Four of the patients had a history of trichotillomania and trichophagia
. Diagnosis was made by upper-gastrointestinal (GI) endoscopy in 3 cases (complemented by abdominal computed tomography (CT) and a barium meal), abdominal CT alone in 1 case, and plain abdominal radiography in 1 case (Figs 1-3).
Trichobezoars are usually found in young female patients with mental retardation and/or psychiatric disorders such as trichotillomania or trichophagia
. Trichobezoars are usually accompanied by psychiatric disorders such as obsessive compulsive personality disorder, pica, anorexia nervosa, or as in our case, depressive behavioral disorder.
 The chief type is phytobezoars, which accounts for 40% of all the bezoars.151 Trichobezoars form the next most common group, generally found in patients with psychiatric disorders such as trichotillomania (urge to pull out one's hair) and trichophagia
(urge to eat one's hair).
(1) Trichobezoars are often associated with psychiatric illness like trichotillomania and trichophagia
usually occurs in young and adolescent females.
A history of trichophagia
was elicited post-surgery and the patient was subsequently referred for psychiatric evaluation and supportive psychotherapy to treat the impulse control disorder and prevent bezoar recurrence.
Clinical diagnosis of bezoars may be difficult, especially when no psychiatric disorder associated with human hair ingestion (trichophagia
, trichotillomania) is reported.
Along with the cosmetic and psychosocial consequences of the disorder, medical complications can occur, including infection, Permanent loss of hair, repetitive stress injury, carpal tunnel syndrome , and gastrointestinal obstruction with bezoars as a result of trichophagia
is not uncommon in the pediatric population but when severe it may lead to trichobezoar formation.
Several examples of pica include amylophagia (the consumption of starch), coprophagia (feces), geophagia (soil, clay, or chalk), hyalophagia (glass), pagophagia (pathological consumption of ice), trichophagia
(hair or wool), urophagia (urine) and xylophagia (wood).
A new weight-loss fad is gaining traction following the publication in the New England Journal of Medicine of a unique case of severe trichophagia
. For those of you who are rusty on your Trivial Pursuit-worthy medical terminology, that means eating one's own hair--10 pounds worth, in the case of this otherwise healthy 18-year-old woman, who amassed a 4.5-kg, 37.5-by-17.5-by-17.5 cm bolus in her stomach.