Rapunzel syndrome is an extremely rare medical condition that results from trichophagia. Persons suffering from trichophagia eat their own hair. The syndrome is named after the long-haired girl Rapunzel in the fairy tale by the Brothers Grimm. Rapunzel syndrome is named after the fairy tale of the same name in which a young girl named Rapunzel lets down her long rope of hair to enable her prince to rescue her. The reason the syndrome references the fairy tale is to provide a visual comparison and understanding of the trichobezoar that is often found in the stomachs of those that ingest their hair. The trichobezoar resembles a thickly bound mass of hair resembling a long tail, or rope of hair, much like Rapunzel’s hair. Trichophagia is often associated with the hair-pulling disorder trichotillomania. Trichotillomania is a disorder that is characterized as recurrent, irresistible urges to pull out one’s hair from the scalp, eyebrows or other areas of the body, despite both wanting and trying to stop.

For most people, hair pulling from the scalp is a very unpleasant experience. However, those that engage in hair pulling and other self-injurious behaviors do so to cope with stressful events and situations. Hair pulling from the scalp often leaves patchy bald spots, which leads to additional stressors, embarrassment, that can interfere with social, familial, romantic, and vocational functioning. Persons struggling with trichotillomania engage in a vicious cycle that includes intense stress, hair pulling, relief, embarrassment, intense stress, embarrassment, hair pulling, etc. To avoid the negative intense feelings associated with the disorder those that suffer feel compelled to engage in the cycle, thereby reinforcing it every time they engage.

Unlike trichotillomania, people with trichophagia or Rapunzel syndrome also ingest the hair that they pull; in extreme cases this can lead to a formation of a hair ball. Rapunzel syndrome, unlike the endearing fairy tale is a rare presentation of a trichobezoar (human hair ball) in which patients commonly present with abdominal pain, stomach bloating, nausea, reduced appetite, vomiting, weight loss, constipation or diarrhea. In serious cases, the bowel can be punctured, leading to sepsis (blood infection).

9 Signs of Rapunzel Syndrome Include:

• Chronic hair pulling, nibbling, or ingesting hair

• Weight loss unrelated to dieting and exercise

• Chronic abdominal pain

• Stomach bloating

• Constipation

• Loss of appetite

• Nausea

• Trichobezoar (hairball) located in the stomach, and its tail

• diarrhea

Effective treatment for Rapunzel syndrome or trichophagia are similar to the treatment approaches used for other impulse control conditions. A combination of psychotherapy and anti-depressant medications are commonly used to control the disorder. Appropriate treatment can help suffers manage the anxiety maintaining the disorder, increasing distress. If the hair is resulting in digestive tract problems, medical help may be needed to remove the hair from the body. Individuals suffering from trichophagia should seek help immediately before a trichobezoar begins to form. If Trichobezoar has already been allowed to form than immediate invasive surgery is required to remove the hairball.

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