling rivalry. It follows a benign course with spontaneous resolution.

Preadolescents and young adults, predominantly females are the most commonly affected and are the ones who
benefit predominantly with therapy. They tend to have chronic and relapsing courses. Treatment consists of cognitive
behavioral therapy (habit reversal training) where the individual is trained to learn to recognize their impulse to pull and also teach them to redirect this impulse. Other forms include biofeedback, hypnosis, acceptance and commitance
therapy. Medications with antidepressants have been tried with fair success rates. With the dawn of mobile technology,
mobile apps (1st App for Pulling and Picking, PullFree: A Strategy-Based App for Trichotillomania) exist to help log
behavior and focus on treatment strategies. Wearable devices and smart watch applications that track the position of
users’ hands and send sound or vibration notifications can be used to notify users of passive hair pulling.

Adult patients usually have an underlying psychiatric disorder and have a protracted course. They are better served by
treating their disorders. Patients with surgical problems require endoscopic or open surgical retrieval of the bezoar.