Trichotillomania with Giant Gastric Trichobezoar in a Female Child: A Case Report

Abstract

Trichotillomania is defined by the Diagnostics and Statistic Manual of Mental Disorders (DSM-5) as an individual repetitively pulling of their own hair, which may be an unconscious action or intentional. The disease is considered one of the anxiety disorders as it has some obsessive-compulsive features. Many patients with this disorder go to a dermatologist for the first time with a complaint of hair loss (alopecia), and many of them deny the self-pulling behaviour. In rare circumstances, this psychological problem may coexist with a complication called gastric trichobezoar, like in this unusual case presentation, which is an accumulation of the patient’s hair in their stomach. It can be huge, presenting as a ‘tail’ extending into the duodenum and leading to what is referred to in the literature as ‘Rapunzel syndrome’. Gastric trichobezoars are most often seen in teenage females. Trichophagia has only been previously confirmed in one-third of these patients, but this is usually a late presentation, occurring after much hair eating for many years.