An 11-year-old girl in Mumbai, India, was hospitalized with pain in her stomach, and surgeons were forced to operate. What they found was a foot-long hairball.
The mass of hair -- known as a trichobozear - -is a potentially fatal result of a mental illness called trichotillomania, a condition in which the patient pulls her hair out and, in many cases, eats it. And while the condition is not well known, American doctors say that it may afflict 1 percent of all Americans.
"It's a fairly uncommon outcome for trichs," said Dr. Martin Franklin, associate professor of clinical psychology and psychiatry at the University of Pennsylvania, who studies trichotillomania in children and adolescents. "But it's pretty life-threatening if you do end up here."
While he notes that most who have trichotillomania do not eat their hair after pulling it out, he said this extreme form of the condition occurs in between 30 and 50 percent of patients.
"Certainly when you eat enough of your hair to require surgery, we're at the other end of the continuum," said Martin.
Trichotillomania often begins in early childhood, and can start as young as 18 months, although it typically doesn't begin until age 10. A person with the illness compulsively pulls out ther hair (between 70 and 93 percent of patients are estimated to be women).
Among adult patients, most have the condition starting in childhood, but in many cases it may go unreported, said Dr. Darin Dougherty, a psychiatrist and co-director of the Trichotillomania Clinic at Massachusetts General Hospital.
Patients often exhibit other repetitive behaviors, because of the disease's similarities to obsessive compulsive disorder.
"People with trich often have other repetitive bodily focused behavior," he said. "In addition to pulling their hair, they also chew on their nails or the inside of their cheek."
Dougherty estimates that with intervention ranging from behavior therapy to medication, 60 to 80 percent of patients can be effectively treated.
But while the condition is usually nonfatal -- most of the effects come from social problems resulting from bald patches -- doctors say those interventions are crucial.
Christina Pearson described her 20-year ordeal as a painful period of thinking she was alone, "thinking I was the world's biggest freak."
For her, pulling her hair out and then chewing on the root (which doctors say is typically not enough to result in an accumulation of hair in the stomach) was an irresistible compulsion.
"I used to cry watching my hand go to my head, and there were times in my 20s that I would tie my hands together."
Ultimately, Pearson learned more about her disorder and got help. Eighteen years ago, she founded the Trichotillomania Learning Center, where she is now executive director, educating people about the condition to prevent the problems she had.
"There's not a lot of thought involved in this. It's more like scratching an itch. It's more like chewing gum," Pearson said. "It would induce a trance for me that would last for hours, and then the next day I would be absolutely traumatized.
"You cannot imagine why you're doing this and why you can't stop. It doesn't make sense."
While cases like the one in Mumbai are not common among trichotillomania sufferers, several occur every few years and they can be fatal when they result in bowel obstruction.