A Very Unusual Case

Ed Cara of Gizmodo.com recently reported on a medical situation in Ecuador involving a 24-year-old woman who sought help because of severe stomach pain along with frequent vomiting. Barely able to eat or drink, she had lost a considerable amount of weight.

Upon examination of her midsection, a hard mass could be felt from the outside. During a 45-minute procedure, surgeons removed from the patient’s stomach a compacted two-pound lump of hair whose 16-inch length included an incursion into the small intestine. (Yes, there is a photo). Her doctors estimated that the accumulated hair had been eaten over a period of at least two years.

Hair-pulling disorder, or trichotillomania, is classified as a body-focused repetitive behavior (a topic which Dr. Pretlow has addressed) and also as a mental health condition. Although the head is most often involved, a sufferer might pluck hair from any part of the body. There may be a ritualistic element, like choosing a certain hair that feels just right. Victims describe the urge to pluck hairs as irresistible, and they are often impelled to bite, chew, or even swallow the extirpated hair.

Hair-pulling may relieve negative feelings or even generate positive ones. An internal conflict or other psychological, or emotional issue is always presumed to be involved. The habit usually shows up between the ages of nine and 13, and some people coexist with it throughout their lives. It is unlikely to just go away, and an ignored, untreated hairball that causes intestinal blockage can be fatal.

The childhood obesity connection

Trichotillomania is often classified as a co-occurring disorder, which means that it typically develops along with another illness; chiefly anorexia, bulimia, or binge eating. Consequently, the two disorders must both be treated at the same time:

[O]ptions for treating both of these conditions include psychosocial methods, such as the use of cognitive-behavioral methods, as well as the utilization of medications. Ideally, all implemented strategies for addressing these issues should be under the guidance of a comprehensive treatment team of eating disorder specialists.

Along with psychological and behavioral therapy, SSRI drugs may help, though no specific drug to knock out trichotillomania has been discovered or developed. This condition has been seen often enough that the compacted mass of hair removed from the Ecuadorian woman and similar patients has a name: It is a bezoar.

The term, referring to any indigestible mass found in an animal’s gastrointestinal system, has ancient connotations. Historically, a bezoar was valued for its alleged curative power, for instance as an antidote to the poison that an enemy had dropped into one’s goblet. A bezoar could typically be worth several times its weight in gold, and might be embellished with precious metals and jewels. But a person unable to afford their own could rent an unadorned bezoar (or a fake one, made of polished stone) from the local alchemist.

Your responses and feedback are welcome!

Source: “Doctors Pulled a 2-Pound Hairball From a Woman’s Stomach,” Gizmodo.com, /07/19/24
Source: “Trichotillomania (hair-pulling disorder),” MayoClinic.org, undated
Source: “Trichotillomania and Eating Disorders,” EatingDisorderHope.com, 06/12/12
Images by Dr. Alexey Yakovlev and Gee Hair/Attribution-ShareAlike 2.0 Generic

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources