Trichophagia and trichobezoar in trichotillomania: A narrative mini-review with clinical recommendations

Abstracts A subset of individuals with trichotillomania (TTM; hair-pulling disorder) engages in trichophagia (TPG; eating hair). In a small minority of these cases, TPG leads to the development of a trichobezoar (TB; hairball) in the gastrointestinal tract, which can result in life-threatening medical complications. The literature on TPG/TB is extremely scarce; however, a substantial number of surgical case reports exist. We conducted a narrative review of this literature with the aim of describing a clinical picture of TTM patients with TB. Most cases are females and peak age at presentation is in middle childhood/adolescence. TBs can remain asymptomatic for years but eventually cause a host of medical complications. Symptoms tend to be nonspecific (e.g., abdominal pain) and patients may deny TTM/TPG when seeking medical treatment. Diagnostic signs include palpable mass in the upper abdomen, bad breath, and alopecia. Many patients have comorbid emotional disorders, but only a small minority has severe mental illness or intellectual disability. Habitual eating of inedible material other than hair appears uncommon, and mostly restricted to early childhood. Fatalities are rare and primarily occur in children after delayed medical attention. Providers should screen for TPG in individuals with TTM of all ages.